1. KASPER and Kentucky’s Response to the Opioid Crisis
David R. Hopkins
KASPER Business Analyst
Office of Inspector General
Mental Health and Addiction Treatment Symposium
October 24, 2019

2. Disclosure David R. Hopkins No relevant financial relationships
No conflicts of interest

3. Contents
Controlled Substance Abuse and the Opioid Crisis
KASPER Program Information
How KASPER is Used

4. Controlled Substance Abuse and the Opioid Crisis

5. Misuse, Abuse, Diversion (SAMHSA)
incorrect use of a controlled substance medication by a patient (wrong time, wrong dose, wrong reason)
Abuse:
maladapted pattern of controlled substance use leading to significant impairment or distress
Diversion:
controlled substance medication leaving the legal distribution channels (manufacture, transport, pharmacy, patient)

6. Commonwealth of Kentucky RESPONSE TO THE OPIOID EPIDEMIC

8. Prelude to House Bill 1 Opioid abuse a national epidemic
KY controlled substance abuse increasing
KY opioid overdose deaths increasing
“Pill mills” proliferating
Governor, Office of Drug Control Policy, Attorney General and legislators viewed medical community as contributors to the problem
Low provider utilization of PDMP (KASPER)

9. 2012 Extraordinary Session HB1 2013 Regular Session HB217

10. Strategies PRESCRIPTION MONITORING PRESCRIBING REGULATIONS
ROGUE PAIN CLINICS
DRUG DISPOSAL
PRESCRIBER AND PUBLIC EDUCATION

11. Kentucky’s Prescription Drug Abuse Strategy Office of Drug Control Policy
Require physician ownership of pain management facilities
Limit prescriber dispensing of C-II medications to a 48 hour supply
Require 7.5% of CME in addiction, pain management or KASPER
Increase public awareness
Increase resources and funding for substance abuse prevention and treatment
Increase drug disposal opportunities
Enhance use of Prescription Drug Monitoring Program
Require daily reporting to KASPER
Mandate KASPER registration and usage
Pharmacists must register
Controlled substance prescribers must register and query under certain circumstances
Utilize KASPER data to identify potentially inappropriate or illegal controlled substance prescribing or dispensing

12. Kentucky Overdose Deaths

13. Kentucky Overdose Deaths

14. Controlled Substances and Overdose Deaths
Approximately 60% of Kentucky resident drug overdose decedents in 2018 received a controlled substance within one year of their date of death.

15. Photo courtesy of www.legacy.com, August 14, 2019
Richard Brown
Photo courtesy of August 14, 2019

16. KASPER Program Information

17. Kentucky All Schedule Prescription Electronic Reporting

18. KASPER
KASPER is Kentucky’s Prescription Drug Monitoring Program (PDMP). KASPER tracks Schedule II – V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers, and provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances.

19. Controlled Substance Schedules
Schedule I – Illegal Drugs
e.g. heroin, marijuana, ecstasy
Schedule II – Most addictive legal drugs; high abuse potential
e.g. fentanyl (Actiq, Duragesic), oxycodone (OxyContin, Percocet), methylphenidate (Ritalin), hydrocodone (Vicodin, Norco)
Schedule III – Less abuse potential than I or II
e.g. testosterone (Androgel), buprenorphine/naloxone (Suboxone)
Schedule IV – Less abuse potential than III
e.g. benzodiazepines (Xanax, Valium)
Schedule V – least abuse potential
e.g. codeine containing cough mixtures

20. KASPER Operation
Over 11 million controlled substance prescriptions reported to the system each year
Over 12.5 million report/data requests processed in 2018
KASPER data updated within 1 to 2 days
Dispensers have 1 business day to report
Reports available to authorized individuals
Available via web typically within seconds
Available 24/7 from any PC with web access

21. KASPER Data KASPER tracks:
Retail pharmacies dispensing into KY (in-state, mail order, Internet)
Hospital emergency departments dispensing controlled substances to an ED patient
Practitioners administering or dispensing a controlled substance in the office
Dispensing from Department for Veterans Affairs pharmacies (except gabapentin)

22. KASPER Data KASPER does not track:
Methadone administered at a federally regulated methadone clinic
Controlled substances dispensed for administration to a patient in a hospital, long-term care facility, jail, correctional facility or juvenile detention facility
Pseudoephedrine (tracked separately via NPLEx)
Dispensing by military pharmacies
Schedule I or other illegal drugs

23. Buprenorphine/Naloxone 3.4%
Top Prescribed Controlled Substances by Therapeutic Category based on Number of Doses
Buprenorphine/Naloxone 3.4%
Suboxone
Lorazepam 2.9%
Ativan
Pregabalin 2.7%
Lyrica
Amphetamine 4.1%
Adderall
Gabapentin 29.0%
Neurontin
Clonazepam 5.0%
Klonopin
Alprazolam 6.8%
Xanax
Tramadol 7.3%
Ultram
Oxycodone 13.2%
OxyContin, Percocet
Hydrocodone/APAP 25.6%
Lortab, Vicodin, Norco

24. KASPER Stakeholders
Licensing Boards – to investigate potential inappropriate prescribing by a licensee.
Practitioners and Pharmacists – to review a current patient’s controlled substance prescription history for medical or pharmaceutical treatment; for the birth mother of an infant being treated for neonatal abstinence syndrome or prenatal drug exposure.
Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution.
Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients.
A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines.
Medical Examiners engaged in a death investigation

25. Controlled Substance Records Reported to KASPER - Total/Per Person
Number of Controlled Substance Prescriptions per Person

26. KASPER Report Requests
Report/Data Requests in Thousands
7354
6871

27. What does a KASPER Report Show?
A KASPER report includes:
The patient name and date of birth
The drug name, dosage, days supply, date prescription written, date prescription filled
The prescriber name and city
The dispenser name and city
Morphine milligram equivalent data
Per opioid prescription
Total for all active opioid prescriptions

29. How KASPER is Used

30. KASPER Prescriber Usage - KRS 218A.172
Query KASPER for previous 12 months of data:
Prior to initial prescribing or dispensing of a Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone
No less than every three months
Review data before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone
Additional rules/exceptions included in licensure board regulations

31. KASPER Regulations – Licensure Boards
201 KAR 5:130
Kentucky Board of Optometric Examiners KASPER requirements
201 KAR 8:540
Kentucky Board of Dentistry KASPER requirements
201 KAR 9:260
Kentucky Board of Medical Licensure KASPER requirements
201 KAR 20:057
Kentucky Board of Nursing KASPER requirements
201 KAR 25:090
Kentucky Board of Podiatry KASPER requirements.

32. General KASPER Query Exceptions
In an emergency situation (disaster or mass casualties)
Within 14 days of surgery or within three days of oral surgery
Patients in hospitals and long term care facilities
Patients in Hospice care or being treated for cancer pain
Single doses of anxiety medicine prior to a procedure
Prescribing a substitute medication within 7 days of initial prescription
Schedule V controlled substances

33. Providing Reports to Patients
KASPER reports can be shared with the patient or person authorized to act on the patient’s behalf
KASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record

34. KASPER Prescriber Report Card
Program Enhancements
KASPER Prescriber Report Card
Launched February 2017
Provides a quarterly and annual summary of a practitioner’s prescribing practices and how they compare with other practitioners in their specialty area

37. Program Enhancements
Drug Conviction data from Administrative Office of the Courts
Class A misdemeanor and felony drug conviction information from the AOC CourtNet system
6.1% (973,245) of YTD 2019 KASPER queries included a request for drug conviction information
1.1% (11,112) of those requests returned drug conviction information for the patient

39. Non-fatal drug overdose warning flag to be added in 4Q 2019
Program Enhancements
Non-fatal drug overdose warning flag to be added in 4Q 2019
Based on patient overdose information reported by Emergency Departments to the Kentucky Health Information Exchange (KHIE)
KASPER will be linked to KHIE to notify practitioners if the patient experienced a non-fatal drug overdose in the ED
Practitioners and pharmacists can view the patient information in KHIE

40. OIG Overdose Death Notification Project
Letters to practitioners who prescribed one or more opioid prescriptions that were active at the time of their patient’s death.
Tips on managing pain and prescribing opioids
Patient Information
Treatment Resource
Locator:
findhelpnowky.org

41. House Bill 1 Controlled Substance Dispensing Comparison
Drug
July 2011 through
June 2012
July 2018
through
June 2019
Percent
Change
Opioid Analgesics
5,762,843
3,770,735
-35%
Opioid Analgesic Average Daily MED 45 39
-13%
Benzodiazepines and Other Sedatives
2,666,208
1,683,861
-37%
Stimulants
1,171,718
1,455,651
+24%
Gabapentin
Not Scheduled
1,759,496
Buprenorphine/ Naloxone
331,190
1,053,251
+218%
All Controlled Substances
11,992,912
11,194,891
-7%
All figures based on dispensed controlled substance prescription data reported to KASPER

42. Opioid Analgesics vs. Medication Assisted Treatment
Source: Kentucky All Schedule Prescription Electronic Reporting System

43. QUESTIONS?
KASPER Web Site: