1. Controlled Substances Prescription Monitoring Program
Dean Wright, RPh
CSPMP Director
Arizona State Board of Pharmacy

2. Controlled Substances Prescription Monitoring Program
Faculty Disclosure Declaration:
I have no actual or potential conflict of interest in relation to this program or presentation.

3. Controlled Substances Prescription Monitoring Program
Learning Objectives:
Describe the prevalence, roles and limitations of
Controlled Substance Monitoring programs
Explain how to gain access and general information
about the AZ Controlled Substance Prescription Monitoring Program (AZ CSPMP)
Review information on last year’s usage of the system
Describe learning lessons from AZ CSPMP screenings

4. Controlled Substances Prescription Monitoring Program
Arizona’s Forty-eighth Legislature passed H.B establishing a Controlled Substances Prescription Monitoring Program (CSPMP). The bill was signed by the Governor on July 2, 2007 and become effective on September 19, 2007.
The new statutes, A.R.S. Title 36, Chapter 28 are available on the Board’s website under the “CS-Rx Monitoring Program” link. Our proposed rules are also available under the same link.

6. Controlled Substances Prescription Monitoring Program
A.R.S. § requires the ASBP to establish a controlled substances prescription monitoring program that:
Includes a computerized central database tracking system track the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances in Arizona,
Assists law enforcement in identifying illegal activity related to the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances,
Provides information to patients, medical practitioners, and pharmacists to help avoid the inappropriate use of Schedule II, III, and IV controlled substances, and
Is designed to minimize inconvenience to patients, prescribing medical practitioners and pharmacies while effectuating the collection and storage of information.

7. Controlled Substances Prescription Monitoring Program
Purpose of the monitoring program:
Improve the State’s ability to identify controlled substance abusers or misusers and refer them for treatment
Identify and stop diversion of prescription controlled substance drugs
Primary function of the Arizona State Board of Pharmacy:
Provide a central repository of all prescriptions dispensed for Schedule II, III, and IV controlled substances in Arizona

8. Controlled Substances Prescription Monitoring Program
A.R.S. § Use and release of confidential information
C. The board may release data collected by the program to the following:
1. A person who is authorized to prescribe or dispense a controlled substance to assist that person to provide medical or pharmaceutical care to a patient or to evaluate a patient..
2. An individual who requests the individual's own prescription monitoring information pursuant to section
3. A professional licensing board established pursuant to title 32, chapter 7, 11, 13, 14, 15, 16, 17, 18, 21, 25 or 29. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting board states in writing that the information is necessary for an open investigation or complaint.
4. A local, state or federal law enforcement or criminal justice agency. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting agency states in writing that the information is necessary for an open investigation or complaint.
5. The Arizona health care cost containment system administration regarding persons who are receiving services pursuant to chapter 29 of this title. Except as required pursuant to subsection B of this section, the board shall provide this information only if the administration states in writing that the information is necessary for an open investigation or complaint.
6. A person serving a lawful order of a court of competent jurisdiction.

9. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
October 2008: Arizona began collecting data from resident and nonresident pharmacies. The first reports were due on or before Friday October 17, 2008 for the week ending October 11, Pharmacies were required to report their controlled substance data retroactively to April 1, 2008.
October 2009: Began collecting data for dispensing practitioners.
There are about 1691 resident and nonresident pharmacies reporting data and about 3800 dispensing practitioners reporting data.

10. Database access as of February 6, 2013:
Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
Database access as of February 6, 2013:
Practitioners: 4436 (20.1%)
Pharmacists: 1928 (31.2%)
Law Enforcement Investigators: 293
Board Investigators: 50
Practitioners, pharmacists, and law enforcement and board investigators from another state may also request access.

11. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
Who is using the database?
Practitioners make 82.5% of the queries
Pharmacists make 17.3% of the queries
Law Enforcement make 0.13% of the queries
Healthcare Boards make 0.07% of the queries

12. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
Queries - By Quarter for 2010
Period RPh Practitioner LE Board
1/1/10-3/31/
4/1/10-6/30/
7/1/10-9/30/
10/1/10-12/31/
Queries – By Quarter for 2011
Period RPH Practitioner LE Board
1/1/11-3/31/
4/1/11-6/30/
7/1/11-9/30/
10/1/11-12/31/
Queries – By Quarter for 2012
1/1/12-3/31/
4/1/
7/1/12-9/30/
10/1/

13. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
How often is the database being used?
Practitioners average 1936 queries per day.
Pharmacists average 407 queries per day.
Law enforcement agents average 2.7 queries per day.
Healthcare Boards average 1.5 queries per day.
Interstate Queries?
Practitioners made 1034 and Pharmacists made 803 in 4th Quarter 2012

14. Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program
Unsolicited Reports Sent to Practitioners
8/ /
9/ /
10/ /
12/ /
1/ /
2/ /
3/ /
4/ /
5/ /
7/ /
8/ /
9/ /
10/ / / /
12/ /
1/ /
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3/ / 4/

15. Practitioner/Pharmacist Procedures for Requesting Access

23. Online Training Course
Once we receive a practitioner’s completed access request paperwork, we will assign the practitioner to our 20-minute online training course. The practitioner will receive an from our training course
Once, the practitioner completes the training course, the practitioner will receive two s from our tech staff with the practitioner’s user name and the database web link and the practitioner’s PIN number, temporary password, login instructions, and an 866 help desk phone number.
This is an example of the first the pharmacist will receive notifying him that he was approved for access

24. Access Notification
Welcome to the AZ CSPMP Database: for Practitioners
This confirms you are APPROVED by the Arizona Board of Pharmacy to access the Controlled Substance Prescription Monitoring Program database. * To access the Practitioner/ Pharmacist website, click on the database link :
Your username is your DEA Registration # with a prefix of AZ;
AZ * User login and password accounts are never to be shared. All user account deletions, additions, access, permissions, and changes must be submitted in writing to:
Dean Wright, CSPMP Director
Arizona State Board of Pharmacy
1700 W. Washington, suite 250
Glendale, AZ 85007
(602) fax (602)  
You should receive a second , within 4 hours, that will contain your account pin number, temporary password, login instructions, and a tech support phone number.
This is an example of the first the pharmacist will receive notifying him that he was approved for access 24

25. Access notification Arizona State Board of Pharmacy
Controlled Substance Prescription Monitoring Program (CSPMP)
Second
This is your temporary password: [kse93DbJg]
Click on the Database link in the first , click on login, enter your user name and temporary password. Click on Practitioner/Pharmacist Query and in the popup box create a permanent password. Then login with your new permanent password.
This confirms that your PIN # is [8776].
This number is required if you call our support center to assist you
with forgotten passwords.
The number to call for this assistance is
It is recommended that you keep this PIN # in a secure, retrievable location. 
If you do not know your PIN # when you call for assistance we will not be able to help you and you will be required to contact AZ CSPMP and start the application process from the beginning again.
This is an example of the second they will receive it contains their PIN# they will need if they call for assistance

26. PMP Queries
Multi-State access is here. Allows access to data from other states and AZ in one report. Click on Multi-State Query to make a request. Pick AZ and other states needed. Put in patient name and DOB and time-frame for search. Note: DO NOT use Multi-State Query, if you only need data for Arizona, use Practitioner/Pharmacist Query.

27. PMP Report
Only one factor in prescriber’s evaluation of patient history.

28. PMP Report
Only one factor in prescriber’s evaluation of patient history.

29. PMP Report
Only one factor in prescriber’s evaluation of patient history.

30. PMP Report
Only one factor in prescriber’s evaluation of patient history.

31. PMP Report
Only one factor in prescriber’s evaluation of patient history.

32. PMP Report
Only one factor in prescriber’s evaluation of patient history.

33. PMP Report
Only one factor in prescriber’s evaluation of patient history.

34. PMP Report
Only one factor in prescriber’s evaluation of patient history.

35. PMP Report
Only one factor in prescriber’s evaluation of patient history.

36. Other Factors that should be documented
Diagnosis (pain is a symptom)
Chief complaint at visit
Changes since last visit
Urine/Blood Drug screen results
Compliance with treatment plan
Other medical conditions and drugs prescribed
Other known prescribers for this patient

37. Review the patient’s history and patterns of drug use
What a patient received over the last 6-12 months is more important than what they got last week.
Most abuse did not start within the last 10 days.

38. PMP Reports Use the PMP report as a tool.
Review any additional records available
Compare with patient charts
Validate unexpected information
Contact prescribers or pharmacies listed, for more details

39. Problems with PMPs Patient identity Pharmacy data entry errors
No unique identifier for all persons
Common names, same DOB
Computer search functions
Michael/Michelle; Terry/Terri
Pharmacy data entry errors
Date of dispensing entered in Date of Birth field
Wrong prescriber selected

40. Issue is ALWAYS Appropriate Medical Care.
PMP Report
Issue is ALWAYS Appropriate Medical Care.
Quantity alone is never the issue.

41. Scenario 4
PMH: cancer
increasing pain and out of pain medication early
Prescription data base search alerted provider that patient was obtaining controlled substances from multiple sources
Provider discussion with patient that for safety all his pain medication should be coming from one location.
New treatment plan for pain control developed.
Importance of contacting provider when pain not controlled with current medication emphasized.
Learning Lesson: talk with your patient closely & frequently

42. QUESTIONS? Arizona State Board of Pharmacy
Web page:
Dean Wright, CSPMP Director
1700 W. Washington, Suite 250
Phoenix, AZ 85007
Fax:

43. QUESTIONS? Arizona State Board of Pharmacy
Web page:
Dean Wright, CSPMP Director
1616 W. Adams, Suite 120
P.O. Box 18520
Phoenix, AZ 85005
Fax: