1. Ohio Automated Rx Reporting System (OARRS) Danna E. Droz, J.D., R.Ph. PMP Administrator Ohio State Board of Pharmacy Cuyahoga County Opiate Summit September 28, 2012

2. 2012 OH State Board of Pharmacy 2 Ohio Revised Code §4729.75 - 4729.84 Authorizes: Creation of Dangerous Drug Database a.k.a. Prescription Monitoring Program (PMP) Creation of Dangerous Drug Database a.k.a. Prescription Monitoring Program (PMP) Board of Pharmacy to Board of Pharmacy to CollectCollect Analyze andAnalyze and Distribute Rx dataDistribute Rx data

3. OARRS Background OARRS is Ohio’s prescription monitoring program (PMP or PDMP) OARRS = Ohio Automated Rx Reporting System Statute term is “dangerous drug database” 2012 OH State Board of Pharmacy 3

4. 4 OARRS Data is not a public record. Data is not a public record. Personal identifiers must be removed after 2 years. Personal identifiers must be removed after 2 years. Access to data is limited to specific individuals AND for specific purposes Access to data is limited to specific individuals AND for specific purposes

5. 2012 OH State Board of Pharmacy 5 Purpose of a PMP Tool for prescribers and pharmacists to identify and prevent abuse, misuse, or addiction Tool for prescribers and pharmacists to identify and prevent abuse, misuse, or addiction Tool for law enforcement to inhibit and prevent diversion Tool for law enforcement to inhibit and prevent diversion

6. 2012 OH State Board of Pharmacy 6 OARRS Collection of Rx Drug Data Rxs dispensed by Pharmacies licensed by Ohio Rxs dispensed by Pharmacies licensed by Ohio Submitted electronically Submitted electronically Once a week Once a week

7. 2012 OH State Board of Pharmacy 7 OARRS Rx Database Pharmacy Law Enforcement Prescribers & Pharmacists Licensing Boards Boards Individuals Grand Jury OSBP-PMP Pharmacy Pharmacy Pharmacy Pharmacy

8. 2012 OH State Board of Pharmacy 8 OARRS drugs Controlled substances C-II, III, IV, and V Controlled substances C-II, III, IV, and V Carisoprodol (Soma®) C-IV as of Jan 11, 2012 Carisoprodol (Soma®) C-IV as of Jan 11, 2012 Tramadol (Ultram®) Tramadol (Ultram®) Does not include drugs used to treat infections, blood pressure, high cholesterol, heart problems, etc. Does not include drugs used to treat infections, blood pressure, high cholesterol, heart problems, etc.

9. 2012 OH State Board of Pharmacy 9 OARRS Available 24/7 Available 24/7 Turnaround time (from click on “ SUBMIT ” request until report is ready) Turnaround time (from click on “ SUBMIT ” request until report is ready) 99% ~ 3 seconds 99% ~ 3 seconds 1% ~ 5 min – 3 hrs M-F 8-4:30 1% ~ 5 min – 3 hrs M-F 8-4:30 Lag time (from Rx is dispensed until Rx appears in OARRS) Lag time (from Rx is dispensed until Rx appears in OARRS) 1-10 days 1-10 days

10. 2012 OH State Board of Pharmacy 10 OARRS Who can access the data? HC professional - own patient HC professional - own patient Pharmacist – own patient Pharmacist – own patient Licensing Board - own licensee (authorized to prescribe, administer, or dispense) Licensing Board - own licensee (authorized to prescribe, administer, or dispense) Law Enforcement – active investigation of drug offense Law Enforcement – active investigation of drug offense Subpoena, etc. – criminal investigation or prosecution Subpoena, etc. – criminal investigation or prosecution Individual – own information Individual – own information

11. Requests Received Aug 2012 Prescribers 52% Law Enforcement 0.6% Pharmacists 42% Source: Ohio Automated Rx Reporting System 2012 OH State Board of Pharmacy 11

12. 12 Medical treatment –Current patient –Prospective patient –appointment, referral, or Rx presented Not –Pre-employment screening –Searching for forged prescriptions –Updating chart records –“Investigating” drug loss Legal reason for prescriber or pharmacist to request OARRS Report 2012 OH State Board of Pharmacy

13. 13 Active drug offense investigationActive drug offense investigation –Forged prescriptions –Drug trafficking –Drug theft or other loss NotNot –Fishing for cases –Pre-employment screening –Checking up on suspicious individuals Legal reasons for law enforcement to request OARRS Report

14. 14 When should a prescriber or pharmacist get an OARRS Report? NEW OARRS rules “Shall” access OARRS scenarios “Should” access OARRS scenarios Any time the provider feels it is prudent 2012 OH State Board of Pharmacy

15. Certification every time a request is submitted by a prescriber I certify that I am requesting the prescription records of my patient for the purpose of providing medical treatment. √ 15

16. 2012 OH State Board of Pharmacy Certification every time a request is submitted by a pharmacist I certify that I am requesting the prescription records of my patient for the purpose of practicing pharmacy. √ 16

17. 2012 OH State Board of Pharmacy Certification every time a request is submitted by a law enforcement officer I certify that I am currently investigating drug charges in the case number listed above against the individual whose records I am requesting. √ 17

18. 2012 OH State Board of Pharmacy Certification every time a request is submitted by a probation officer I certify that I am currently investigating this individual’s compliance with drug-related terms and conditions imposed by the court. √ 18

19. 2012 OH State Board of Pharmacy 19

20. 20 Understanding the OARRS Report Be sure it is the correct patient and only one person. Review the patient list. Twins, spouses sometimes included Are some of the prescribers in the same group practice? Are the prescribers specialists? Where are the pharmacies located? 2012 OH State Board of Pharmacy

21. 21 OARRS Data from OARRS is NOT evidence! Verify Information.

22. Disclaimer on each Report “The State of Ohio does not warrant the above information to be accurate or complete. The Report is based on the search criteria entered and the data entered by the dispensing pharmacy. For more information about any prescription, please contact the dispensing pharmacy or the prescriber. 2012 OH State Board of Pharmacy 22

23. 23 OARRS Use the OARRS report as a tool. –Review any records available –Validate the information –Contact prescribers or pharmacies listed, if necessary –Ask questions of the patient. 2012 OH State Board of Pharmacy

24. 24 Look for history or patterns What a patient received over the last 6 months is more important than what they got last week. Most abusers did not start within the last 10 days. 2012 OH State Board of Pharmacy

25. 25 OARRS Errors?? Questions?? Call dispensing pharmacy to verify prescription info. Call prescriber to verify patient, therapy info. 2012 OH State Board of Pharmacy

26. 26 Other Factors to Consider Diagnosis Urine/Blood Drug screen results Compliance with treatment plan Other medical conditions Other drugs not in OARRS Other known prescribers for this patient 2012 OH State Board of Pharmacy

27. 27 OARRS Report Issue is ALWAYS Appropriate Medical Care. Quantity alone is never the issue. OARRS Report is only ONE factor in patient evaluation.

28. HB 93: Boards Must Adopt Rules re Use of OARRS Medical Board ORC 4731.055 and OAC 4731-11-11 Pharmacy Board ORC 4729.162 and OAC 4729-5-20 Nursing Board ORC 4723.487 and OAC 4723-9-12 Dental Board ORC 4715.302 and OAC 4715-6 Optometry Board –ORC 4725.092 2012 OH State Board of Pharmacy 28

29. Medical Board OARRS Rule summary Prescriber MUST query OARRS if –Patient is/will be on OARRS drug for 12 weeks or more. –Patient refuses drug screen or screen is inconsistent with treatment –Patient forged/altered a prescription –Patient steals or borrows drugs –Increases dose without prescriber direction 2012 OH State Board of Pharmacy 29

30. Medical Board OARRS Rule summary Prescriber MUST query OARRS if –Patient sells prescription drugs –Patient receives OARRS drugs from multiple prescribers, without authorization –Family/friend has expressed concern about patient’s drug use –Patient is arrested/convicted of drug related offense. 2012 OH State Board of Pharmacy 30

31. Medical Board OARRS Rule summary Prescriber should query OARRS if Patient has history of chemical dependency or illegal drug use Patient appears impaired at office visit Patient loses Rx or requests early refills Patient repeatedly visits ER/ED to obtain drugs Patient shares drugs with others 2012 OH State Board of Pharmacy 31

32. Pharmacy Board OARRS Rule summary Pharmacist MUST query OARRS if Patient is receiving OARRS drugs from multiple prescribers Patient is receiving OARRS drugs for more than 12 weeks Patient abuses OARRS drugs –Over-utilization –Early refills –Visible intoxication or sedation 2012 OH State Board of Pharmacy 32

33. Pharmacy Board OARRS Rule summary, cont. Pharmacist MUST query OARRS if Prescription is from unfamiliar prescriber Prescription or patient is from out-of-normal geographic region 2012 OH State Board of Pharmacy 33

34. Pharmacy Board OARRS Rule summary, cont. Initial OARRS report must cover 12 months time period. Frequency of subsequent reports – pharmacist’s professional judgment. Issue: Pharmacist must devise a recordkeeping system for OARRS queries. 2012 OH State Board of Pharmacy 34

35. Other Boards Rules are similar 2012 OH State Board of Pharmacy 35

36. QUESTIONS