1. State of the States Prescription Drug Abuse and Overdose Policy National Center for Injury Prevention and Control Division of Unintentional Injury Prevention Christopher M. Jones, PharmD, MPH LCDR, US Public Health Service Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

2. Overview  Current Policy Strategies  State laws/regulations  PDMPs  Prescribing Guidelines  Policy Strategy Trends

3. Doctor Shopping Laws CDC PHLP 2013

4. Tamper Resistant Forms CDC PHLP 2013

5. Physical Exam Requirements CDC PHLP 2013

6. Patient ID Requirements CDC PHLP 2013

7. Pill Mill Laws CDC PHLP 2013

8. Prescription Limits CDC PHLP 2013

9. Immunity from Prosecution CDC PHLP 2013

10. Prescribing Guidelines  Prescribing guidelines  Washington – Rule  Utah  New Mexico  Oklahoma  NYC  ED prescribing guidelines  Washington  Ohio  Oklahoma  Arkansas  Oregon  Maine  NYC

11. PDMPs and Health Information Technology  Interoperability  Active – Alabama, Arizona, Connecticut, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Michigan, New Mexico, North Dakota, Ohio, South Carolina, South Dakota, Virginia  In Process – California, Colorado, Delaware, Idaho, Massachusetts, Minnesota, Mississippi, Montana, Nevada, New Jersey, North Carolina, Rhode Island, Texas, Utah, Washington, West Virginia  EHR Integration  Florida, Illinois, Indiana, Kansas, Maine, Ohio, Texas, Washington, West Virginia PDMP CoE at Brandeis University, NABP PMPi, MITRE Corp, SAMHSA

12. PDMP Proactive Reporting PDMP CoE Brandeis University. 2013.

14. Top 10 Proposed Legislation 1. Immunity from prosecution laws and/or naloxone – 21 states 2. Required use/registration of PDMP – 13 states 3. PDMP enhancements (access, reporting time, delegates) – 11 states 4. Creation of Commission or Working Group – 9 states 5. Mandatory provider education on pain/addiction – 7 states 6. Abuse-deterrent formulation substitution restrictions – 6 states 7. Opioid prescribing standards/rules – 5 states 8. PDMP funding – 4 states 9. OTP standards – 4 states 10. Quantity/dose limits – 2 states CQ State Tracker, CDC PHLP. 2013

15. Honorable Mentions 1. Alaska – required consultation with pain management specialist prior to prescribing ≥ 120 MME of an opioid 2. Iowa – promulgate rules/regulations on opioid prescribing in the ED 3. New Mexico – rescheduling hydrocodone 4. West Virginia - Prohibit prescribing of OxyContin or fentanyl unless the product also contains naloxone CQ State Tracker, CDC PHLP. 2013

16. Conclusions  State level policies can significantly impact the prescription drug overdose epidemic  Many states are instituting similar policies…no need to recreate the wheel  Robust evaluations of policies and dissemination of findings are critical

17. Christopher M. Jones, PharmD, MPH cjones@cdc.gov Thank You The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.