1. Florida’s Prescription Drug Monitoring Program
Joni Kellams, MSN, ARNP, FNP-BC

2. Learning Objectives
Identify dependence syndrome and the extent of the prescription drug abuse problem.
Understand the progression of controlled substance monitoring.
Define the role of Florida’s Prescription Drug Monitoring Program (PDMP).
Learn basic understanding of how to access and use Florida’s PDMP: Electronic- Florida Online Reporting of Controlled Substances Evaluation (E- FORCSE).

3. Addiction
Dependence Syndrome: A cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include:
a strong desire to take the drug,
difficulties in controlling its use,
persisting in its use despite harmful consequences,
a higher priority given to drug use than to other activities and obligations,
increased tolerance, and
sometimes a physical withdrawal state.
Reference: World Health Organization (2016). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for ;2016. Retrieved from
Photo credit: Hisamitsu America, Inc. (2016). Kicking opioid addiction. Retrieved from
Source: World Health Organization (2016). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for ;2016. Retrieved from

4. The Prescription Addiction Crisis
#1 cause of accidental deaths in the US is now poisoning (which includes drug overdose)
#2 cause of accidental deaths is motor vehicle incidents
$193 billion annual cost from the addiction crisis due to:
Crime
Health Care Costs
Diminished Work Productivity
References: Center for Disease Control and Prevention (2014). Vital Statistics. Retrieved from
National Institute on Drug Abuse (2015). Trends & Statistics. Retrieved from
Photo credit: Drugsdb.com (2014). Most abused drugs in the US. Retrieved from
Sources: CDC (2014). Vital Statistics. Retrieved from ; NIDA (2015). Trends & Statistics. Retrieved from

5. Prescription Painkillers: Rates of prescription painkiller overdose deaths, prescription painkiller sales, and prescription painkiller abuse treatment admissions, United States,
Reference: Centers for Disease Control and Prevention (2011). Prescription painkiller overdoses in the US. Retrieved from
Prescription painkiller deaths increased from 4,000 to 15,000 from
The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices increased 4 times from
Source: Centers for Disease Control and Prevention (2011). Prescription painkiller overdoses in the US. Retrieved from

6. The Prescription Addiction Crisis: Florida
In 2010: highest number of prescription-related deaths= 2,710
Reference: Bondi, P. (2014). Statewide taskforce on prescription drug abuse & newborns: 2014 progress report. Retrieved from
Source: Bondi, P. (2014). Statewide taskforce on prescription drug abuse & newborns: 2014 progress report. Retrieved from

7. The Prescription Addiction Crisis: Florida
“For one opioid pain killer (oxycodone) Florida practitioners purchased more than 40 million pills between January and June of 2010, compared with a total of 4.5 million purchased by practitioners in the rest of the country. Ohio is the second leading State for oxycodone distribution, but purchases there represent only two percent of those in Florida.” (Executive Office of the President of the United states, 2011)
Reference: Executive Office of the President of the United States (2011). National drug control strategy. Retrieved from
Photo credit: Westbridge (2014). Prescription drug abuse in Florida. Retrieved from
Source: Executive Office of the President of the United States (2011). National drug control strategy. Retrieved from

8. Prescription Drug Monitoring Program (PDMP)
A tool used to address prescription drug diversion and abuse.
Serve multiple functions:
patient care tool
drug epidemic early warning system
drug diversion and insurance fraud investigative tool
help prescribers prevent drug interactions, identify drug‐seeking behaviors (“doctor shopping”)
can be used by professional licensing boards to identify clinicians with patterns of inappropriate prescribing and dispensing
assist law enforcement in cases of controlled substance diversion
Reference: Executive Office of the President of the United States of America (2011). Prescription drug monitoring programs [Fact Sheet]. Retrieved from
Source: Executive Office of the President of the United States of America (2011). Prescription drug monitoring programs [Fact Sheet]. Retrieved from

9. PDMP Benefits
Play a key role in reducing the supply and abuse of controlled substances specifically targeted as highly addictive, such as opioids and benzodiazepines
States with active PDMPs show a downward trend in opioid dispensation by approximately 3%
Reduction in oxycodone-related deaths
References: Worley, J. (2012). Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research. Issues In Mental Health Nursing, 33(5), p. doi: /
Brady, J. E., Wunsch, H., Dimaggio, C., Lang, B. H., Giglio, J., & Guohua, L. (2014). Prescription Drug Monitoring and Dispensing of Prescription Opioids. Public Health Reports, 129(2),
Delcher, C., Wagenaar, A. C., Goldberger, B. A., Cook, R. L., & Maldonado-Molino, M. M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida’s prescription drug monitoring program. Drug and Alcohol Dependence, 150(2015),
Photo credit: Remedy Health Media, LLC. (2016). 8 dos and don’ts of opioid safety. Retrieved from
Sources: Worley, J. (2012); Brady (2014); Delcher (2015).

10. PDMP: National Legislation
National All Schedules Prescription Electronic Reporting Act (NASPER)- Federal legislation enacted in encouraged states to adopt PDMPs
All states, except Missouri, have a enacted legislation for a PDMP
References: National All Schedules Prescription Electronic Reporting Act (2007). Now that NASPER has been signed into law, what’s next? Retrieved from
Missouri Prescription Drug Monitoring Program NOW Coalition (n.d.) About us: Missouri prescription drug monitoring program NOW coalition. Retrieved from
Photo credits: Fronthill Counseling (2016). Missouri: Only State Not on Prescription Drug Monitoring Program. Retrieved from
State of California (2016). Legislation. Retrieved from
Sources: National All Schedules Prescription Electronic Reporting Act (2007). Now that NASPER has been signed into law, what's next?; Missouri Prescription Drug Monitoring Program NOW Coalition (n.d.) About us: Missouri PDMP NOW coalition.

11. PDMP and Drug Abuse: Florida’s Timeline
2009: Governor Rick Scott signed SB 462 (PDMP Bill) into law
Statute Florida’s PDMP Statute
2010: 2,710 overdose deaths (highest rate)
2011: PDMP implemented in Florida
2012: Reduction in overdose deaths to 2,090
2013: Overdose deaths reduced under 2,000 (to 1,916) for first time since 2006
Reference: Florida Department of Health (2015). E-FORCSE prescription drug monitoring program annual report. Retrieved from
The Florida Legislature (n.d.) The prescription drug monitoring program. Retrieved from
Sources: Florida Department of Health (2015). E-FORCSE prescription drug monitoring program annual report.; The Florida Legislature (n.d.) The prescription drug monitoring program.

12. PDMP Success in Florida
There was a 25% reduction in oxycodone- related deaths in Florida the month after implementation of the PDMP
A steady decline in prescription-related deaths each year after implementation of the PDMP (2011), where the trend before that time showed steady increases each year
Reference: Delcher, C., Wagenaar, A. C., Goldberger, B. A., Cook, R. L., & Maldonado-Molino, M. M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida’s prescription drug monitoring program. Drug and Alcohol Dependence, 150(2015),
Bondi, P. (2014). Statewide taskforce on prescription drug abuse & newborns: 2014 progress report. Retrieved from
Photo credit: Medscape (2015). National drop in opioid prescriptions, overdose. Retrieved from
Sources: Delcher et al. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida's prescription drug monitoring program.; Bondi, P. (2014). Statewide taskforce on prescription drug abuse & newborns: 2014 progress report.

13. E-FORCSE: Florida’s PDMP
E-FORCSE: Electronic- Florida Online Reporting of Controlled Substances Evaluation
Health Information Designs, LLC: selected by E-FORCSE to develop the database to collect and store prescribing and dispensing information for CII-CIV medications
RxSentry: web-based program developed by Health Information Designs, LLC for the database
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Photo credit: Florida Department of Health (n.d.) E-FORCSE home page. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

14. E-FORCSE: Important Terms
Patient Advisory Report (PAR)- written information given to a prescriber, dispenser, pharmacy or patient regarding the dispensing of controlled substances
Controlled Substance- a controlled substance listed in Schedule II, III, or IV
Dispenser- dispensing pharmacist or dispensing healthcare practitioner
Prescriber- any prescribing physician or other prescribing healthcare practitioner
Law Enforcement Agency- Department of Law Enforcement, a Florida sheriff’s department, a Florida police department, or a law enforcement agency of the Federal Government which enforces the laws of this state or the United States relating to controlled substances, and which its agents and officers are empowered by law to conduct criminal investigations and make arrests
Program Manager- an employee of or a person contracted by the Department of Health who is designated to ensure the integrity of the prescription drug monitoring program
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

15. E-FORCSE: Access and Required Use
Access granted to individual practitioners and pharmacists licensed in Florida
Access NOT granted to hospitals, pharmacies, clinics, healthcare facilities
Required use: whenever a healthcare practitioner DISPENSES a medication
Report within 7 days after dispensing
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Photo credit: Legion Magazine (2007). A prescription for change. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

16. E-FORCSE: When Reporting is NOT Required
Administering:
Directly to a patient if the amount is adequate to treat the patient during that particular treatment session
To a patient or resident receiving care as a patient at a hospital, nursing home, ambulatory surgical center, hospice or intermediate care facility for the developmentally disabled
In the Emergency Room of a licensed hospital
Administering or Dispensing:
In the health care system of the Florida Department of Corrections
To a patient under the age of 16
Dispensing:
A one-time, 72-hour re-supply of controlled substances
Reference: Florida Department of Health (2012) Prescription Drug Monitoring Program Annual Report. Retrieved from
Photo credits: Medypal (2014). Top hospitals in Bangalor. Retrieved from
Health News Florida (2016). Prison System, Contractor Accused Of Denying Inmate Surgeries. Retrieved from
Jai Medical Centre (n.d.). Repeat prescriptions. Retrieved from
Source: Florida Department of Health (2012) Prescription Drug Monitoring Program Annual Report. Retrieved from

17. Prescriber Mandates
22 states have prescriber mandates to use the PDMP in specific circumstances
Prescribing practitioners that do not dispense prescriptions are NOT mandated to use the PDMP in Florida
Reference and photo credit: Maryland Department of Health and Mental Hygiene (2015). PDMP implementation and operations update. Retrieved from
Source: Maryland Department of Health and Mental Hygiene (2015). PDMP implementation and operations update. Retrieved from

18. Prescriber Mandates
In order for the PDMP to work effectively, dispensers and prescribers must use the electronic database system
Prescriber participation is paramount to the successfulness of the PDMP
Reference: Rutkow, L., Turner, L., Lucas, E., Hwang, C., & Alexander, G. C. (2015). Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access. Health Affairs, 34(3), doi: /hlthaff
Photo credit: National Public Radio (2013). Top medical prescribers rake in speaking fees from drugmakers. Retrieved from
Source: Rutkow, L., Turner, L., Lucas, E., Hwang, C., & Alexander, G. C. (2015). Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access. Health Affairs, 34(3),

19. How to Use E-FORCSE: Accessing RxSentry
Request an account using the online Practitioner/Pharmacist E-FORCSE Access Request Form
Required Information on Access Request Form: Name, DOB, Last 4 of SSN, State License Type and Number, Date License Expires, Contact Information, Address
DEA Number is not required to access E-FORCSE
E-FORCSE staff will review request and verify information
Then 2 s will be sent to address you provided:
Temporary password and instructions for accessing system
Personal PIN number for Help Desk Assistance
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

20. E-FORCSE: RxSentry Query
Query- used to report information on recipient controlled substance usage, or created to report information on your prescribing history
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Photo credit: Clustrix (2016). Why clustrix: SQL scales. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

21. Query Types
Recipient Query- used by practitioners and pharmacists to generate a Patient Advisory Report (PAR) and create queries regarding recipient usage of controlled substances. Required fields when searching for a Recipient Query: First and Last Name of recipient, DOB, Dispensed start and end date
Search History Query- used by practitioners to view a history of all queries performed using their user ID
Prescriber DEA Query- used by practitioners to view a history of all dispensed prescriptions attributed to their DEA number
Reference: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

22. E-FORCSE: Report Queue
Allows you to check the status of a submitted query and view your reports once they have generated
Map Results- Graphical depiction of results
Doctor Bag- represents the physician’s address and will display the physician’s name and number of prescriptions written for the recipient
Mortar and Pestle- represents the pharmacy’s address and will display the pharmacy’s name and phone number (photo)
Reference and photo credit: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Source: Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from

23. Conclusion Prescription drug abuse is a nation-wide epidemic
Florida has been at the epicenter for the prescription drug abuse crisis
A PDMP is a tool to combat drug diversion and abuse
PDMPs effectively reduce opioid supply and abuse, dispensation, and overdose deaths
Florida’s opioid-related overdose deaths decreased after implementation of the PDMP
Prescriber usage will increase the effectiveness and success of PDMPs
E-FORCSE is Florida’s PDMP and access to the database is easily manageable
E-FORCSE will provide information on a recipient’s dispensing history and your prescribing history

24. References
Bondi, P. (2014). Statewide taskforce on prescription drug abuse & newborns: 2014 progress report. Retrieved from Online-2014.pdf
Brady, J. E., Wunsch, H., Dimaggio, C., Lang, B. H., Giglio, J., & Guohua, L. (2014). Prescription Drug Monitoring and Dispensing of Prescription Opioids. Public Health Reports, 129(2),
Center for Disease Control and Prevention (2014). Vital Statistics. Retrieved from
Centers for Disease Control and Prevention (2011). Prescription painkiller overdoses in the US. Retrieved from
Delcher, C., Wagenaar, A. C., Goldberger, B. A., Cook, R. L., & Maldonado-Molino, M. M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida’s prescription drug monitoring program. Drug and Alcohol Dependence, 150(2015),
Executive Office of the President of the United States (2011). National drug control strategy. Retrieved from
Florida Department of Health (2015). E-FORCSE prescription drug monitoring program annual report. Retrieved from reports/_documents/2015-pdmp-annual-report.pdf
Florida Department of Health (2012) Prescription Drug Monitoring Program Annual Report. Retrieved from reports/_documents/ pdmp-annual-report.pdf

25. References
Health Information Designs (2015). Training guide for Florida practitioners and pharmacists. Retrieved from
Maryland Department of Health and Mental Hygiene (2015). PDMP implementation and operations update. Retrieved from ned120815OGA1655.pdf
Missouri Prescription Drug Monitoring Program NOW Coalition (n.d.) About us: Missouri prescription drug monitoring program NOW coalition. Retrieved from
National All Schedules Prescription Electronic Reporting Act (2007). Now that NASPER has been signed into law, what’s next? Retrieved from
National Institute on Drug Abuse (2015). Trends & Statistics. Retrieved from topics/trends-statistic
Rutkow, L., Turner, L., Lucas, E., Hwang, C., & Alexander, G. C. (2015). Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access. Health Affairs, 34(3), doi: /hlthaff
The Florida Legislature (n.d.) The prescription drug monitoring program. Retrieved from
World Health Organization (2016). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for ;2016. Retrieved from
Worley, J. (2012). Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research. Issues In Mental Health Nursing, 33(5), p. doi: /