State PDMP administrators, pharmacies, federal partners, and subject matter experts came together this week at the annual conference of the National Association for State Controlled Substance Administrators (NASCSA) in Richmond, Virginia. Members of the Appriss Health team joined partner members for this exchange of ideas and strategies to address the misuse and abuse of controlled substances. Here’s what we learned, in no particular order:
1. Technology is enabling patients to become their own CEOs.
Healthcare tech entrepreneur Robin Farmanfarmaian highlighted cutting edge products and services that are quickly providing innovative health care solutions. The $3 trillion healthcare industry is already integrating many of these advanced technologies, such as sensors, point-of-care diagnostics, 3D printing, tissue engineering, artificial intelligence, virtual reality, and robotics. In a pilot program in Ontario, Canada conducted earlier this year, drones were used to deliver defibrillators to patients suffering from heart attacks, and in April a kidney was delivered by drone to a Maryland woman who had waited eight years for a lifesaving transplant. Farmanfarmaian encouraged attendees to do a deeper dive on these advancements and by ready to play a role in the “patient as CEO” dynamic on the horizon.
2. Compliance and data accuracy are a continuing challenge.
Representatives from several chain retail pharmacies discussed the struggles of ensuring data submitters are getting accurate and timely data to the PDMP. Pharmacists are primarily focused on the patient, so uploading data to the PDMP may not always be top of mind. “We make sure that we’re offering support and education, and identifying trends to help improve accuracy,” says Tomson George, Senior Manager of Professional Affairs with Walgreens.
Compliance with state mandates is another challenge for pharmacies. When legislation passes that requires a complex change in reporting, pharmacies often are given a very brief window of time to respond and comply. More time and outreach from the state PDMP would make a big difference, they said.
Data error correction remains one of the highest priorities for state PDMPs. It is very time-consuming for state PDMP administrators to manage error correction, even when a handful of pharmacies are non-compliant. Fortunately, panelists representing several state PDMPs noted that submitters are more invested than ever in supporting data accuracy. When, in the past, administrators had to send stern messages alerting dispensers and employ other means to ensure compliance, the vast majority now appreciate seeing their own audit reports and confirming that they are compliant.
3. While marijuana can help alleviate a patient’s pain, it does present some patient risk as well.
To date, 33 states and the District of Columbia have made marijuana legal for medical use, and 11 states and the District of Columbia allow recreational use. Jacquelyn Bainbridge, a professor of clinical pharmacy at the University of Colorado, stresses that cannabis can still be addictive and have permanent effects on the brain, particularly for adolescents. Patients suffering from acute or chronic pain may see marijuana as a safer alternative to opioids, but it’s important to remember that cannabis is not curative — it can only alleviate symptoms. The FDA has had to step into an enforcement role against makers of cannabis products making curative medical claims, but in actuality present health risks.
After legalization for recreational use in Colorado in 2012, emergency visits linked to marijuana tripled over the next five years at University of Colorado Hospital. Risk of hospitalization for symptoms linked to the consumption of edibles is also significant.
4. The modern drug trade is much more devastating than anything in the past.
In a federal partners panel, Kemp Chester, assistant director of the White House Office of National Drug Control Policy, discussed the illicit drug market’s move from the street to the dark web. Traffickers are paying with cryptocurrency, so there’s no face-to-face transaction. The office has is working to help domestic and foreign businesses better protect themselves and their supply chains from inadvertent fentanyl trafficking and foster public-private collaboration to curb the production and sale of fentanyl and other synthetic opioids.
He noted that PDMPs remain a key part of the federal response to the opioid epidemic. “We know that PDMPs work. We know they play an integral part in reducing overprescribing, doctor shopping, and substance use disorder,” says Chester. “We want to increase PDMP usage across the country. We want integration into the provider workflow and connectivity first with adjacent sates, and then a system of connected states.”
5. Don’t fear an audit.
Like virtually all public agencies, many PDMPs will be subject to state audit at some point. A panel of PDMP administrators discussed the process and lessons learned. While no one looks forward to the arduous process, an audit almost always results in positive outcomes.
Michelle Ricco-Jonas, program manager for the New Hampshire Prescription Drug Monitoring Program, noted that many states will model the audit process for PDMPs after other states. These documents are available to the public; she recommends looking at completed audits for guidance on what to expect.
“As time-consuming as it was, I looked at it as a positive. I was frank and honest with the state auditors about the deficiencies they uncovered. We worked with pharmacies and others to mitigate the issues and improve the accuracy of our data. It helped demonstrate that we needed more resources. I used it to my program’s advantage.”
All of the panelists were able to advocate for and receive funding to hire additional staff and enhance the reporting features of their PDMPs.
We thank NASCSA for this excellent learning and networking opportunity.
Photo caption: A panel discussion on prescription drug monitoring program compliance and reporting included (left to right) Christie Frick, director the South Carolina PMP; Katrina Howard, PMP pharmacist consultant with the Minnesota PMP; Darla Zarley, grant and project analyst with the Nevada Board of Pharmacy; and Kevin Borcher, program director of the Nebraska PMP.