Presentation Transcript

1. An Update on KASPER Post House Bill 1 David R. Hopkins KASPER Program Manager Office of Inspector General Kentucky Cabinet for Health and Family Services Kentucky Society of Oral & Maxillofacial Surgeons March 9, 2013
2. Disclosure David R. Hopkins No relevant financial relationships. No conflicts of interest. Cabinet for Health and Family Services
3. Contents Controlled Substance Abuse and Pill Mills Provider Shopping An Update on the KASPER Program Controlled Substance Prescribing in Kentucky (HB1) Controlled Substance Trends in Kentucky Cabinet for Health and Family Services
4. KASPER KASPER is Kentucky’s Prescription Monitoring Program (PMP). KASPER tracks Schedule II – V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers. Enhanced KASPER (eKASPER) is the real-time web accessed database that provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances. Cabinet for Health and Family Services

5. Problems with Controlled Substances

6. Misuse, Abuse, Diversion Misuse: When a schedule II – V substance is taken by an individual for a non-medical reason. Abuse: When an individual repeatedly takes a schedule II – V substance for a non-medical reason. Diversion: When a schedule II – V substance is acquired and/or taken by an individual for whom the medication was not prescribed. Cabinet for Health and Family Services
7. A National Perspective From 1992 to 2003 the 15.1 million Americans abusing controlled prescription drugs exceeded the combined number abusing: Cocaine (5.9 million), Hallucinogens (4.0 million), Inhalants (2.1 million), and Heroin (.3 million). Source: Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S. Published by The National Center on Addiction and Substance Abuse at Columbia University (CASA), July 2005. Cabinet for Health and Family Services
8. A National Perspective Opioid pain relievers involved in more than 15,000 deaths in the United States 1 in 20 people in the U.S. reported using prescription painkillers for nonmedical reasons in the last year Enough prescription painkillers were prescribed in 2010 to medicate every adult American around the clock for a month Source: U.S. Centers for Disease Control and Prevention, Vitalsigns newsletter, November 2011.
9. ED Visits involving Narcotic Pain Relievers Cabinet for Health and Family Services
10. Prescription Drug Abuse in Kentucky 6.6% of Kentuckians (ages 12+) have used prescription pain relievers for nonmedical reasons in past year. (KY tied for second in nation) National average = 4.9% Kentucky prescription opioid pain reliever overdose death rate is 17.9 per 100,000 of population (KY ranks sixth in the nation) National average is 11.9 per 100,000 of population Source: Data from the 2007, 2008 and 2009 National Surveys on Drug Use and Health, published by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Statistics and Quality. Cabinet for Health and Family Services
11. Opioid Analgesics Most Frequently Detected in Kentucky Overdose Deaths 2006 - 2011 Source: Annual reports of the Office of the Kentucky Medical Examiner, compiled by Dr. Len Paulozzi, U.S. Centers for Disease Control, 2012. Cabinet for Health and Family Services
12. Generation Rx 19% of teens report abusing prescription medications to get high. 40% of teens agree that prescription medicines, even if not prescribed by a doctor, are safer than illegal drugs. 29% of teens believe prescription pain relievers are not addictive. 62% of teens say prescription pain relievers are easy to get from parents’ medicine cabinets Source: 2005 Partnership Attitude Tracking Study on Teen Drug Abuse, The Partnership for a Drug-Free America, May 16, 2006. Cabinet for Health and Family Services
13. “Pharm Parties” Short for pharmaceutical party, often attended by teens and young adults. Bowls and baggies of random prescription drugs called “trail mix”. Collecting pills from the family medicine cabinet called “pharming”. Internet chat rooms are used to share “recipes” for getting high with prescription drugs. Reported by Donna Leinwand, USA Today, June 13, 2006 Cabinet for Health and Family Services
14. Hydrocodone DEA believes hydrocodone the most abused prescription drug in the U.S. 1 Usage increased 400% in last 10 years Hydrocodone attributed ER visits increased 500% in last 10 years The U.S. has approximately 4.6% of the world’s population and consumes 99% of all the hydrocodone produced 2 The “Cocktail”: hydrocodone, Xanax and Soma 1. Source: www.drug-addiction.com, The Facts About Hydrocodone Addiction. 2. Source: 2008 Annual Report of the International Narcotics Control Board. Cabinet for Health and Family Services
15. Hydrocodone Photo from Broadband DSLReports.com Cabinet for Health and Family Services
16. Oxycodone Street names: OC, Oxies, Roxies, Oxycotton, Hillbilly Heroin, Blue Highly addictive opioid OxyContin, Percodan, Percocet > 79,000,000 doses dispensed in KY in 2011 The U.S. consumes 83% of all the oxycodone produced 1 1. Source: 2008 Annual Report of the International Narcotics Control Board. Cabinet for Health and Family Services
17. “Study Drugs”: Adderall & Ritalin Highly addictive amphetamine based stimulants used to treat ADHD 2 - 4% of college students on ADHD medication (1) An estimated 5 – 10% of youth are misusing or abusing ADHD medications (2) As many as 20% of college students have use Adderall and Ritalin to study, write papers and take exams (1) Most obtained from fellow students Pill prices increase during exam time Source: Adderall Used for Recreation and Study on UMass Campus, Michelle Williams, The Massachusetts Collegian, December 7, 2010. Source: Dr. Timothy Wilens, Center of Addiction Medicine, Massachusetts General Hospital, August 15, 2012. Cabinet for Health and Family Services
18. Fentanyl Synthetic opioid delivered via transdermal patch or lozenge 1 (fentanyl lollipops - Actiq) 50 to 100 percent more potent than morphine Patches stolen from nursing home patients Methods of abuse:1 Applying multiple patches to the body at one time Eating or sucking on a patch Extracting the drug from a patch, mixing it with an alcohol solution, and injecting it with a hypodermic needle 1. Source: www.drug-addiction.com, Abuse of High-Potency Fentanyl Skin Patches Linked to Hundreds of Deaths. Cabinet for Health and Family Services

19. The Faces of PrescriptionDrug Abuse

20. Jeff and Chris George Photos from Palm Beach Post Cabinet for Health and Family Services
21. Dr. Paul H. Volkman Story: Bill Estep, Lexington Herald-Leader, February 14, 2012. AP Photo released by U.S. Marshals Service (undated) Cabinet for Health and Family Services
22. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services
23. Care More Pain Management Clinic Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012 Cabinet for Health and Family Services
24. Celebrities Photos from The Internet Movie Database Cabinet for Health and Family Services
25. Stevie Nicks Photo from starpulse.com Cabinet for Health and Family Services
26. Heather Locklear Photo from Huffpost Celebrity on Moviefone Cabinet for Health and Family Services
27. Sarah McKinley AP Photo Cabinet for Health and Family Services
28. Dr. Dennis Sandlin Associated Press Photo, The Mountain Eagle, December10, 2009 Cabinet for Health and Family Services
29. Tasha Parsons/Devin Parsons Source: Decatur County Jail Cabinet for Health and Family Services
30. Erica Hughes Photo by Pam Spaulding, The Louisville Courier-Journal, November 30, 2009 Cabinet for Health and Family Services

31. Provider Shopping

32. Provider Shopping Provider shopping is when controlled substances are acquired by deception. Acts related to attempting to obtain a controlled substance, a prescription for a controlled substance or administration of a controlled substance, prohibited under KRS 218A.140 include: Knowingly misrepresenting or withholding information from a practitioner. Providing a false name or address. Knowingly making a false statement. Falsely representing to be authorized to obtain controlled substances. Presenting a prescription that was obtained in violation of the above. Affixing a false or forged label to a controlled substance receptacle. Cabinet for Health and Family Services
33. Typical Provider Shopping Behaviors Cabinet for Health and Family Services
34. Typical Provider Shopping Behaviors (Cont.) Cabinet for Health and Family Services
35. Dentists can be Targets! Police believe Michael Osswald had a good con going: He would visit a dentist, complain of tooth pain, and receive a prescription for painkillers. According to arrest warrant Osswald visited 28 dentists in four months and received 541 hydrocodone during three of those months. As a result of HB1, the targets of Osswald’s alleged scams used KASPER to determine he had received prescriptions from other dentists, and at least one alerted police. Sgt. John McGuire - Louisville Metro Police Department prescription drug diversion unit. Osswald charged with 22 counts of obtaining a controlled substance by fraud. Story: Mark Vanderhof, Louisville Courier-Journal, December 10, 2012 Cabinet for Health and Family Services

36. KASPER Program Update

37. Status of Prescription Drug Monitoring Programs (PDMPs) VT ME WA NHMARICTNJDEMD DC MT ND MN NY OR WI SD ID MI WY PA IA NE OH IL IN NV WV UT VA CO KS KY CA MO NC TN OK SC AZ NM AR GA AL MS TX LA AK FL Operational PDMPs Enacted PDMP legislation, but program not yet operational Legislation pending HI GU Research is current as of February 1, 2012
38. 2011 KASPER Reports Requested Cabinet for Health and Family Services
39. KASPER Operation KASPER tracks most Schedule II – V substances dispensed in KY. Over 11 million controlled substance prescriptions reported to the system each year. KASPER data is 1 to 7 days old. Dispensers have 7 days to report. Health Information Designs processes & provides data once per day. Reports available to authorized individuals. Available via web typically within 15 seconds (90% of requests). Available 24/7 from any PC with Web access. Cabinet for Health and Family Services
40. 2012 Controlled Substances Dispensed Cabinet for Health and Family Services
41. 2012 KASPER Reports Requested Cabinet for Health and Family Services
42. Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2012 Lorazepam 4.0% Ativan Zolpidem 3.5% Ambien Amphetamine 2.7% Adderall Phentermine 2.4% Adipex-P Hydrocodone 41.5%Lortab Lorcet Vicodin Diazepam 4.5% Valium Clonazepam 6.6% Klonopin Tramadol 6.9% Ultram Alprazolam 11.8% Xanax Oxycodone 15.9%OxyContin Percodan Percocet Cabinet for Health and Family Services
43. KASPER Stakeholders Licensing Boards – to investigate potential inappropriate prescribing by a licensee. Practitionersand Pharmacists – to review a current patient’s controlled substance prescription history for medical and/or pharmaceutical treatment. Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution. Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients. A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines. Cabinet for Health and Family Services
44. KASPER Usage December 31, 2012 Pharmacists = 2.1% (83% of KY pharmacists have accounts) Law Enforcement = .5% (17% of KY LE have accounts) Judges, Other = .1% Prescribers = 97.3% (83% of KY prescribers have accounts) Cabinet for Health and Family Services
45. Goals of KASPER KASPER was designed as a tool to help address prescription drug abuse and diversion by providing: A source of information for health care professionals An investigative tool for law enforcement and regulatory agencies KASPER was not designed to: Prevent people from obtaining prescription drugs Decrease the number of doses dispensed Cabinet for Health and Family Services

46. Using eKASPER

47. To Request an eKASPER Report Via secure WEB application. Application accessible from any PC with WEB access. Practitioners and pharmacists can receive a report often within 15 seconds (as long as the report does not require further review by the KASPER staff). Available 24 / 7. URL: https://ekasper.chfs.ky.gov. Cabinet for Health and Family Services
48. eKASPER Report Processing 92% of reports auto-matched by eKASPER Available within 15-30 seconds Manual Queue: Processed 8:00 a.m. to 4:30 p.m. Monday through Friday Weekday manual reports typically available within one hour Cabinet for Health and Family Services
49. eKASPER Report Request - Master Cabinet for Health and Family Services
50. eKASPER Report Request - Delegate Cabinet for Health and Family Services
51. eKASPER Support Help desk e-mail ekasperhelp@ky.gov Help desk phone (502) 564-2703 Account assistance: ekasper.admin@ky.gov Cabinet for Health and Family Services
52. KASPER Cautions IMPORTANT The Master Account Holder is responsible for all usage under the account including delegates! Do not share your userid/password! A subordinate may order an inappropriate report under your name. Delegate accounts have their own userid/password and provide you the ability to review all reports delegates request under your master account. Verify the information in the report! KASPER may contain inaccurate data. Assume the data on the report is inaccurate before assuming the patient is doing something wrong. Cabinet for Health and Family Services
53. Intervention Health care providers have an excellent opportunity and a professional responsibility to address concerns about a patient’s prescription drug problem. Utilize KASPER to screen for potential prescription drug related problems. Don’t just stop treating or dispensing to the patient. Consult with the other prescribers or other dispensers on the KASPER report. Cabinet for Health and Family Services
54. Diversion What do you do when diversion is suspected? If you suspect an individual is involved in diverting controlled substances, we ask that you please report them to the proper law enforcement authorities. If unsure who to contact please call the Drug Enforcement and Professional Practices Branch of the Office of the Inspector General for assistance. (502) 564-7985 http://www.chfs.ky.gov/os/oig/auditsinv.htm Cabinet for Health and Family Services
55. Diversion Reporting Provider Shoppers/Diverters KRS 218A.280 Controlled substances – Communications with practitioner not privileged. Information communicated to a practitioner in an effort unlawfully to procure a controlled substance, or unlawfully to procure the administration of any controlled substance, shall not be deemed a privileged communication. Cabinet for Health and Family Services
56. Drug Enforcement andProfessional Practices Branch Paula York Jill Lee Laura Beth Wells Open Amanda Ward Duncan McCracken Chris Johnson DEPPB Phone Number: 502-564-7985 Cabinet for Health and Family Services

57. Controlled Substance Prescribingin KentuckyRecent Legislative Changes

58. eKASPER Reporting Schedule II controlled substances and Schedule III controlled substances that contain hydrocodone administered to a patient Beginning July 1, 2013 Controlled substance dispensing must be reported within seven days of dispensing through June 30, 2013 Must be reported within one day of administration on or after July 1, 2013 Cabinet for Health and Family Services
59. eKASPER Accounts eKASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans. Cabinet for Health and Family Services
60. eKASPER Master Accounts *Includes physicians, dentists, optometrists and podiatrists Cabinet for Health and Family Services
61. eKASPER Dentist Usage - KRS 218A.172 (HB1) eKASPER must be queried: Prior to initial prescribing or dispensing of a Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone No less than every three months Before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone Does not apply to prescribing of a 3 day supply of a CIII controlled substance following performance of oral surgery by a dentist Cabinet for Health and Family Services
62. eKASPER Dentist Usage – 201 KAR 8:540 (Proposed) eKASPER must be queried prior to initial prescribing of any CS except: prescribing of a 3 day supply of a C-III or the following C-IV’s following performance of oral surgery: Prescribing or dispensing a C-IV or C-V not listed above Prescribing pre-appointment anxiety medication up to a 2 day supply with no refills Ambien Anorexics Ativan Klonopin Librium Nubain Oxazepam Phentermine Soma Stadol Stadol NS Tramadol Valium Versed Xanax Cabinet for Health and Family Services
63. KASPER Reports 2011 weekday average: 2,888 Current weekday average: 18,722 Cabinet for Health and Family Services
64. What if I cannot “Query” KASPER? If eKASPER indicates “manual process” Record the eKASPER report request number in the patient’s chart If the eKASPER system is unavailable or Internet access unavailable Document circumstances why eKASPER could not be queried If eKASPER outage, record the date and time, and eKASPER system outage logs will confirm lack of system availability Cabinet for Health and Family Services
65. eKASPER Delegate Accounts eKASPER delegate accounts allowed for: An employee of the practitioner’s or pharmacist’s practice acting under the specific direction of the practitioner or pharmacist Cabinet for Health and Family Services
66. eKASPER Prescriber Reports CS prescribers can obtain an eKASPER report on themselves: To review and assess the individual prescribing patterns To determine the accuracy and completeness of information contained in eKASPER To identify fraudulent prescriptions Cabinet for Health and Family Services
67. eKASPER Patient Reports eKASPER reports can be shared with the patient or person authorized to act on the patient’s behalf eKASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record Cabinet for Health and Family Services
68. eKASPER Error Correction Patient or provider should contact the dispenser to correct records in error Inaccurate KASPER reports due to system errors should be reported to the Drug Enforcement and Professional Practices Branch 502-564-7985 Cabinet for Health and Family Services
69. HB1 Early Results Figures shown in doses dispensed Cabinet for Health and Family Services

70. Controlled Substance Trendsin Kentucky

71. Controlled Substance Prescribing 2011 Cabinet for Health and Family Services
72. Controlled Substance Usage 2011 Cabinet for Health and Family Services
73. Hydrocodone Prescribing 2011 Cabinet for Health and Family Services
74. Hydrocodone Usage 2011 Cabinet for Health and Family Services
75. Oxycodone Prescribing 2011 Cabinet for Health and Family Services
76. Oxycodone Usage 2011 Cabinet for Health and Family Services Cabinet for Health and Family Services
77. Oxymorphone Prescribing 2011 Cabinet for Health and Family Services
78. Oxymorphone Usage 2011 Cabinet for Health and Family Services
79. Alprazolam Prescribing 2011 Cabinet for Health and Family Services
80. Alprazolam Usage 2011 Cabinet for Health and Family Services
81. Tramadol Prescribing 2011 Cabinet for Health and Family Services
82. Tramadol Usage 2011 Cabinet for Health and Family Services
83. Methadone Prescribing 2011 Cabinet for Health and Family Services
84. Methadone Usage 2011 Cabinet for Health and Family Services
85. Buprenorphine Prescribing 2011 Cabinet for Health and Family Services
86. Buprenorphine Usage 2011 Cabinet for Health and Family Services
87. QUESTIONS? David R. Hopkins Kentucky Cabinet for Health and Family Services 275 East Main Street, 5ED Frankfort, KY 40621 502-564-2815 ext. 3333 Dave.Hopkins@ky.gov KASPER Web Site: www.chfs.ky.gov/KASPER