Ph 2 paulozzi paone_kelly

Pharmacy Track Panel Discussion:

Trends in Prescribing Prac7ces

Presenters: Len Paulozzi, MD, MPH Denise Paone, EdD Tom Kelly, R.Ph., B.Sc

Moderator: Andrew Kolodny, MD

Disclosures

•  Len Paulozzi •  Denise Paone has no financial rela7onships with proprietary en77es that produce health care goods and services

•  Thomas Kelly has financial rela7onships with proprietary en77es that produce health care products and services. These financial rela7onships are: –  President/C.E.O. Medicine To Go Pharmacies

•  Retail pharmacies –  President/C.E.O./Partner, PPTP.net, LLC

•  Online due diligence tool for preven7on of misuse, abuse, and diversion

Learning Objec7ves

1.  Describe current trends in effec7ve prescribing habits.

2.  Outline best prac7ces for u7lizing data and PDMPs as effec7ve tools in dispensing controlled substances.

3.  Evaluate opportuni7es for pharmacists to collaborate with prescribers to create an effec7ve treatment plan for their pa7ents.

TM

Centers for Disease Control and Prevention National Center for Injury Prevention and Control

Trends in Prescribing of Controlled Substances, United States, 2007-‐2012

Len Paulozzi, MD, MPH

Centers for Disease Control and Preven7on

Na7onal Prescrip7on Drug Summit

Atlanta, GA April 22, 2014

5

Overview

Trends in mortality

Trends in prescribing of controlled substances Conclusions

Motor vehicle traffic, poisoning, and drug poisoning death rates, United States,

1980-‐-‐2010

0

5

10

15

20

25

1980 1985 1990 1995 2000 2005 2010

Deaths pe

r 100,000 po

pula?on

Motor vehicle traffic

Poisoning

Drug poisoning

CDC/NCHS Na7onal Vital Sta7s7cs System accessed through CDC WONDER.

Drug overdose deaths by major drug type, United States, 1999-‐2010

CDC/NCHS Na7onal Vital Sta7s7cs System, CDC WONDER

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Num

ber of Deaths

Year

Opioids Heroin Cocaine Benzodiazepines 16,651

8

Rates of opioid overdose deaths, sales and treatment admissions, U.S., 1999-‐2010

National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS

0

1

2

3

4

5

6

7

8

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Rate

Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000

9

Prescrip7on Data Source

  Purchase from IMS

•  Na7onal Prescrip7on Audit (NPA) 2007-‐2012 •  Data from 38,000/57,000 pharmacies

•  Includes retail, mail-‐order, and long-‐term care •  Na7onal-‐level counts for prescrip7ons and units (e.g., pills)

es7mated using a proprietary method

•  CDC converted to popula7on-‐based rates •  Non-‐Butrans buprenorphine excluded from opioid rates

10

Total prescrip7on rate, United States, 2007-‐2012

128,000

129,000

130,000

131,000

132,000

133,000

134,000

135,000

136,000

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Source: IMS Na7onal Prescrip7on Audit (NPA)® Extracted July, 2013

Increase from 13.1 to 13.5 prescrip7ons per person from 2007 to 2012.

11

Opioid analgesic prescrip7on and unit rates, United States, 2007-‐2012

7,500

8,000

8,500

9,000

9,500

10,000

0

100,000

200,000

300,000

400,000

500,000

600,000

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Units per 10,000

Unit rate Prescrip7on rate

1% drop from 2010

Source: IMS Na7onal Prescrip7on Audit (NPA)® Extracted July, 2013. Excludes buprenorphine other than BuTrans products. Units limited to solid dosage forms.

1% increase from 2010

12

Percent change in prescrip7on rates, all drugs versus opioid analgesics, U.S., 2007-‐2012

-‐1 -‐0.5

0 0.5 1

1.5 2

2.5 3

3.5

2008 2009 2010 2011 2012

Percen

t chan

ge

All rx Opioids


13

Hydrocodone and oxycodone prescrip7on rate, United States, 2007-‐2012

0 500

1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Hydrocodone Oxycodone

OxyCon7n® reformulated , September, 2010


14

Other major opioids prescrip7on rate, United States, 2007-‐2012

0

100

200

300

400

500

600

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Morphine Fentanyl Methadone Codeine Oxymorphone


15

Other major opioids prescrip7on rate, United States, 2007-‐2012

0

100

200

300

400

500

600

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Morphine Fentanyl Methadone Codeine Oxymorphone


Methadone increased sharply to 2008, when DEA compelled restricted use of the largest formula7on. Rate in 2012 same as rate in 2007.

16

Oxymorphone prescrip7on rate, United States, 2007-‐2012

0

10

20

30

40

50

60

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Source: IMS Vector One® Na7onal (VONA) Extracted July, 2013

Abuse-‐resistant extended-‐release formula7on (Opana ER) came on market February, 2012.

Rate dropped 19% from 2011 to 2012.

17

Opioid analgesic prescrip7on rate by payment, United States, 2007-‐2012

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

10,000

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Total Cash

Cash 17% of all opioid rx

Source: IMS Na7onal Prescrip7on Audit (NPA)® Extracted July, 2013 Excludes buprenorphine other than BuTrans products

Cash 9% of all opioid rx

18

Hydrocodone and oxycodone prescrip7on rate paid with cash, United States, 2007-‐2012

0 100 200 300 400 500 600 700 800 900

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Hydrocodone Oxycodone

48% drop from 20077

39% drop


19

Benzodiazepine prescrip7on and unit rates, United States, 2007-‐2012

200,000

205,000

210,000

215,000

220,000

225,000

230,000

235,000

240,000

2,500 2,700 2,900 3,100 3,300 3,500 3,700 3,900 4,100 4,300

2007 2008 2009 2010 2011 2012

Units per 10,000

Prescrip?on

s pe

r 10

,000

Prescrip7on rate Unit rate


20

Major benzodiazepine prescrip7on rate, United States, 2007-‐2012

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000

Alprazolam

Clonazepam

Lorazepam

Diazepam

Temazepam


21

Carisoprodol prescrip7on rate, United States, 2007-‐2012

290

300

310

320

330

340

350

360

370

2007 2008 2009 2010 2011 2012

Prescrip?on

s pe

r 10

,000


DEA places carisoprodol in Schedule IV, Jan 2012; 11% drop

Conclusions

 Drug overdose epidemic driven by overdoses of prescrip?on opioids, oPen combined with benzodiazepines and/or muscle relaxants  Opioid overdose rates parallel prescrip?on rates

 Steady increase in opioid prescribing rate since 1999 has finally leveled off  Abuse-‐resistant formula?on, scheduling change appear to be associated with largest declines in certain drugs

 Overall declines alone likely too small to reduce prescrip?on overdose mortality aPer 2010

Comments or questions: Len Paulozzi, MD, MPH

[email protected]

The findings and conclusions in this report are those of the author and do not necessarily represent the official posi6on of the Centers for Disease Control and Preven6on/the Agency for Toxic Substances and Disease Registry. The presenter has no conflicts of interest to report.

Acknowledgements: Jinnan Liu, PhD Karin Mack, PhD

Chris Jones, PharmD, MPH

Prescrip?on Monitoring Program (PMP) in New York City

Denise Paone, EdD Director of Research and Surveillance

Bureau of Alcohol and Drug Use Preven7on, Care, and Treatment

New York City Department of Health and Mental Hygiene

Disclosure Statement

Denise Paone has no financial rela7onships with proprietary en77es that produce health care goods and services

25

PMP: Background •  Historically , seen as a law enforcement tool:

–  To iden7fy pa7ents and prescribers engaged in possible aberrant behavior –  To iden7fy “doctor shoppers” –  To inves7gate drug diversion & fraud

•  NYC DOHMH using PMP as a public health surveillance tool: –  To iden7fy and describe palerns of opioid analgesic use at pa7ent and prescriber

levels

–  To iden7fy pa7ents at risk for fatal and non-‐fatal overdose –  To reduce prescrip7on drug misuse and diversion –  As a drug epidemic warning system

•  NYC DOHMH uses PMP as a pa7ent care tool: –  To iden7fy pa7ents with possible substance use disorders –  To avoid risky drug Interac7ons –  To iden7fy and reduce pa7ent visits to mul7ple prescribers

•  PMP not meant to infringe on the legi7mate prescribing of controlled substances

Source: http://www.pmpalliance.org/content/prescription-monitoring-frequently-asked-questions-faq

PMP: public health surveillance tool

•  Number of prescrip7ons, pa7ents, prescriber, pharmacies

•  Rate of opioid analgesic prescrip7ons filled overall and by drug type

•  Median day supply

•  Rate of pa7ents filling opioid analgesic prescrip7ons

•  Rate of high dose opioid analgesic prescrip7ons filled

PMP surveillance used to inform public health ini?a?ves

•  Opioid prescribing guidelines •  City Health Informa7on (CHI) – primary care

•  Emergency Department guidelines

•  Staten Island detailing campaign •  Focused on prescribers

•  Morphine milligram equivalent calculator

•  Media campaign •  Public Service Announcement on “prescrip7on painkiller use”

Analy?c methods •  Focus on schedule II prescrip7on opioid analgesics (excluding codeine-‐cII)

•  Exclude missing pa7ent or prescriber IDs, veterinarians, or ins7tu7onal licenses

•  Report rates per 1,000 residents and adjust to 2000 US Standard popula7on

Descrip?ve sta?s?cs

•  Demographic characteris7cs of pa7ent (gender, age, residence, payment)

•  Prescriber profession, specialty (if available), license loca7on

•  Pharmacy loca7on

Prescrip?on variables

•  Dura7on of ac7on –  Long-‐ac7ng or short-‐ac7ng

•  Day supply •  Morphine Equivalent Dose (MED)

–  Conversion of the daily dose of an opioid analgesic prescrip7on to its morphine milligram equivalent

– High MED, or high dose, prescrip7ons confer increased risks of overdose, specifically when MED ≥ 100.

USING PMP TO DESCRIBE PATTERNS OF OPIOID ANALGESIC PRESCRIPTION USE IN NEW YORK CITY

Opioid analgesic (OA) prescrip?ons NYC, 2008–2012

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2008 2009 2010 2011 2012

Num

ber o

f Pre

scrip

tions

Year Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008–2012

Opioid analgesic prescriptions

Oxycodone

Hydrocodone

Note: Schedule II opioid analgesics

From 2008–2012 there was a 17% increase in the number of pa?ents filling OA prescrip?ons

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

2008 2009 2010 2011 2012

Num

ber o

f pre

scrip

tions

Year

Patient

Prescriber

Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008-2012

15% of prescribers wrote 83% of opioid analgesic prescrip?ons

48%

2%

37%

15%

14%

49%

1%

34%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Prescribers Prescriptions Prescribing frequency

Very Frequent Prescribers 530-10,185 Rx/year

Frequent Prescribers 50-529 Rx/year

Occasional Prescribers 4-49 Rx/year

Rare Prescribers 1-3 Rx/year

Prescrip7ons filled by NYC residents, 2012

15%

83%

Perc

ent

Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012 35


In 2012, 10% of prescribers (n = 5,384) wrote 75% of prescrip?ons (n =1,623,157)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Perc

ent o

f pre

scrip

tions

Percent of prescribers


Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012

Two-‐thirds of pa?ents filled only one prescrip?on; one-‐third filled 78% of all opioid analgesic

prescrip?ons

63%

22%

14%

9%

5%

6%

8%

14%

10%

49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Patients Prescriptions Prescription Frequency

15 prescriptions 5 prescriptions 3 prescriptions 2 prescriptions 1 prescription

Prescrip7ons filled by NYC residents, 2012

Perc

ent

Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012 37

37%

78% Note: Schedule II opioid analgesics

Pa?ents visi?ng mul?ple prescriber and mul?ple pharmacies are rare

•  In 2012, 1.2% (9,137) of pa7ents visited 4+ prescribers and 4+ pharmacies

– Filled 7.9% (170,282) of all prescrip7ons – Visited 15,042 unique prescribers – Visited 2,913 unique pharmacies


Two-‐thirds of opioid analgesic prescrip?ons filled were paid with commercial Insurance

67%

14%

8%

6% 4%

1%

Commercial Insurance

Private Pay (Cash, Charge, Credit Card)

Medicare

Other

Medicaid

Workers Comp



Staten Islanders filled OA prescrip?ons at higher rates in 2012

0

50

100

150

200

250

300

350

400

450

500

NYC Bronx Brooklyn Manhattan Queens Staten Island

Age

-adj

uste

d ra

te o

f pre

scrip

tions

fille

d pe

r 1,

000

resi

dent

s

Borough of Residence

Opioid Analgesics Oxycodone Hydrocodone



Rates are adjusted to 2000 US Census population

OA prescrip?ons filled by Staten Islanders have longer median day supply

0

5

10

15

20

25

30


Med

ian

Supp

ly, D

ays

Borough of Residence Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2012

Note: Schedule II opioid analgesics Median day supply is calculated from day supply of each prescrip7on filled in the year.

OA prescrip?ons filled by Staten Islanders are more frequently high dose (>100 MED)

0

20

40

60

80

100

120

140

160


Age

-adj

uste

d ra

te o

f hig

h do

se p

resc

riptio

ns

fille

d pe

r 1,0

00 re

side

nts

Borough of Residence

2008 2009 2010 2011 2012


High dose is any opioid analgesic prescrip7on with a calculated morphine equivalent dose (MED) greater than 100. Among pa7ents receiving opioid prescrip7ons, overdose rates increase with increasing doses of prescribed opioids.

Source: New York State Department of Health, Bureau of Narcotic Enforcement, Prescription Drug Monitoring Program, 2008–2012

Rates are adjusted to 2000 US Census population

PMP PUBLIC HEALTH SURVEILLANCE AND DATA DRIVEN INITIATIVES

Neighborhoods with high rates of OA prescrip?ons have high rates of uninten?onal (overdose) deaths

involving opioid analgesics

*Paone D, Bradley O’Brien D, Shah S, Heller D. Opioid analgesics in New York City: misuse, morbidity and mortality update. Epi Data Brief. April 2011. Available at http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-data-brief.pdf .

OA PRESCRIPTION RATES OA MORTALITY RATES

Opioid prescribing guidelines •  Less oqen: avoid prescribing opioids for

chronic non-‐cancer, non-‐end-‐of-‐life pain   e.g., low back pain, arthri7s, headache,

fibromyalgia •  Shorter dura7on: when opioids are

warranted for acute pain, 3-‐day supply usually sufficient

•  Lower doses: if dosing reaches 100 Morphine Milligram Equivalents (MME) , reassess and reconsider other approaches to pain management

•  Avoid whenever possible prescribing opioids in pa7ents taking benzodiazepines Cita7on: Paone D, Dowell D, Heller D. Preven7ng misuse of prescrip7on opioid drugs. City Health Informa7on. 2011; 30(4): 23-‐30

New York City Opioid Treatment Guidelines, Clinical Advisors: Nancy Chang, MD; Marc N. Gourevitch, MD, MPH; Mark P. Jarrel, MD, MBA; Andrew Kolodny, MD; Lewis Nelson, MD; Russell K. Portenoy, MD; Jack Resnick, MD; Stephen Ross, MD; Joanna L. Starrels, MD, MS; David L. Stevens, MD; Anne Marie S7lwell, MD; Theodore Strange; MD, FACP; Homer Venters, MD, MS

45

New York City Emergency Department Discharge Opioid Prescribing Guidelines Clinical Advisory Group: Jason Chu, MD, Brenna Farmer, MD, Beth Y. Ginsburg, MD, Stephanie H. Hernandez, MD, James F. Kenny, MD, MBA, FACEP, Nima Majlesi, DO, Ruben Olmedo, MD, Dean Olsen, DO, James G. Ryan, MD, Bonnie Simmons, DO, Mark Su, MD, Michael Touger, MD, Sage W. Wiener, MD.

Emergency Department guidelines

Released January, 2013

Adopted by 35 NYC emergency departments

46

Staten Island public health “detailing” campaign

•  1-‐on-‐1 “detailing” visits from Health Department representa7ves

•  Deliver key prescribing recommenda7ons, clinical tools, pa7ent educa7on materials

•  ~1,000 Staten Island physicians, nurse prac77oners, physicians assistants

•  June–August 2013 •  PMP data analyzed to evaluate

prescribing palerns pre-‐ and post-‐campaign

47

Morphine Milligram Equivalent (MME) calculator

•  A tool to calculate total MME per day

•  Gives alert for dosages >100 MME •  Quick and easy to use •  Web-‐based applica7on

–  Search for “NYC MME Calculator” hlp://www.nyc.gov/html/doh/html/mental/MME.html

•  Smartphone app

49

Media campaigns •  Campaign One:

–  Goal: Increase awareness of risk of opioid analgesic overdose –  Ran twice (2012, 2013)

•  Campaign Two: –  Goal: Reduce s7gma and raise awareness of opioid analgesic

misuse –  2 tes7monials

•  Mom lost son to opioid analgesic overdose •  NYC resident in recovery

–  Ran 2013 and 2014

51

Summary •  PMPs can be used as a public health surveillance tool to understand palerns of opioid analgesic prescrip7on use

•  New Yorkers filled ~2 million opioid analgesic prescrip7ons per year from 2008-‐2012

•  From 2008-‐2012 Staten Island residents filled high dose prescrip7ons (>100 MED) at highest rates

•  High rates of opioid analgesic prescrip7on use mirror high rates of opioid analgesic overdose mortality

Improving Outcomes while Deterring Misuse, Abuse, &

Diversion Tom Kelly, R.Ph., B.Sc.

C.E.O./Partner:

Medicine To Go Pharmacies, PPTP.net

Disclosures

•  Thomas Kelly has financial rela7onships with proprietary en77es that produce health care products and services. These financial rela7onships are:

•  President/C.E.O. Medicine To Go Pharmacies – Retail pharmacies

•  President/C.E.O./Partner, PPTP.net, LLC – Online due diligence tool for preven7on of misuse, abuse, and diversion

Learning Objec7ves

1.  PMP's and PDMP's are valuable clinical tool promo7ng improved outcomes.

2.  There is a difference between healthcare and enforcement.

How Did We Get Here?

•  1980 prehistoric •  1996 Oxycon7n launched “less poten7al for addic7on and

abuse”, chronic pain pa7ents undertreated. •  Non profits funded by opiate pharma manuf. (Am. Pain

Founda7on) •  8/31/2000 FDA approves NDA for Roxicodone 15mg & 30mg •  Current Trends:

–  6/3/2011 Fla: HR 7095 an7-‐pill mill legisla7on signed by Gov. Rick Scol

–  DEA suspends permits for 2 CVS and 6 Walgreens pharmacies and some independent pharmacies in Fla.

–  DEA suspends permits: 3 Cardinal Health distribu7on centers, Walgreen’s, Juniper, Fl., AmerisourceBergen, Orlando, Fl., Harvard Drug Group, Livonia, Mi.

–  McKesson pays $13 million in fines for: Fl., Tx., Md., Ut., Co., Ca.

The Strange Down Stream Trends

•  Viola7ons everywhere, wholesale distributors: “But how much can we sell?”

•  Blind speed limits •  Contrac7on in opioid analgesic distribu7on •  Some pa7ents struggle to get medica7ons, really?

–  4.8% of worlds popula7on consumes 80% opioid analgesics but significant hitches in supply stream

•  Wholesalers using numbers, not encouraging or establishing the use of sound clinical guidelines –  Place pharmacist on review team

Unfortunate Reali7es •  Growing popula7ons trends for chronic pain pa7ents

–  Advanced trauma care leading to more survivors (fortunate reality) –  Diabetes explosion CDC 1980-‐2011 2.5 to 6.9% -‐ genera7ng more neuropathies? –  Arthri7s rates increasing –  Obesity increasing

•  As they say in enforcement: “Follow the money” –  2008 recession compounds problem, economic relief in black market

•  60% of diverted medica7ons sourced from friends and family, Get Rx for 120, use 40 divert 80. Difficult to detect.

–  Is black market larger than legal market? •  #120 oxycodone 15mg @ $60 legal via insurance, black market at $1/mg @$1,800

–  Heroin cheap, easy to turn •  Prescrip7on opioid analgesics & heroin more valuable than cash

•  We cannot enforce our way out •  What are liabili7es for not performing due diligence? •  Fewer Fellowships offered in pain management, family prac7oners

and GP’s are prescribing –  Only a couple of extra pain pa7ents per prescriber add up

•  Not my pa7ents

Its busy, What Can I Do? (opportuni7es) •  Promote and u7lize PMPs as a tool to achieve posi7ve outcomes

(healthcare term, not enforcement, & not an excuse to dispense!)

•  Establish PMP review in workflow, promote states to allow registered technicians and nurses to access data bases

•  Reduce liability with due diligence

•  Verify pa7ent iden7ty at drop off: government issued, commercial services •  Collaborate, let prescribers know around the clock IR meds for pain control

not illegal but frowned upon, decrease # doses on the street, use sound clinical judgment

•  Collaborate, perform random medica7on counts for pa7ents exhibi7ng adherent behavior for your prescribers

•  Review, review, review clinical risks with pa7ents, par7cularly those who are opiate naive

•  Counsel all regarding secure storage, i.e. dental rxs, loaded gun in medicine cabinet analogy

•  Ins7tute a treatment agreements, aka narco7c contract

But What Can I Do? Con7nued… (more opportuni7es)

•  Market topically compounded analgesics-‐ far lower poten7al for abuse •  Partner with adver7zing vendors to include medica7on guide specific for

commonly abused medica7on, i.e. LDM Group, CarePoints (slide) •  Increase sensi7za7on: Use social media & poster up, “Who Knew Grandma

Kept a Stash”, Partnership for a Drug Free New Jersey, DEA’s Na7onal Prescrip7on Drug Take Back Day, etc. (slide)

•  Partner with teaching ins7tu7ons. Sponsor substance abuse CE + CME’s for health care providers, including pediatricians, den7sts, and oral surgeons (slide)

•  Get involved, collaborate, join work groups, encourage community based ac7on, no one group can defeat this scourge alone (slide) –  Form local coali7ons, churches, schools, enforcement, civic groups,

etc. •  Sponsor a local drop off box for unused medica7ons

–  www.americanmedicinechest.com/_media/permcollec7on1.pdf

Provide Naloxone Rescue Kits (opportunity)

•  A lille work results in most significant outcomes alainable

•  Develop collabora7ve prac7ce agreements

•  Trails already blazed, follow the footsteps – hlp://stopoverdose.org/index.htm – hlp://harmreduc7on.org/

– hlp://prescribetoprevent.org/about-‐us/

Educa7on Opportuni7es: Pharmacy Student and Technician Training

•  Establish and teach clinical guidelines for counseling pa7ents to avoid issues associated with controlled medica7ons.

•  Encourage training in detec7ng evidence of misuse, substance abuse, addic7on, pseudo addic7on, and diversion in pa7ent popula7ons.

•  Amplify the value of PMPs as a clinical tool. •  If a palern of abuse is detected, provide outline on how to assist the pa7ent and associated healthcare providers move forward toward posi7ve outcomes. i.e. addic7on services, mental health services, etc.

•  Provide protocols on when and how to engage enforcement.

Big Ideas-‐ Opportuni7es to do beler?

•  Develop systems for ease of use for busy prac7ces, pharmacies and prescribers alike. Current models D+ –  Allow nurses and pharmacy technicians access?

•  Reward health care professionals for accessing PMPs. –  Direct compensa7on, rebate professional license fees, tax credits?

•  Establish and encourage realis7c reimbursements to pharmacies for Medica7on Therapy Management (MTM) reviews for chronic pain pa7ents.

•  Develop Accountable Care Organiza7on (ACO) models for how dispensing pharmacies can partner with ACOs & manage chronic pain pa7ents to improve outcomes and subsequently reduce costs.

DEA Na?onal Drug Take Back Day

Who Knew Grandma Kept a Stash! Partnership for a Drug Free New Jersey

A local church adver?zed on OUR prescrip?on bags!

Thank you! Tom Kelly, R.Ph., B.Sc. PPTP.net/Medicine To Go Pharmacies PO Box 2253 Long Beach Branch Beach Haven, NJ 08008 1-‐609-‐242-‐1400 voice [email protected] email www.PPTP.net website

Ph 2 paulozzi paone_kelly

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