1. Drug Diversion and Substance Use Disorder Management: Optimizing Collaboration Across the Continuum
Michael O’Neil, Pharm.D.
Professor and Chair, Department of Pharmacy Practice
Drug Diversion, Substance Abuse, and Pain Management Consultant
South College School of Pharmacy
Knoxville, TN
(304)

2. Disclosure
I do not have (nor does any immediate family member have) a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation.

3. Personal Appreciation
NABP
Boards of Pharmacy
Educators
Family

4. Drug Diversion and Substance Use Disorder Management: Optimizing Collaboration Across the Continuum Objectives Participants will be able to: Define and identify key components of the Collaborative Continuum: Who’s in the mix? Where/when is the collaboration? What information is being shared/What’s not? Recommend strategies to improve outcomes-what does work

6. Premises of SUD and Drug Diversion:
Socioeconomics / environment play a major role
SUD does note require a “low” socioeconomic status
More than 80% of patients with a SUD have an underlying psychiatric condition (diagnosed or diagnosed)
There has and will always be an element of society that wants to “disconnect”
There has always been some “element” of addiction in society… e.g. alcohol, drugs, gambling
There has always been and will always be “Greed” at the corporate and individual level.
There are always 2 elements involving prescription drugs: abusers and diverters
~50% of drug diversion of prescription drugs is for money or trade
~50% of prescription drug abuse and diversion is not controlled substances

7. O’Neil’s Rules of SUD and Drug Diversion
“Don’t confuse issues with facts”
“If we create a better mousetrap…we will create a smarter mouse”

8. Who’s in the Collaborative Mix?
Ground Zero / Level 1
Prescribers (MDs, DOs, PAs, NPs)
Pharmacists
Law Enforcement Officers
Level 2
Health Professional Boards (Includes NABP)
Level 3
Educators (+/-)
Pharmaceutical Companies /Retailers
CDC, Health Depts., etc.
Legislators
Level 4
Substance Abuse Coalitions (+/-)
Patients

9. Where Does Collaboration Occur Now
Where Does Collaboration Occur Now? (Traditional Silo Approach of Collaboration-Reactive)
Prescribers
(collaboration is primarily with Pharmacists)
PDMP is primary tool
Often lack understanding of pharmacist corresponding responsibilities X
Pharmacists
(collaboration is primarily with prescribers)
PDMP (+)
Time limited by volume
Pharmacy activities restricted by Retail Management
Often lack of understanding of responsibilities
Law Enforcement
(Confidentiality e.g. HIPAA / Blue wall
limits collaboration)
PDMP (+/-)
Most collaboration requires a warrant
Not medically trained
Legislators-Pharmaceutical companies/Lobbiest-Health Professions Boards -Patients-Retailers
When do the various entities finally interface? …. usually at the legislative sessions due to some proposed bill……on opposing sides….intentions are usually good but misunderstood. Where is NABP

10. What Information is being shared?
Most efforts have been in response to the “Opioid Epidemic”-reactional approach
Deaths
Overdoses
Unusual Headlines (e.g. fentanyl)
Arrest of Pill Mill-Prescribers
PDMP data?
Statistics on Addiction/Lack of beds
-Naloxone prescribing / dispensing regulations
-Neonatal Abstinence Syndrome
-Rescheduling combination hydrocodone products
What do these examples all have in common?

11. How Do We Make This Work?
Prescribers
(collaboration is primarily with Pharmacists)
PDMP is primary tool
Often lack understanding of pharmacist responsibilities
Pharmacists
(collaboration is primarily with prescribers)
PDMP (+)
Time limited by volume
Pharmacy activities restricted by Retail Management
Often lack of understanding of responsibilities
Law Enforcement
(Confidentiality e.g. HIPAA / Blue wall
limits collaboration)
PDMP (+/-)
Most collaboration requires a warrant
Not medically trained
We are not likely to change to current legislative and regulatory processes…BUT
we can change the information provided at EVERY level and become more proactive and preventive in current and future medication related disasters
AT A MINIMUM Prescribers-Pharmacist-Law Enforcement-Legislators- Health Professions Boards -Patients-Retailers-Educators-Medical Examiners-Nurses-Addiction Specialist-Patients = Substance Abuse Prevention Coalitions

12. Who’s in the Collaborative Mix?
Ground Zero / Level 1
Prescribers (MDs, DOs, PAs, NPs)
Pharmacists
Law Enforcement Officers
Level 2
Health Professional Boards (Includes NABP)
Level 3
Educators (+/-)
Pharmaceutical Companies /Retailers
CDC, Health Depts., etc.
Legislators
Level 4
Substance Abuse Coalitions (+/-)
Patients
Nurses

13. Substance Abuse Prevention Coalition
Pharmacists
-Pharmacy Students
-Pharmacy School Reps
-Board of Pharmacy Members
-Profession organization Reps
Prescribers
MD,DOs,FNPs,PAs
-ER Docs
-Internal Med
-Nursing
-Medical Organization Reps
-Pain Specs.
Law Enforcement
-Police
-Sherriff
-Task force
-Sate Police
-BCI/DEA
Substance Abuse Prevention Coalition
Members
Legislators
-Congressman
-Senator
-Attorney
-Advsors
PDMP Representatives
Medical Examiners
Addiction Specialist
Health Dept

14. Who’s in the Collaborative Mix?
Ground Zero / Level 1 + Level 2
Substance Abuse Prevention Coalitions

15. What Needs to Be Discussed
Trends
-Medication/Substance Abuse Patterns
-Prevention: What’s working what’s not
-Statistics
e.g. Prescription stimulants, noncontrolled prescription medications, NAS
Policies
-What’s working-what’s not
-******New legislation******
-Emphasis on prevention
e.g. marijuana, mandating technology, record keeping requirements

16. Charge to NABP, State Boards of Pharmacy, AACP members, Pharmacists and Student Pharmacists
NABP-get pharmacists on coalitions State Boards of Pharmacy - get Board members on coalitions AACP-Get faculty/student pharmacists on coalition Be an active member of local community (usually county) Substance Abuse Coalitions If you do not do this you are not in the game!