1. Preventing Prescription Drug Abuse: Laws and Legislation Hollie Hendrikson, MSc. Hollie.Hendrikson@ncsl.org 303-856-1525 Policy Specialist, Health Program National Conference of State Legislatures

2. Prescription Drug Overdose and Abuse: A Growing Problem Source: National Center for Health Statistics, Drug Poisoning Deaths in the United States Databrief, 2011.

3. Prescription Drug Abuse: Overdose Death Rates and Amount Sold Drug overdose death rates per 100,000 people (2008) Amount of prescription painkillers sold per 10,000 people (2010) Source: National Center for Injury Prevention and Control, 2011.

4. Impact of Opioid Use on Health Care Source: National Center for Injury Prevention and Control, 2011. For every 1 overdose death there are:

5. Other source Bought from drug dealer From one doctor Free from friend or relative Bought from friend or relative Took from friend or relative w/o asking 70% obtained from friend or relative Where are the nonmedical users getting their drugs? Source: SAMHSA, 2009 National Survey on Drug Use and Health (September 2010).

6. Common Legislative Issues Prescription Drug Monitoring Programs (PDMP) “Doctor Shopping” Tamper-resistant prescription forms Pain management clinic oversight Immunity or “Good Samaritan” laws

7. Established to help prescribers, pharmacies, law enforcement agencies, etc., track who is writing, filling and receiving prescribed controlled substances. In Oklahoma: – PDMP is housed in the Bureau of Narcotics (CA, NJ, PA, TX). – Prescriptions are required to be reported to PDMP. – Data collected daily. – Data accessible to: prescribers, pharmacists, pharmacies, law enforcement, licensing boards, the Attorney General and medical examiners. Prescription Drug Monitoring Programs (PDMP)

8. States with Prescription Drug Monitoring Programs Source: National Center for Injury Prevention and Control, 2011.

9. 2012 Prescription Drug Monitoring Program Legislation Idaho House Bill 439: Allows licensed practitioners in other states to access data and information within the PDMP. Enacted, 2012. Louisiana Senate Bill 112: Authorizes the sharing of PDMP information with PDMP located in other states. Enacted, 2012. New Hampshire Senate Bill 215: Establishes a PDMP. Enacted, 2012. Utah House Bill 257: Provides a procedure for an emergency room employee to look up information in the PDMP. Enacted, 2012.

10. “Doctor Shopping” typically refers to a patient obtaining controlled substances from multiple providers without the prescribers’ knowledge of the other prescriptions. Uniform Narcotic Drug Act of 1932 – Almost all states have adopted a general fraud statute that prohibit obtaining drugs by: fraud, deceit, misrepresentation, subterfuge or concealment of material fact. Doctor Shopping Laws

11. Specific doctor shopping laws: – Prohibit patients from withholding prior prescription information from any health care provider. Example: – South Dakota: any person who knowingly obtains a controlled substance from a medical practitioner and who knowingly withholds information from that medical practitioner that (s)he has obtained a controlled substance of similar therapeutic use in a concurrent time period from another medical practitioner. Doctor Shopping Laws, cont.

12. States with Doctor Shopping Laws Source: National Center for Injury Prevention and Control, 2011.

13. Requiring special tamper-resistant prescription forms for controlled substances. As of 2008, all prescriptions covered by the Medicaid program are required to use special tamper-resistant prescription forms. In Oklahoma: – Tamper-resistant prescription forms are required for all prescriptions. – All written prescriptions must conform with federal tamper-resistant prescription form regulations. Tamper-Resistant Form Laws

14. States with Tamper-Resistant Form Laws Source: National Center for Injury Prevention and Control, 2011.

15. 2012 Tamper-Resistant Legislation Tennessee Senate Bill 3003: Requires the board of pharmacy to publish a list of opioid drugs incorporating tamper-resistant technology. Enacted, 2012.

16. Pain management clinics or “pill mills” are facilities that employ a physician who is primarily engaged in the treatment of pain by prescribing or dispensing controlled substance medications. Pain clinic laws typically require oversight of clinic or describes specific regulations (patient registration, physician licensure, ownership requirements, payment methods, etc.). Pain Management Clinic Laws

17. States with Pain Management Clinic Laws Source: National Center for Injury Prevention and Control, 2011.

18. 2012 Pain Management Clinic Legislation Tennessee House Bill 1040: Establishes certain requirements for pain management clinics including allowed payment methods, limits on clinic ownership, and prescription limits. Enacted, 2012.

19. Provides a degree of immunity to an individual seeking help for themselves or for another person experiencing an overdose. Examples: – A person experiencing an overdose and needing medical attention will not be prosecuted for possession resulting from evidence gained from the call for help (New Mexico and Washington). Protection from prosecution will not extend to other criminal charges (Washington). Immunity from Prosecution Laws

20. States with Immunity or “Good Samaritan” Laws Source: National Center for Injury Prevention and Control, 2011.

21. Hollie Hendrikson, MSc. Hollie.Hendrikson@ncsl.org 303-856-1525 http://www.ncsl.org/issues-research/health/prevention-of- prescription-drug-overdose-and-abuse.aspx