1. PRESCRIPTION MONITORING PROGRAMS
Promoting Appropriate Use of Controlled Substances
I am an active user of the PMP: Yes/No
The PMP’s primary purpose is to identify doctor-shopping behavior: True or False
The primary users of PMP data are law enforcement/regulatory entities: T or F
Virginia is interoperable with other State PMPs: Yes/No
Virginia’s Prescription Monitoring Program

2. Prescription Monitoring Program
Virginia Cancer Pain Initiative
From The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction (Annu.Rev.Public Health :559–74)

3. Source: NSDUH 2013

4. Prescription Monitoring Program
From The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction (Annu.Rev.Public Health :559–74)

5. Figure 3: Fatal Overdose in Virginia: Prescription Opioids and Heroin
The graphs on the map above compare the proportion of the state’s population that lived in that Division in (black bar) to the proportion of drug cases submitted to DFS in CY 2014, for the listed drug types. For example, about 5% of Virginia’s population in 2014 lived in Division 4, but that Division submitted about 26% of benzodiazepine cases.
Data Source: OCME Fata Drug Overdose Quarterly Report

6. Figure 6: Virginia Prescription Opioid Data Comparing Hospitalizations to Fatal Overdoses
Statewide, benzodiazepine cases submitted to DFS increased 187% between CY 2001 and Between 2013 and 2014, they decreased 3%. Although Division 4 has consistently had the highest number of submissions, the number of cases from other Divisions is growing faster. In 2001, 42% of benzodiazepine submissions were from Division 4. That dropped to 26% in 2014.
Data Sources: OCME Fata Drug Overdose Quarterly Report (2015 data are projected, preliminary figures); OFHS response to data request 12/30/2015.

7. Public Health Impact of Opioid Analgesic Use
For every 1 overdose death there are 35
161
Estimated $193 billion in economic costs for illicit drug abuse in the U.S. in 2007
Hansen et al estimate costs of non-medical use of prescription opioids was $53.4 billion in 20061
Oxycodone, hydrocodone, propoxyphene, and methadone accounted for two-thirds of costs
Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than nonabusers2
461
Treatment admissions are for primary use of opioids from Treatment Exposure Data set
Emergency department (ED) visits are from DAWN,Drug Abuse Warning Network,
Abuse/dependence and nonmedical use in the past month are from the National Survey on Drug Use and Health

8. Prescription Monitoring Program
Prescription Monitoring Programs (PMP) are systems in which controlled prescription drug data are collected in a database and made available to authorized users to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse, and diversion of controlled substances.
What it is not intended to do
Not to prevent people from getting drugs for legitimate medical purposes
Not to decrease the number of prescriptions for pain management
Not to target patients, prescribers, or pharmacies for investigation

9. PRESCRIPTION MONITORING PROGRAMS
49 states and DC have authorizing legislation
49 state programs are operational*
Programs may vary as to drugs collected and who has access
Some standardization is occurring

10. Who May Get PMP Information?
Prescription Monitoring Program
Who May Get PMP Information?
Prescribers and Pharmacists for their patients
Investigators for licensing boards, if there is an open investigation
Certain law enforcement agents, if there is an open investigation
Patients for their own prescription history

11. ELEMENTS OF DATA COLLECTION
Prescription Monitoring Program
ELEMENTS OF DATA COLLECTION
What Drugs Are Reported?
Who Must Report?
Exemptions To Reporting?
Drugs:
Oxycontin, methadone, morphine, Ritalin (SCHEDULE II)
Lortab, Vicodin, testosterone, Tylenol with Codeine (SCHEDULE III)
Valium, Xanax, Ambien (SCHEDULE IV)
Who must report:
Pharmacies, non-resident pharmacies (mail order), dispensing physicians
Exemptions:
Dispensing of manufacturer’s samples
Dispensing pursuant to a manufacturer’s indigent patient program
Dispensing in a bona fide medical emergency
Administering of covered substances
Dispensing within an appropriately licensed narcotic maintenance treatment program
Dispensing to inpatients in hospitals or nursing homes (does not include assisted living)
Dispensing to inpatients in hospices
Dispensing by veterinarians to animals

12. WHO MAY GET INFORMATION?
Prescription Monitoring Program
WHO MAY GET INFORMATION?
Prescribers and Pharmacists
Licensing boards
Certain law enforcement agents
Patients for their own prescription history
Others
Patient must be over 18 and provide a notarized request by mail or in person.

13. Prescription Monitoring Program
Legislation
Prescribers may request their own prescribing history for the previous 90-day period (2013)
Mandatory PMP registration and use of PMP under certain circumstances for prescribers (2014)
Automatic registration for prescribers and pharmacists (2015)
2012 LEGISLATION
Add method of payment as a required element
Remove restriction on number of licensed delegates a prescriber may have
Provide authority for federal law enforcement with drug diversion investigative authority to request PMP information when there is an open investigation (restricted to DEA currently)
Provide authority to send unsolicited reports to State Police Drug Diversion Agents on patients exhibiting extreme “doctor shopping” or forgery indications

14. 2016 Legislation Mandatory requests Unsolicited reports
Continuing education
Expanded access
Daily reporting to be required 1/1/2017

15. Prescription Monitoring Program
INITIATIVES
Morphine Equivalent Dose Score
Automatic Registration
Mandatory Requests
Increase Interoperability
Integration with EHR systems and Pharmacy applications

16. IMPACT-DOCTOR SHOPPING
Prescription Monitoring Program
IMPACT-DOCTOR SHOPPING
The 10 and 10 number for the first half of 2016 was 8.

17. Prescription Monitoring Program

19. Figure 15: Opioids Prescribed in Virginia Six Drugs Represent 90% of Opioid Prescriptions in First Half of 2015
Data Sources: Brandeis University report, 11/23/2015. That report used Virginia Prescription Monitoring Program database as its source.

20. DATACENTER LOG-IN SCREEN
Prescription Monitoring Program
DATACENTER LOG-IN SCREEN

21. SUBMIT REQUEST SCREEN

22. Prescription Monitoring Program
HOW TO LOCATE REPORTS
Click on Patient’s name to view request screen and obtain report

23. Prescription Monitoring Program
Days supply
Pay:
01 = Private Pay
02 = Medicaid
03 = Medicare
04 = Commercial Ins.
05 = Military Inst. and VA
06 = Workers Comp
07 = Indian Nations
99 = Other

24. Prescriber: Pharmacist: Dispense controlled substance
Prescribe as planned
Contact pharmacy
Discuss concerns
Change treatment plan
Refer to specialist
Refer to substance abuse treatment
Discharge from practice
File complaint with law enforcement
Pharmacist:
Dispense controlled substance
Contact prescriber
Discuss concerns
Contact pharmacy
Decline to dispense
File complaint with law enforcement

26. Prescription Monitoring Program
Virginia’s Prescription Monitoring Program adds MEDD score to Patient Reports
New information was added to PMP patient reports on June 2, An “Active Cumulative Morphine Equivalent” score will be displayed just to the right of the patient information section of the report if the patient has active prescriptions for opioids. Also commonly known as the Morphine Equivalent Daily Dose (MEDD), this feature is meant to readily identify the potency among different opioids as a single score describing the equivalent dose of morphine taken on a daily basis.
At the end of the PMP report a morphine equivalent table will be displayed as well as a table computing the patient’s unique score based on the patient’s active prescriptions.
This score represents only opioids dispensed to a patient. It does not reflect any information on the use of any other type of controlled substance such as benzodiazepines or stimulants.
If a patient does not have an active opiate prescription, no cumulative score is provided.

29. Prescription Monitoring Program
Source: Appriss.com, NARxCHECK Product Sheet

30. POST-QUESTIONS
The PMP’s primary purpose is to identify doctor-shopping behavior: True or False
The primary users of PMP data are law enforcement/regulatory entities: T or F
Virginia is interoperable with other State PMPs: Yes or No

31. Prescription Monitoring Program
PROGRAM HOME PAGE
Reports and Statistics
Laws and regulations
Brief introduction and Use Instructions
Contact Information

32. Prescription Monitoring Program
CONTACT INFORMATION
Phone #: or
Fax -