Fma presentation

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Recent Trends in Pain Clinic and Community Pharmacy Activity Presented by Dr. Jacinta Gau, Ph.D. Research Assistance by Erika Brooke, M.S. University of Central Florida 1

Transcript of Fma presentation

Recent Trends in Pain Clinic and Community Pharmacy ActivityPresented by Dr. Jacinta Gau, Ph.D.

Research Assistance by Erika Brooke, M.S.

University of Central Florida 1

Background of the Study

• UCF researchers received federal funding to study HB 7095 (“pill mill law”) from multiple perspectives

• Cannot fully isolate from PDMP and the 2010 pain clinic law, as well as ramped-up law enforcement efforts

• These laws imposed new restrictions on persons who prescribe or dispense controlled substances for the treatment of chronic, non-malignant pain, and on pain clinics and pharmacies

• This presentation will focus on facilities

• The following data are from the Florida Department of Health

• Analyses and interpretations are those of the UCF researchers, not DOH

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Part I: Registration and New Establishments

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New PMC Applications Received (Monthly Mean)

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New PMC Applications Received (Annual Counts)

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*2013 data as of May 10

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New PMCs (Monthly Mean)

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New PMCs (Annual Counts)

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Summary of PMC Application and New PMC Trend

• High in 2010, likely an artifact of FS 458.3265

• Continual reduction thereafter suggests genuine downward trend in new applications and new clinics

• Monthly mean new apps. down 74% in 2013 compared to 2011

• Consistent with hypothesis that HB 7095 had an impact

• Deterrence?

• Consistent with other data and reports

• Medical examiner reporting reduction in Rx pill related deaths

• News reports of a reduction in the number of clinics

• Law enforcement claims that Rx pills are becoming harder to get and more expensive

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New CPharm Applications Received (Monthly Mean)

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New CPharm Applications Received (Annual Counts)

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New CPharm Permits Issued (Monthly Mean)

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New CPharm Permits Issued (Annual Counts)

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Summary of CPharm New Applications and Permits• Apparent slight downward trend since 2010

• Suggests no systematic efforts to circumvent the dispensing ban through collusion

• No new market

• However, viewed in light of anecdotes about restrictive dispensing practices at large pharmacies and small supplies that run out, need to monitor legitimate pain patients’ access

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PMC Administrative Closures(Monthly Mean)

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PMC Administrative Closures (Annual Counts)

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*2010 data incomplete; 2013 as of May 1015

Summary of Administrative Closures• Clear downward trend in self-closures since 2011

• Consistent with hypothesis that HB 7095 had an impact, even if indirect

• Reduction in new applications and permits

• Fewer in operation overall meant a more stable customer base

• Future question: were they closing for non-voluntary reasons instead? In particular, law enforcement investigations?

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Part II: Enforcement

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PMC Complaints Received and Disciplinary Actions(Monthly Mean)

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Compl.

Disc.

Em. Axn

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PMC Complaints Received and Disciplinary Actions(Annual Counts)

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CPharm Complaints Received and Disciplinary Actions(Monthly Mean)

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CPharm Complaints Received and Disciplinary Actions(Annual Counts)

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Summary of Complaints and Discipline• Noticeable decline in complaints about PMCs– monthly mean

down 66% in 2013 relative to 2010

• Sharpest annual drop is from 2011 (7.42; n = 89) to 2012 (3.08; n = 37)– HB 7095 took effect July 1, 2011

• Required reception and waiting areas, restrooms

• Enhanced ability for clinics to be declared nuisances

• Deterrence

• Closures of problematic locations

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Summary of Complaints and Discipline• No similar trend in complaints about community pharmacies

• Suggests that this the PMC decline is not simply part of a general decline in complaints– the PMC decline was unique

• Suggestive of legislation taking effect and having an impact

• But there are a lot of complaints about pharmacies

• Perhaps worth a legislative investigation

• Hard to interpret DOH disciplinary action patterns

• Missing variable: referrals to law enforcement

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