1. Maine Diversion Alert Program

2. PMP

3. Rx abuse in Maine Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. 2011.Centers for Disease Control and PreventionNational Center for Injury Prevention and Control Drug Overdose Deaths By State - 2008

4. Rx abuse in Maine Source: Maine Treatment Data System, Maine Office of Substance Abuse and Mental Health Services (2013).

5. So, why is the problem so big here? Kilograms of prescription painkillers sold, rates per 10,000 people Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention 2011.Centers for Disease Control and PreventionNational Center for Injury Prevention and Control

6. Source: Substance Abuse and Mental Health Services Administration (2010.

7. What is the Diversion Alert Program? Monthly emailed/mailed alerts to health care providers showing individuals arrested for illegal drug related crimes; Online, password protected drug arrest database; and Educational resources to assist in responding to patients charged with illegal drug related crimes.

8. Is it legal to distribute arrest information? Yes. Under Maine’s Criminal History Record Information Act, a criminal justice agency may disclose to the public criminal history record information related to an offense for which a person is currently within the criminal justice system. This includes recent arrests that are actively being prosecuted [16 M.R.S. § 612(3)(A)].

9. Arrest, summons, conviction Arrest: gives notice to an individual that he/she is being charged with a crime. Person is detained. Summons: gives notice to an individual that he/she is being charged with a crime. Conviction: formal declaration by a court that a person has been found to have committed (is “guilty” of) a crime.

10. How does the program work? Law enforcement agencies submit data. Data is entered into online database. Public health district and statewide reports are emailed or mailed to registered participants.

11. Districts Reports Aroostook Washington/Hancock Penobscot/Piscataquis Kennebec/Somerset Lincoln, Waldo, Knox, Sagadahoc Androscoggin, Franklin, Oxford Cumberland York Statewide

12. Who can register to access Diversion Alert data? Pharmacists Licensed Maine prescribers (e.g. NPs, MDs, DOs, PAs, dentists, podiatrists) Sub-recipients authorized by licensed prescribers or pharmacists (e.g. medical office managers, social service providers) Law enforcement personnel

13. Data accuracy Data cannot be guaranteed without error. You may also wish to confirm the identity of the individual through: –Booking photo included in monthly reports –Contacting law enforcement agency that arrested the individual

15. Participant responsibilities Use of data in a manner consistent with professional/ethical standards; Treat data as sensitive information; Keep data in a safe location; Using other resources confirm that a positive identification has been made.

16. Data should not be used as: as a data source for academic research; as the sole source for clinical decision- making.

17. Why use Diversion Alert? Helps you make informed decisions about patient care; Identifies patients: –In need of substance abuse treatment –Who may be drug seeking for the purpose of diversion Assist in compliance with rules/guidelines recommended by professional boards.

18. Responding to patients charged with prescription or illegal drug related crimes. Tips are based on the recommendations of: James A. Owen (PharmD, Assoc. Vice President, Professional Practice, American Pharmacists Association) and Crespi Lofton, (MS), in conjunction with staff from the American Pharmacists Association. The recommendations were published in the Journal of the American Pharmacists Association, January/February 2014, Volume 54(1) under the title “Pharmacists’ role in addressing opioid abuse, addiction and diversion.”

19. Find out as much info as needed to make an informed decision about how to respond to your pt. Talk to your patient to determine the issue behind the arrest (i.e. addiction, profit, helping a friend). Check PMP for atypical or concerning patterns. Talk to prescribers and pharmacists who share the patient’s treatment with you. Contact the arresting agency for more information about the criminal charge.

20. If you suspect misuse, abuse or diversion… Notify the patient’s prescriber and local law enforcement. Refuse to fill the prescription.

21. ME regulation pertaining to refusal to fill and reporting to law enforcement: 2. Refusal to fill prescription, dispense drug or sell targeted methamphetamine precursor; law enforcement reporting. A pharmacist or person acting at the direction of a pharmacist may exercise discretion and refuse to fill any prescription, dispense any drug or sell any targeted methamphetamine precursor if unsatisfied as to the legitimacy or appropriateness of any prescription presented, the validity of any photographic identification or the identity of any patient presenting a prescription or any person acting on behalf of the patient, or the intention of the customer to use the drug or targeted methamphetamine precursor according to the instructions for use. A pharmacist or person acting at the direction of a pharmacist may make a report to a law enforcement agency when that person has reasonable cause to suspect that a prescription is not legitimate or appropriate, that a person has presented photographic identification that is not valid or that a customer has the intention to use a drug or targeted methamphetamine precursor in a manner inconsistent with the instructions for use. Maine Regulations—32 M.R.S.A, Section 13795 [ 2005, c. 430, §10 (AFF); 2005, c. 430, §7 (AMD).]

22. 3. Immunity; presumption of good faith. A pharmacist or person acting at the direction of a pharmacist who in good faith and pursuant to subsection 2 refuses to fill any prescription, dispense any drug or sell any targeted methamphetamine precursor or who makes a report to a law enforcement agency is immune from any civil liability that might otherwise result from that action, including, but not limited to, any civil liability that might otherwise arise under state or local laws or rules regarding confidentiality of information. In a proceeding regarding immunity from liability, there is a rebuttable presumption of good faith. [ 2005, c. 430, §10 (AFF); 2005, c. 430, §7 (NEW).] ME regulation pertaining to refusal to fill and reporting to law enforcement con’t:

23. Federal Regulations A pharmacist is required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription. Such a determination is made before the prescription is dispensed. The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances. Such action is a felony offense, which may result in the loss of one’s business or professional license (see United States v. Kershman, 555 F.2d 198 [United States Court Of Appeals, Eighth Circuit, 1977]). Source: DEA Pharmacist’s Manual: An Information Outline of the Controlled Substances Act of 1970

24. Document your response to the criminal charges against your patient: Document that you received the information, investigated the allegations, and had a discussion with your patient. Come up with a tentative plan about how to respond before you talk to your patient. Document your final plan and the reasoning behind it. Follow through on your plan and document that you did. If you modify your initial plan, document that you did so and why.

25. References: Centers for Disease Control and Prevention. Policy Impact: Prescription Painkiller Overdoses. Atlanta, GA: US Department of Health and Human Services; 2011. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2011. Available from URL: http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16External Web Site Icon. Owen, JA & Lofton, C. (2014). Pharmacists’ role in addressing opioid abuse, addiction and diversion. Journal of the American Pharmacists Association, 54(1). DEA. Pharmacist’s Manual: An Information Outline of the Controlled Substances Act of 1970. Washington, DC: DEA; 2010. http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_manual.htm. Accessed March 5, 2014.

26. Clare Desrosiers, Program Director clare@diversionalert.org 207-521-2408 www.diversionalert.org Contact information