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URL:https://www.deadiversion.usdoj.gov/...0/feb_2020/ortique.pdf
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Title:DC Prescription Drug Monitoring Program
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Body:Prescription Drug Monitoring Program

Justin Ortique, PharmD, RPh Supervisory Pharmacist - Pharmaceutical Control Division

LEARNING OBJECTIVES

 Understand how the Prescription Drug Monitoring Program (PDMP) operates

 Review current and pending legislation

 Understand the benefits of the PDMP  Review the PDMP registration process and learn how to conduct a patient query

 Understand a Patient NarxCare report  Understand your Prescriber Report

. The DC PDMP should be used as a tool to assist providers with their treatment decisions

. There are no punitive consequences intended for providers who use the DC PDMP

. There are no penalties associated with failure to query the DC PDMP

. There are no mandates for providers to query the DC PDMP

DISCLAIMERS

WHAT IS A PRESCRIPTION DRUG MONITORING PROGRAM?

District of Columbia PDMP

RxCheck (Federal)

NABP

Pharmacy Management System

Health Care Practitioner

Maryland PDMP (CRISP)

Virginia PDMP

Pharmacy

Integration

EHR, PMS & HIE (CRISP DC)

PDMP FLOW CHART

Licensed Professional Number of Registered PDMP Users Physician (MD, DO) 10,689

Physician Assistant 627

Advanced Practice Nurses 1,551

Pharmacist 2,061

Dentist 1,126

Veterinarian 302

Podiatrist 133

Optometrists 175

Naturopathic Physician 30

VA Prescriber 30

Pharmacy Technician (Delegate)* 16 Other (Licensing Board Investigators, Law Enforcement, Medical Examiner, Midwife) 28

TOTAL 16,768

DC PDMP REGISTRATION SNAPSHOT Registration Numbers as of 1/16/2020

REGISTRATION OVER TIME 585

1,561

13,939

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2017 2018 2019

DC Health PDMP User Registration, 2017-2019

DEFINITIONS

, Butalbital or Gabapentin application

REPORTING EXCEPTIONS/EXCLUSIONS

. A DC licensed methadone treatment program or substance abuse treatment pharmacy or facility . A DC licensed pharmacy that dispenses controlled substances (schedules II-V, cyclobenzaprine, gabapentin and butalbital) for inpatient hospital are or nursing home patients only

. A pharmacy or facility that dispensing covered substances to inpatients in hospices . A pharmacy or a facility that never possesses or dispenses controlled substance (schedules II-V), cyclobenzaprine, gabapentin or butalbital

. A dispensing facility that is experiencing a hardship created by a natural disaster or other emergency beyond the control of the licensee

. An ongoing controlled research project or clinical trial approved by a regionally accredited institution of higher education or under the supervision of a governmental agency

PDMP USERS

PRESCRIBER ROLE . Supports avoidance of prescribing duplicate or inappropriate therapies that enable diversion

. Detection of patients at risk of drug abuse

. Prescribers have access to self-reports illustrating their prescribing activity

. Must provide notice at their practice stating the use of the PDMP

. Any covered substance being dispensed including those dispensed at their practice must be reported

. Dispensers are required to report all covered substances dispensed unless exempt

. May access database to analyze patient history of covered substance

. Corrections must be made by the dispenser within 72 hours

. Must give notice at their facility stating that patient information will be sent to the PDMP

. Based on data review, the dispenser can discuss concerns with prescriber and patient

DISPENSER ROLE

. Alabama . Connecticut . Delaware . Georgia . Indiana . Iowa . Kansas . Louisiana DC PDMP currently shares data with the following 24 states: NABP PMP INTERCONNECT

. Maryland

. Massachusetts

. Michigan

. Military Health System* . Minnesota

. Mississippi

. New Jersey . New York

. North Carolina . North Dakota . Pennsylvania . Puerto Rico *

. Rhode Island . South Carolina . Texas

. Virginia . Washington

. West Virginia

. 33 states require both prescribers and dispensers . 11 states require prescribers only

. 7 states plus Puerto Rico have no mandates

. Guam requires dispensers only MANDATORY REGISTRATION MANDATORY QUERY

. 19 states require both prescribers and dispensers . 26 states plus Guam require prescribers only

. 6 states plus Puerto Rico have no mandates

NATIONAL PDMP SNAPSHOT

REGISTRATION

DC PDMP Website- https://dchealth.dc.gov/PDMP

Click "Create An Account" REGISTRATION

https://districtofcolumbia.pmpaware.net/login

. Name

. License Number . NPI (If applicable)

. DEA Number (If applicable)

. Work Address REQUIRED INFORMATION FOR REGISTRATION

EMAIL VERIFICATION

HOW TO RUN A PATIENT SEARCH

1. Select the RxSearch tab, then choose Patient Request.

2. Enter search criteria

3. At a minimum, you must provide: . First name (full or partial*) . Last name (full or partial*) . Date of birth . Prescription fill dates 4. Click Search at the bottom of the screen to submit your request.

5. If multiple patients are identified- refine your search by providing additional search information 6. Click on "Run Report", the patient prescription results will be displayed.

SEARCH TIPS

Partial Spelling: Using Partial Spelling can be helpful for hyphenated or commonly abbreviated names (Will vs. William). At a minimum, enter the first three characters of the patient's first and/or last name.

. Prescription Fill Dates - The maximum time period for your search is 36 months. . PMP Interconnect Search - allows you to search other participating state databases for the patient's records.

To improve the likelihood of finding a specific patient:

. For out-of-state searches - Limit your search criteria to only the required fields.

. For in-state searches - In addition to the required fields, include additional details such as ZIP code

DELEGATE REGISTRATION

PRESCRIBER SELF-REPORT

. This report provides a summary of a healthcare provider's own prescribing history, compared to a prescriber of the same specialty

. Launched April 2018, updated February 2020

. Available on a quarterly basis to all registered prescribers who have prescribed at least 1 controlled substance in past 6 months . Prescribers can access their Prescriber Report on their AWARxE Dashboard

. Report is not punitive and only shared with the prescriber

PRESCRIBER REPORTS

NARXCARE OVERVIEW . The NarxCare report is divided into 4 regions 1. Header 2. Scores and Indicators 3. Graphs 4. Full Prescription Detail

HEADER

SCORES AND INDICATOR

GRAPHS

FULL PRESCRIPTION DETAIL

. Grant funding is currently available for the integration of PDMP data into:

. Electronic Health Records (EHRs)

. Health Information Exchanges (HIEs)

. Pharmacy Management Systems

GATEWAY INTEGRATION

https://info.apprisshealth.com/dcpdmpehrintegration

. Over 100 EHR, HIEs and Pharmacy Management Systems connections have been established to date . Some examples include: - Cerner - Epic - eClinicalWorks (eCW) - Athena Health - iPatientCare - Advanced EMR Solutions - Allscripts - NextGen - PioneerRx - Greenway Health - E-MDs - PDX - Practice Fusion

EHR VENDORS

CLINICAL ALERTS

CDC GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN

. Clinicians should review the patient's history of controlled substance prescriptions using PDMP data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.

. Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every 3 months.

BEST PRACTICE FOR CLINICIANS

https://www.cdc.gov/drugoverdose/pdf/presc ribing/Guidelines_Factsheet-a.pdf

MANDATES

B22-0459 - Opioid Abuse Treatment Act of 2017

 Requires Prescribers and Pharmacists licensed in the District of Columbia to register with the DC PDMP

 Prohibits Health Occupations Boards from licensing, renewing, reactivating, or reinstating a licensee that is required to be registered, without proof that the licensee has registered with the PDMP.  Allows the FBI to obtain reports related to drug investigations.

 Enables the Program to take action against an individual that submits a false statement to the program to gain access to the database or who falsely alters information in the database.

 Allows the Program to review and analyze data collected in the system to identify misuse or abuse of covered drugs, possible violations of law or breaches of professional practice (pursuant to developed criteria), and to report this information to the relevant prescriber or dispenser.

. 1003.2 Beginning August 1, 2019, prior to applying for renewal of a controlled substance registration, a practitioner shall be registered with the District of Columbia Prescription Drug Monitoring Program (PDMP). . 1003.3 The department shall not renew a controlled substance registration for a practitioner that is not registered with the PDMP.

TITLE 22-B DCMR, PUBLIC HEALTH AND MEDICINE CHAPTER 10

Medicaid Partnerships

. Beginning October 1, 2021, Medicaid providers will be required to query the PDMP before prescribing a covered substance

Inclusion of more timely or real-time data contained within a PDMP: . Sending proactive (or unsolicited) reports to providers . Designing, validating, or refining algorithms for identifying high-risk prescribing activity to use as a trigger for proactive reports.

. Improving PDMP infrastructure or information systems to support proactive reporting and data analysis, including enhancing reporting system to increase frequency and quality of reporting.

. Developing and disseminating information or guidance to aid in proactive reporting (example guidance for opioid naïve patients, patients with overlapping opioids and benzodiazepines).

FEDERAL SUPPORT ACT HIGHLIGHTS

. On October 24, 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act was signed into law

. Integrating tools such as cumulative morphine milligram equivalent (MME) calculations into patient PDMP reports

. Incorporating prescriber notification of patient overdose deaths.

. Requiring pharmacists to check the prescription drug history of covered individuals through a qualified prescription drug monitoring program before dispensing controlled substances to such individuals.

. Ensuring that PDMPs are easy to use and access by providers: . Facilitate improved delegate access and training.

. Expand access to PDMPs via integration into electronic health records, pharmacy management systems and health information exchanges. FEDERAL SUPPORT ACT HIGHLIGHTS

DC PDMP ADVISORY COMMITTEE

. DC PDMP Advisory Committee was established in January 2018

. Quarterly meetings in 2019

. Recommendations to DC Health Director regarding: - PDMP Best Practice - Regulatory and Legislative Updates - PDMP Education and Outreach to Prescribers and Dispensers - Program enhancements

NEXT MEETING DATE: APRIL 21, 2020,10:00 AM-12:00 PM

. LIVE.LONG.DC - Led by the Department of Behavioral Health, DC's lead agency in combating the opioid epidemic, Mayor Muriel Bowser's LIVE LONG DC Plan aims to reduce opioid use and misuse and to reduce opioid- related deaths by 50% by 2020. - LIVE LONG DC will employ evidence-based strategies and promising practices to meet the specific needs of Washington, DC. - LIVE LONG DC is the District of Columbia's interagency effort to work with public and community partners to:

 Increase public awareness and prevention  Enhance treatment offering  Strengthen recovery support

ADDITIONAL HIGHLIGHTS

. The Opioid Learning Institute, led by HealthHIV

. The site currently has 12 free modules with training on opioids . The free online and self-paced continuing education curriculum covers topics related to opioid prescribing practices, the prevention and treatment of opioid use disorder, harm reduction approaches, and other relevant topics around opioids.

OPIOID LEARNING INSTITUTE https://opioidhealth.org/

Participating Pharmacy Address Ward Morgan Pharmacy 3001 P ST NW Washington, DC 20007 2 Grubbs Care Pharmacy NE 326 EAST CAPITOL ST NE Washington, DC 20003 6 Grubbs Care Pharmacy NW 1517 17TH ST NW Washington, DC 20036 2 Grubbs Care Pharmacy SE 2910 MARTIN LUTHER KING JR AVE SE Washington, DC 20032 8 Kalorama Pharmacy 1631 KALORAMA RD NW Washington, DC 20009 1 Good Care Pharmacy 2910 MARTIN LUTHER KING JR AVE SE Washington, DC 20032 8 Excel Pharmacy 3923 South Capitol St SW Washington, DC 20032 8 CVS #22 320 40TH STREET NE Washington, DC 20019 7 CVS #1340 845 BLADENSBURG ROAD NE Washington, DC 20019 5 CVS #1360 2834 ALABAMA AVE SE Washington, DC 20020 7 CVS #1364 6514 GEORGIA AVE NW Washington, DC 20012 4 CVS #1354 2601 CONNECTICUT AVE NW Washington, DC 20008 3 CVS #2834 3031 14TH STREET NW Washington, DC 20009 1 Safeway #1445 2845 ALABAMA AVE SE Washington, DC 20020 7 Walgreens #15360 801 7TH STREET NW Washington, DC 20001 2 Walgreens #16049 (Howard University Hospital) 2041 GEORGIA AVE NW Washington, DC 20060 1 Giant #384 1535 ALABAMA AVE SE Washington, DC 20032 8

NARCAN PILOT PROGRAM

WHAT ACTION SHOULD A PRACTITIONER TAKE IF DRUG MISUSE OR ABUSE IS SUSPECTED BY A PATIENT?

A. Contact Law Enforcement

B. Refer patient to Department of Behavioral Health (DBH) treatment and recovery support services

C. Check the PDMP LEARNING QUESTIONS

WHAT ACTION SHOULD A PRACTITIONER TAKE IF DRUG MISUSE OR ABUSE IS SUSPECTED BY A PATIENT?

A. Contact Law Enforcement

B. Refer patient to Department of Behavioral Health (DBH) treatment and recovery support services

C. Check the PDMP LEARNING QUESTIONS

DISPENSATIONS OF WHICH PRODUCTS ARE REPORTED TO THE PDMP?

A. Naloxone

B. Controlled substances (schedules II-V, cyclobenzaprine, gabapentin and butalbital)

C. Medical marijuana

LEARNING QUESTIONS

DISPENSATIONS OF WHICH PRODUCTS ARE REPORTED TO THE PDMP?

A. Naloxone

B. Controlled substances (schedules II-V, cyclobenzaprine, gabapentin and butalbital)

C. Medical marijuana

LEARNING QUESTIONS

WHICH OF THE FOLLOWING IS NOT REQUIRED WHEN RUNNING A PATIENT QUERY?

A. Home Address

B. First name (full or partial)

C. Last name (full or partial)

D. Date of birth LEARNING QUESTIONS

WHICH OF THE FOLLOWING IS NOT REQUIRED WHEN RUNNING A PATIENT QUERY?

A. Home Address

B. First name (full or partial)

C. Last name (full or partial)

D. Date of birth LEARNING QUESTIONS

TRUE/FALSE ?

1. Prescribers/Dispensers may have up to four (4) delegates each.

2. Prescribers and Dispensers are NOT mandated to query the PDMP.

3. DC licensed practitioners can access Maryland, Delaware and Virginia PDMP data.

4. A Nurse Practitioner is required to report tramadol dispensations to the PDMP.

5. Covered substance dispensation data is reported to the DC PDMP every 72 hours.

LEARNING QUESTIONS

TRUE/FALSE ?

1. Prescribers/Dispensers may have up to four (4) delegates each.

2. Prescribers and Dispensers are NOT mandated to query the PDMP.

3. DC licensed practitioners can access Maryland, Delaware and Virginia PDMP data.

4. A Nurse Practitioner is required to report tramadol dispensations to the PDMP.

5. Covered substance dispensation data is reported to the DC PDMP every 72 hours.

LEARNING QUESTIONS

F

F

T

T

T

DISCUSSION QUESTION

A Dentist administers Percocet to a patient after a dental procedure. Is the Dentist required to query the patient in the DC PDMP and report the Percocet administration?

DISCUSSION QUESTION

A Dentist administers Percocet to a patient after a dental procedure. Is the Dentist required to query the patient in the DC PDMP and report the Percocet administration?

Answer : . No, the ADMINISTRATION of a covered substance should not be reported to the DC PDMP. . The Dentist is not mandated to query the DC PDMP but is required to register.

. For more information on the DC PDMP, please visit the District of Columbia, DC Health website at (https://dchealth.dc.gov/pdmp )

. For questions about the program, email doh.pdmp@dc.gov

. For free educational programs about opioids, please visit (https://dchealth.dc.gov/dcrx )

. Prescription Drug Monitoring Program Training and Technical Assistance Center (PDMP TTAC) at Brandeis University - http://www.pdmpassist.org/

. CDC Guideline for Prescribing Opioids for Chronic Pain - https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf . For technical assistance, please contact Appriss at (855) 932-4767

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