Oklahoma PMP
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Transcript of Oklahoma PMP
Oklahoma PMP
Prescription Drug Abuse
The term “doctor shopping” has
traditionally referred to a patient obtaining controlled substances from multiple health care practitioners without the prescribers’ knowledge of the other prescriptions.
Definition
Almost all states have a “general” fraud
statute that adopts verbatim or with slight alteration the provision in the Uniform Narcotic Drug Act of 1932 or the Uniform Controlled Substances Act of 1970. These statutes prohibit obtaining drugs, including through “doctor shopping,” by any or all of the following means: fraud, deceit, misrepresentation, subterfuge, or concealment of material fact.
National Restrictions
Applicable Laws
Category Legal CitationPhysical Examination/ Patient Physician Relationship
Okla. Stat. tit. 59, § 509Okla. Admin. Code § 535:15-3-13
Tamper-Resistant Forms Okla. Admin. Code § 317:30-5-70.2
Prescription Limits Okla. Admin. Code § 317:30-5-77.1
ID Requirement Okla. Admin. Code § 475:30-1-15
Okla. Stat. tit. 63, § 2-309C
Okla. Stat. tit. 63, § 2-309B
Doctors say they often rely on their own instant
judgments in the office and have little reliable means of double-checking the patients' information
It puts doctors in the uncomfortable position of playing private eye.
Unfortunately, with the widespread misuse of controlled substances and diversion risks, we're often taken advantage of
Doctor shoppers often visit facilities where medical professionals don't know them
How PMP’s Can Help
Patients who have pain but cannot not find a
doctor who will adequately treat it Patients who are addicted Patients who divert prescription drugs for
profit and/or to feed their addiction
Types of Doctor Shoppers
It's a relatively insignificant source of diverted prescription drugs, as compared with theft from drug stores, warehouses, acquisition over the Internet, theft from people's homes
What Every Pharmacists Should Know
Stolen Script Pads Reproduced Script Pads Early Fills Cash Fills vs. Insurance Pill Mills Script Mills Scripts Called In
Fraud and Forgery
Period 5/
56/6
7/7
8/8 9/9
10/10
15/15
Notes
Q1 2010 524
224
98 46 25 17 2 Online system in place 3 ½ years by this point. Data collected every 30 days
Q2 2010 658
272
140
77 44 24 3
Q3 2010 811
344
141
75 46 27 2
Q4 2010 656
280
128
60 32 20 1 Daily Reporting Begins
Q1 2011 630
246
117
59 32 13 1
Q2 2011 596
258
112
58 30 18 4
Q3 2011 649
232
101
40 21 9 0
Q4 2011 475
162
79 40 14 5 0 Voluntary Real-Time Reporting Begins
Q1 2012 478
168
72 33 17 10 0 Real-Time Reporting Required
Q2 2012 424
147
49 21 9 3 0 Four Online Alerts Broadcast on Specific Patients (Unsolicited Reports Pending)
Oklahoma Shoppers
In general, the number of doctor shoppers represent
a very small number of total patients A study in West Virginia found that doctor shoppers
are at a much higher risk of death from overdose and abuse
Doctor shoppers divert care from legitimate patients especially in emergency rooms
In Oklahoma, a single doctor shopper visited 108 doctors and 93 pharmacies in less than a year
Prescribing more doses than needed increases opportunity
Impact
A statewide electronic database that gathers
information from dispensers of controlled substances Pharmacies Doctors Veterinarians
A tool used to guard against the diversion of controlled drugs
A diagnostic tool used by practitioners to evaluate patients
A research tool to identify trends and help identify solutions
PMP’s and What They Do
Controlled Drugs in Oklahoma
Pain Killers58%Sedatives
13%
Stimulants10%
Tranquilizers19%
2011 Prescriptions by Therapeutic Class
Trends
Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Oxycodone
NaN 264551
282545
304928
300396
342269
472881
512376
578256
619458
673645
719294
762572
250,000
350,000
450,000
550,000
650,000
750,000
Oxycodone Prescription Totals (Tabs and Capsules Only)
# o
f Scri
pts
#1 Hydrocodone
1H 08 2H 08 1H 09 2H 09 1H 10 2H 10 1H 11 2h 11 1h 12 2h 12 1h 13 2h 13
Total
61319853
66266746
74173925
78701892
75586470
81456696
88388437
93797045
96141811
93185651
96003738
97361650
62,500,000
67,500,000
72,500,000
77,500,000
82,500,000
87,500,000
92,500,000
97,500,000
Hydrocodone (2008 - 2013)
Tota
ls
According to the National Institutes of Health, approximately 30 percent of all
Americans complain of sleep disruption, while 10 percent display symptoms congruent with chronic insomnia. One of the most common treatments for insomnia is prescription sleep medications that help people fall asleep and remain asleep. Historically barbiturates were initially popular for treating insomnia, but their long "hangover" effect made them easily replaced with the introduction of the benzodiazepines. Triazolam (Halcion), diazepam (Valium), and oxazepam (Serax) rapidly became the treatment of choice for insomnia. Recently a new class of nonbenzodiazepines---the "z-sedatives"--has overtaken the older benzodiazepines as the most commonly prescribed sleep medications. The three most popular z-drugs are zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). The Food and Drug Administration (FDA) also recently approved the production of zolpidem tartrate, a generic form of Ambien. Many dentists prescribe these medications for patients who have difficulty sleeping the night prior to an appointment or as a procedural sedative. With 43 million prescriptions for sleep medications filled in 2005, generating $2.7 billion for pharmaceutical companies, it is important that dentists be aware of these drugs' mechanism of action and potential drug interactions.
http://www.ncbi.nlm.nih.gov/pubmed/18069595
The Rise of z-Sedatives
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993866/
Some combinations of drugs can be dangerous
and even deadly. Mixing benzodiazepines and opiates can be extremely dangerous. Both benzos and opiates are central nervous system depressants. When taking both a benzodiazepine, such as lorazepam, and an opiate like morphine, the drugs can lead to excessive depression of the nervous system, causing respiratory depression and ultimately death.
http://www.desmoinesaddictiontreatment.com/rehab-guide/dangers-of-using-benzodiazepines-with-opiates/
Opiates and Benzos
According to the evidence, there is a positive
association between the risk of death and the use of benzodiazepines in combination with methadone. Though limited, there is an indication that opioids, including buprenorphine, have the potential for increased risk in combination with benzodiazepines. Clinical mechanisms are hypothesized.
- See more at: http://www.thementalelf.net/mental-health-conditions/anxiety-disorders/is-it-safe-to-prescribe-benzodiazepines-and-opioids-together/#sthash.L92Va1MB.dpuf
Opiate/Benzo Research
“UserX had this happen to him when he never did benzos
(oxy+diazapam). the high was no where near as good as pure OC. now he cant do opiates without wanting benzos, its like the high is incomplete. but now hes a benzo addict...”
“My doctor has me on 8 MG of Xanax daily. (QID) 2 MG. Xanax bars) then for my spinal infection Percocet 10/325 6 times a day. Im also on Zoloft 200 MG's a day... im only 27 years old and i feel like i am 50 years old. Im going to ask to be switched to Valium again because of the rebound anxiety i get with Alprazolam.. i also live in the state of CALIFORNIA i possess my Prop 215 Card for Medicinal Cannabis(i feel Cannabis is the best medicine for anxiety and severe pain HANDS DOWN!!!! im allowed to exceed the limit on my card. i can possess 6 pounds of buds, and grow up to 90 plants. I love California”
Real Conversations from Drug Seekers
DrX
8th in Schedule II Prescribing 1st in Scehdule III Prescribing 1st in Scheudle IV Prescribing At one point was writing nearly 3% of all opiates
dispensed in Oklahoma 10+ Overdose Deaths Multiple Counts of Murder Previous felony convictions involving controlled
drugs Motivation?
When Overprescribing Becomes Criminal
More than 100mg of morphine equivalent per
day increases the risk of death by overdose by 9 times.
Direct correlation between mortality and morphine equivalent
Opiate Naïve Patients
Morphine Equivalent
Nationally Recognized as the Leaders in
Innovation and Leadership Among State PMP’s Real Time Reporting by Dispensers (Within 5 Minutes)
Practitioner Use up 167% Pharmacy Use up 1,085% Law Enforcement/Regulatory Use up 60%
For the 1st Time in the Last Two Years Accidental Overdose Deaths have Declined
Full Time PMP Trainer Hired De-Identified PMP Data Being Provided to ODMHS Nov.
1, 2013
Making a Difference
Question and Listen Challenge and Communicate Risk Experimentation Reflect Consider Dynamics Inside and Outside the
Organization Be Authentic Be Outcome Driven Dare to Imagine
Leadership and Innovation
Interstate Data Sharing (November 1, 2014) Access by Federal Medical Professionals
without being Registrants Enumerated Delegate Accounts Mandatory PMP Queries
New Processes Recommended prescribing guidelines Prescriber dispensing education
New Laws
We cannot solve a
problem by using the same kind of thinking we
used when we created them. [A. Einstein]
Vision