Prescription Drug M isuse and The North Carolina Controlled - - PowerPoint PPT Presentation

Joint Legislative Health Care Oversight Committee September 7, 2010

William Bronson, Drug Control Unit Division of Mental Health, Developmental Disabilities & Substance Abuse Services

Prescription Drug M isuse and The North Carolina Controlled Substances Reporting System

Epidemics of unintentional drug overdose deaths in the U.S., 1970-2006*

1 2 3 4 5 6 7 8 9 10

'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06

Year Crude rate per 100,000

Heroin Crack cocaine Prescription drugs

* 2006 rate is estimated. Len Paulozzi, M D, M PH National Center for Injury Prevention and Control Centers for Disease Control and Prevention

Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2008

2008 NSDUH Survey

Past M onth Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2008

2008 NSDUH Survey

Unintentional drug overdose death rates and total sales of opioid analgesics in morphine equivalents by year in the U.S.

1 2 3 4 5 6 7 8 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 100 200 300 400 500 600 700 800 Deaths/100,000 Opioid sales (mg/person)

Len Paulozzi, M D, M PH Centers for Disease Control and Prevention

Deaths vs M isuse

1 2 3 4 5 6 7 8 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 100 200 300 400 500 600 700 800 Deaths/100,000 Opioid sales (mg/person)

Unintentional Deaths in NC Due to Controlled Substances 2003-2009

2010 Data Extrapolated. J anuary – J une Deaths = 422

466 589 650 708 636 798 826 844 100 200 300 400 500 600 700 800 900 2003 2005 2007 2009 DEATHS

Source: NC State M edical Examiner’s Office

NC Admissions To Substance Abuse Treatment by % of Total

TEDS DATA

1 2 3 4 5 6 7 8 9 10 2000 2002 2004 2006 2008 Other Opiates Stimulants Tranquilizers Sedatives

Controlled Substances Reporting System NCGS 90-113.70-76

• Passed in August 2005
• Reporting began July 2007
• Required all dispensers to report to a

centralized data base

• Reporting first year was 1x per month
• Required reporting on the 15th and 30th per

month (August 1, 2008)

• Weekly reporting began 01/ 02/ 10

CSRS - Who has Access?

State Shall Release Data to:

• Persons authorized to prescribe or dispense

for the purposes of providing medical care for THEIR patients

• A person requesting their own data
• The 21 Special Agents of the SBI pursuant to a

bona fide investigation

• Licensing Boards with jurisdiction over health

care professionals- pursuant to an ongoing investigation

CSRS - Who has Access? (con’t)

• Primary M onitoring Authorities from other

states pursuant to an ongoing investigation

• Division of M edical Assistance
• DHHS must report “ Unusual Patterns of

Prescribing” to the Attorney General – criteria set by a multidisciplinary advisory committee

• Anonymous data for research and statistics
• M edical Examiners (effective 8/ 9/ 09)
• Practitioners may share & document (8/ 9/ 09)

CSRS Data Overview

• Over 53,500,000 prescriptions in the database

(started July 1, 2007)

• Approx. 17 million per year
• Over 1,000,000 queries have been made of

the system

• Over 7400 dispensers and practitioners

currently registered to use the system

• Averaging 2200 queries per day

CSRS Data J uly-December 2009

• 459,214 Individuals Received Prescriptions for

Schedule II Drugs

• 146,627,299 Doses (15.31 for each person in NC)
• 1,306,915 Persons received RX for 255,359,099

Doses of Schedule II and Schedule III drugs

• 2,488,186 persons received RX for 375,628,876

doses of Schedule II,III, and IV Drugs (39 doses for each person in NC - 27% population received at least 1 script)

Trends Schedule II

5 10 15 20 25 30 35 40 1 s t 2 8 2 n d 2 8 1 s t 2 9 2 n d 2 9 1 s t 2 1 N um ber of Patients

Sch II => 10&10 Sch II => 15&15 Linear (Sch II => 10&10)

Patients with M ultiple Prescribers and Dispensers Source: NC CSRS

Trends Schedule II & III

20 40 60 80 100 120 140 160 180 1st 2008 2nd 2008 1st 2009 2nd 2009 1st 2010 Num ber of Patients

Sch II & III =>10 & 10 Sch II & III => 15 & 15

Patients with M ultiple Prescribers and Dispensers Source: NC CSRS

Trends Schedule II, III & IV

50 100 150 200 250 1st 2008 2nd 2008 1st 2009 2nd 2009 1st 2010 N um ber of P atients

Sch II, III & IV => 10 &10 Sch II, III & IV => 15 &15

Patients with M ultiple Prescribers and Dispensers Source: NC CSRS

RECOM M ENDATIONS

1. Allow Law Enforcement Drug Investigation Units to Receive Information from the CSRS (But no Direct Access)

• Special Software Available
• M ust be pursuant to an Investigation
• Attorney General Notification Required
• SBI Diversion Unit Notification Required
• Specialized Training Required

Recommendations (con’t)

2. Require and Record Photo ID from Person picking up prescription 3. Require Physician Dispensed M edication to be Reported into CSRS.

• Exclude Hospital ED
• Exclude Veterinarians

Recommendations (con’t)

4. Allow Delegated Accounts (Dr. or Pharmacist M ay designate someone in

• ffice to do CSRS look-up)
• M ust be licensed personnel or Certified

Pharmacy Tech

• Prescriber or Pharmacist continues to have

responsibility and liability

Recommendations (con’t)

5. Change penalty for improper use of the system to a crime. M ajor Breach – Felony. M inor infraction – M isdemeanor 6. Adopt Interstate Compact to allow interstate sharing of information (to be released late 2010)

Recommendations (con’t)

7. Explicitly Permit “Unsolicited Reporting” by DHHS to Prescribers and/ or Dispensers

• Permit it but do not mandate
• Allow it to be a report or an alert notification
• Allow it up to the extent that resources are

available

• Hold the state immune for reporting or not

reporting in good faith

8. Consider Closer Regulation of Pain Clinics