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Prescription
Monitoring Programs (PMPs): An Overview According to the National Alliance for Model State Drug
Laws, 36 states have operating PMPs or have approved PMP legislation—all
with the goal of detecting and preventing abuse and diversion of
pharmaceutical products. Specific
purposes of PMPs include: ·
Education and Information—PMPs provide feedback to
physicians and pharmacists about prescribing and dispensing. PMPs also
produce prescription drug abuse data which can raise public awareness. ·
Public Health Initiatives—PMP data are used to implement
new programs, evaluate current programs and establish health policies. ·
Intervention and prevention—Patient specific data allow
health care professionals to distinguish between legitimate medical concerns
and instances of potential drug abuse. ·
Investigation and law enforcement—PMP data provide law
enforcement agencies with information that can aid in the prosecution of
crimes involving prescription drugs. ·
Protection and confidentiality—Even though most PMPs predate
the Health Insurance Portability and Accountability Act, all PMPs already incorporate
extensive security measures to protect patients confidentiality and no
breaches of security have been documented to date. All PMPs gather the same basic information
including patient name, address, type and amount of drug dispensed, prescribing
physician’s name, pharmacy name, date of dispensing, and prescription number.
Other pertinent information is also gathered depending on individual state
needs. This information is housed in a state database where prescribers, law
enforcement agencies and state officials can detect abuse, misuse or
diversion of pharmaceutical products. Though PMPs collect similar data and share the
same goals, their overall operational procedures remain a function of each
individual state. PMPs can be run by various state agencies including public
health departments, law enforcement agencies or boards of pharmacy; the
schedules of drugs that are monitored can vary; the reporting timeframes can
vary from monthly to daily; and the ways in which the information is used can
vary as well and research into which methods of use are more effective in
curbing abuse, misuse and diversion of pharmaceutical products continues. A 2004 report by the U.S. General Accounting
Office, State Monitoring May Help to
Reduce Illegal Diversion, stated
that monitoring programs have been effective in reducing prescription drug
diversion, but also noted that as drug diverters became increasingly aware of
a state’s ability to track a person’s drug history, those diverters tended to
relocate their diversion activities elsewhere, usually to neighboring states.
For this reason, the Department of Justice is currently funding pilot
projects for state PMPs to share data. An article in the January 2006 edition of Legisbrief, from the National Conference of State
Legislatures noted that PMPs are
effective in gathering information for their own state, but remain unable to
share information across state lines which make evaluating prescription drug
abuse trends at a regional or national level difficult. Given that PMPs continue to emerge throughout the
nation, it is necessary to scientifically confirm their effectiveness and
value to the medical community and general public. The RADARS System is able to evaluate and measure
rates of prescription drug abuse, misuse and diversion over specific time
spans and can report data at a three-digit ZIP code level to evaluate the
effectiveness of interventions and programs such as PMPs.
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Interview with
RADARS System Scientific Advisory Board Member, Danna Droz, R.Ph., J.D. Danna Droz is the Prescription
Monitoring Program (PMP) Administrator for the Ohio State Board of Pharmacy
with primary responsibility for the Ohio Automated Prescription Reporting
System and currently serves as a member of the RADARS System Scientific
Advisory Board. She developed and implemented KASPER (Kentucky All Schedule
Prescription Electronic Reporting), a nationally recognized PMP and is a frequent lecturer on drug law
topics including pharmacy drug law, drug law for practitioners, PMPs, federal
drug law, drug diversion and legal issues in pain management. Q. Please tell us about your current
work. In
2005, Ohio’s governor signed legislation authorizing the Board of Pharmacy to
implement a PMP. Previously, I administered the KASPER program in Kentucky
which seemed to influence a large number of individuals to travel to Ohio to
see physicians and obtain prescriptions. Knowing that I had retired in 2003,
the Board invited me to develop a similar program for Ohio. I’m very
passionate about PMPs and their value to health care practitioners as well as
law enforcement so I moved to Columbus, OH. We opened OARRS, the Ohio
Automated Rx Reporting System, in October 2006. After 14 months, we are
processing nearly 1,000 requests for information every weekday, with 79% of
these coming from prescribers and 17% from pharmacists. I’m not aware of
another state that has experienced this rate of growth. The Ohio Board and
the staff have been incredibly supportive. Their support and a great staff of
two are helping us to build a first class PMP. Q. Many states have implemented a PMP.
How can these data be used by various parties? First,
states vary widely in who has access to the data. Some states allow only
physicians and some allow only law enforcement and the rest are somewhere in
the middle. Most states that allow physician access also allow pharmacists to
obtain information. In addition, numerous other entities are identified in
individual state laws including the Medicaid programs, the state’s attorney
general, or researchers (using de-identified data). So, not every program
will allow every group to use the data. Secondly,
most of the programs provide a list of prescriptions obtained by the patient,
not an assessment. Thus the person receiving the list of prescriptions can
evaluate it, in light of other information such as the patient’s diagnosis,
physical symptoms, and other non-PMP drugs. The same list of prescriptions
might indicate abuse or misuse in a chronic pain patient but be perfectly
legitimate in a cancer patient. It is impossible to make good judgments based
only on PMP data. Physicians
are the primary clients of every PMP that allows physicians to obtain patient
prescription information. The physicians can use the report to validate the
patient-provided drug history or to evaluate compliance with their treatment
plan. For example, is the patient getting all the prescriptions filled at the
appropriate intervals? Are they obtaining similar drugs from other
physicians? Is the patient in compliance with any agreement to use only one
or two pharmacies? Does the patient need drug abuse counseling or other types
of drug abuse/addiction treatment? Pharmacists
are an extension of the physician, but many times they have access to
additional information that a physician does not have, such as when patients
utilize multiple pharmacies for their prescriptions. The pharmacists are drug
experts and often detect early refills, duplicate therapies, or forged
prescriptions. They can then consult with the prescriber(s)
to ensure that the patient receives appropriate treatment. State
and federal regulators are responsible for protecting the public from health
care professionals. When someone complains that a physician is
“over-prescribing” or prescribing inappropriately, the licensing board needs
to obtain detailed prescription information about a large number of patients.
With a PMP report, the initial phase of the investigation can be done very
quickly and substantiate the complaint or provide a reasonable basis to close
the case. Law
enforcement officers use PMP information to focus their investigations.
Typically, an officer receives a complaint that an individual is forging
prescriptions or obtaining prescription by deception, both of which are
criminal activity. Without a PMP, the officer must contact every pharmacy in
the area to try to locate the prescriptions that become evidence of the
crime. With a PMP report, the officer can contact only the specific
pharmacies where the evidence is likely to be located. PMP information does
not alter the investigation that is required; it simply streamlines it. Q. Are there any limitations to PMP
data? Yes, states typically restrict
the data in a number of ways to protect patient confidentiality. Primarily,
states restrict the purpose for which an individual can obtain the data. A
good example is that a pharmacist may only obtain a report on a patient, i.e.
someone who has, at a minimum, presented a prescription. They may not use a
PMP report for pre-employment screening purposes. Another restriction is the
length of time that the PMP can retain the patient’s identifying information.
The data has value in healthcare and law enforcement for only for 2 to 3
years. So there’s no reason to retain that data any longer. (There is,
however, value in retaining de-identified data for longer periods for
research purposes.) Probably the most important
limitation is remembering that this data is subject to errors that are
inherent in the pharmacy process. Pharmacy personnel make data entry errors
such as reversing the digits on a birth date or attributing a prescription to
the wrong prescriber. Other times the patient may
decide to pick up a prescription at a different pharmacy after it was
telephoned in and prepared for dispensing. If the first pharmacy already
reported the prescription to the state PMP, the drug may appear to have been
dispensed twice. Understanding the pharmacy workflow and recordkeeping is a
major key to understanding what the data may or may not mean. What opportunities for research are
there using PMP data? PMP data are a rich resource
for current dispensing patterns. I’m working with some researchers in Ohio to
see if we can correlate prescription drug dispensing patterns with street
availability of prescription drugs. It may not be possible but we don’t know
until we study it. Another researcher wants to study the effects of marketing
on certain products. Yet another is discussing differences in narcotic use by
specific populations. In addition, PMP data could be used to validate other
research or data sources. Of course, all of this is using de-identified data. PMP data might answer numerous
other questions. Some states do not allow research with PMP data at all and
not every state collects all the same data elements. Yet, since 35 states now
have a PMP or are in the process of developing it, the next few years can be
very exciting in terms of the research that can guide public health
initiatives. |
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RADARS System to
Host Second Annual Scientific Meeting on Prescription Drug Abuse: From Signals to Interventions Research on the abuse, misuse and diversion of prescription drugs
continues to provide essential information concerning prescription drug
safety in the nation. In an effort to continue to contribute to the
understanding of prescription drug abuse, misuse and diversion, the RADARS
System will host its second annual scientific meeting: From Signals to Interventions on May 1, 2008 in Bethesda,
Maryland. The second annual scientific meeting will focus on new developments in
prescription drug abuse research and interventions. In addition, an overview
of newly developed signal detection systems and annualized 2007 data will be
presented. Speakers will include experts in public health interventions and
in prescription drug abuse and interventions. To date, three speakers have
been confirmed and will be presenting on the follow topics: ·
Dr.
Jennifer Sabel from the Washington State Department
of Health will present on Prescription
Opiate Deaths in Washington State and Potential Solutions ·
Patrizia Carrieri
from the French National Institute from Health and Medical Research will
present on The Importance of Measuring
Drug Related Harms and Benefits of Treatment in Post-Marketing Surveillance:
Lessons from Buprenorphine ·
Commander
John Burke from the National Association of Drug Diversion Investigators will
present on Law Enforcement and the
Pharmaceutical Industry-Collaboration for Success In 2007, annual meeting attendees
included several pharmaceutical manufacturers;
representatives from government regulatory agencies including the U.S. Drug
Enforcement Agency, U.S. Food and Drug Administration; the Substance Abuse
and Mental Health Services Administration; representatives from organizations
such as the National Association of Drug Diversion Investigators and the
American Association for the Treatment of Opioid Dependence; and researchers
in the field of prescription drug abuse. Key findings presented
at the 2007 Annual Scientific Meeting include: ·
Prescription opioid abuse is widespread, affecting nearly
all areas of the United States (see map). ·
No community is immune to prescription opioid abuse: 93
percent of reporting three-digit ZIP codes had at least one case of
prescription opioid abuse, misuse or diversion in 2006. ·
The highest pockets of abuse, misuse and diversion occur
in the Appalachian Region and the Northeast. ·
No single prescription opioid is responsible for the
problem. RADARS System data indicate that abusers typically take advantage of
multiple opioids. ·
According to data from the Poison Center Signal Detection
System, there were 9,240 exposures to prescription opioids
in young children from January 2003 to July 2006. Detailed information
on the 2008 annual meeting is posted on the RADARS System website at www.radars.org. |
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Study Provides Overview of Prescription
Drug Diversion Trends While
national surveys have documented prescription drug abuse and misuse as a
widespread problem, few studies have focused on the problem of prescription
drug diversion where regulated pharmaceuticals are moved to the illicit
marketplace. A study using data gathered from the Drug
Diversion Signal Detection System was published in a recent issue of Law Enforcement Executive Forum. The Diversion
of Prescription Opioid Analgesics by
James A. Inciardi, et al., provides an overview of prescription
drug diversion and highlights the need to understand where and how
prescription drug diversion occurs. Drug
Diversion data reported in the journal article revealed that from January
2002 through December 2006, “a total of 64,655 investigations of prescription
drug diversion were initiated...and typically, more than one drug was
involved in each case.” Furthermore, survey data found that
despite the recent media focus on the Internet as a primary source for
diversion, drug abusers typically avoid the Internet as a source for
prescription drugs. These
findings are an important step towards understanding how therapeutic
medications are moved to the illegal marketplace, however RADARS System
researchers note that more studies are required to fully understand this
problem. The
Drug Diversion Signal Detection System, one of the first signal detection
systems developed under the RADARS System, continues to research current
prescription drug diversion trends across the nation providing a unique look
at one of the facets of the prescription drug abuse spectrum for the RADARS
System. |
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Recent
RADARS System Publications and Presentations ·
Inciardi JA, Surratt HL, Lugo Y, Cicero TJ. The Diversion of
Prescription Opioid Analgesics. Law
Enforcement Executive Forum. 2007; 7. ·
Cicero TJ, Inciardi JA, Surratt HL. Trends in the Use and Abuse of Branded and Generic
Extended Release Oxycodone and Fentanyl Products in the United States. Drug and Alcohol Dependence. 2007; 91:
115-120. |
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·
The Center
for Substance Abuse Treatment hosted the 2008 Buprenorphine
Summit on February 21-22, 2008. The meeting, Buprenorphine in the Treatment of Opioid
Addiction: Balancing Medication Access with Quality Care, brought
together experts in the field of opioid addiction treatment to review current
patterns of buprenorphine use in the treatment of
opioid addiction. Nabarun Dasgupta, doctoral candidate in epidemiology
at the University of North Carolina at Chapel Hill attended the meeting and
presented RADARS System data on current trends in buprenorphine
abuse, misuse and diversion. ·
The
American Society of Addiction Medicine will host its 39th Annual
Medical-Scientific Conference April 10-13, 2008 in Toronto, Ontario, Canada. Richard C. Dart, M.D.,
Ph.D., Executive Director of the RADARS System will attend and present at a
seminar held Sunday, April 13, 2008. Buprenorphine and Office-Based Treatment of Opioid
Dependence will cover the efficacy and safety of buprenorphine treatment. Dr. Dart’s presentation will
present prescription drug abuse, misuse and diversion data from the RADARS
System. ·
The College
of Problems of Drug Dependence will host its 70th Annual
Scientific Meeting June 14-19, 2008 in San Juan, Puerto Rico. ·
The Drug
Information Association will host its 44th Annual Meeting June
22-26 in Boston, MA. |
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RADARS System
Mission Statement The RADARS System provides timely and
geographically-specific data to the pharmaceutical industry, regulatory
agencies, policymakers and medical/public health officials to aid in
understanding trends in the abuse, misuse, and diversion of prescription drugs
in the United States. |
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Rocky Mountain
Poison and Drug Center and Denver Health The RADARS System is a governmental nonprofit operation
of the Rocky Mountain Poison and Drug Center
(RMPDC), an agency of Denver Health
and Hospital Authority (DHHA). The RMPDC has been in operation for more
than 50 years, making it one of the oldest poison control centers in the
nation. DHHA is the safety net hospital for the City and County of Denver.
DHHA is the Rocky Mountain region’s academic Level I trauma center and includes
Denver Public Health, Denver’s 911 emergency medical response system, nine
family health centers, 12 school-based clinics, NurseLine, correctional care,
Denver CARES, the Denver Health Medical Plan, and the Rocky Mountain Center
for Medical Response to Terrorism, Mass Casualties and Epidemics.
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RADARS®
System § 777 Bannock Street § Mail Code 0180 § Denver, CO 80204 To
unsubscribe, please reply to this email with “unsubscribe” Questions or
comments? Email the RADARS System at radars@rmpdc.org |
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