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Initiatives to Combat Prescription Drug Abuse in Kentucky: a n Update on KASPER. David R. Hopkins KASPER Program Manager Office of Inspector General Kentucky Cabinet for Health and Family Services The Different Faces of Substance Abuse January 28, 2014. Contents. Pill Mills

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initiatives to combat prescription drug abuse in kentucky a n update on kasper
Initiatives to Combat Prescription Drug Abuse in Kentucky:

an Update on KASPER

David R. Hopkins

KASPER Program Manager

Office of Inspector General

Kentucky Cabinet for Health and Family Services

The Different Faces of Substance Abuse

January 28, 2014

contents
Contents
  • Pill Mills
  • KASPER Program Review
  • House Bill 1 Preliminary Results and Evaluation

Cabinet for Health and Family Services

jeff and chris george
Jeff and Chris George

Photos from Palm Beach Post

Cabinet for Health and Family Services

dr paul h volkman
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

care more pain management clinic
Care More Pain Management Clinic

Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012

Cabinet for Health and Family Services

care more pain management clinic1
Care More Pain Management Clinic

Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012

Cabinet for Health and Family Services

ernest william singleton
Ernest William Singleton

Photo: Lexington Community Corrections, January 2013

Cabinet for Health and Family Services

kitson clothing collection
Kitson Clothing Collection

Story: WXIX Fox 19 Digital Media Staff, June 21, 2013

Cabinet for Health and Family Services

kitson clothing collection1
Kitson Clothing Collection

Cabinet for Health and Family Services

slide12

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

slide13

2011 KASPER Reports Requested

Cabinet for Health and Family Services

kasper operation
KASPER Operation
  • KASPER tracks most Schedule II – V substances dispensed in KY
    • Over 10 million controlled substance prescriptions reported to the system each year
  • KASPER data is 1 to 3 days old
    • Dispensers have 1 business day to report
  • Reports available to authorized individuals
    • Available via web typically within 15 seconds (97% of requests)
    • Available 24/7 from any PC with Web access

Cabinet for Health and Family Services

slide15

Annual KASPER Records Total / Per Person

2.39 2.43 2.65 2.65 2.72 2.72 2.47

Number of Controlled Substance Prescriptions per Person

Cabinet for Health and Family Services

slide16

KASPER Reports Requested

Cabinet for Health and Family Services

top prescribed controlled substances by therapeutic category by doses 2013
Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2013

Lorazepam 4.0%

Ativan

Testosterone 3.5%

AndroGel

Zolpidem 3.4%

Ambien

Amphetamine 3.1%

Adderall

Hydrocodone 41.3%Lortab

Lorcet

Vicodin

Diazepam 4.3%

Valium

Clonazepam 6.7%

Klonopin

Tramadol 6.8%

Ultram

Alprazolam 11.2%

Xanax

Oxycodone 15.4%OxyContin

Percodan

Percocet

Cabinet for Health and Family Services

kasper stakeholders
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 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.
  • Medical Examiners engaged in a death investigation

Cabinet for Health and Family Services

controlled substance dispensing one year comparison
Controlled Substance Dispensing – One Year Comparison

Figures shown in doses dispensed

Cabinet for Health and Family Services

hydrocodone
Hydrocodone

Cabinet for Health and Family Services

oxycodone
Oxycodone

Cabinet for Health and Family Services

alprazolam
Alprazolam

Cabinet for Health and Family Services

methadone
Methadone

Cabinet for Health and Family Services

oxymorphone
Oxymorphone

Cabinet for Health and Family Services

tramadol
Tramadol

Cabinet for Health and Family Services

buprenorphine
Buprenorphine

Cabinet for Health and Family Services

controlled substance prescribing 2013
Controlled Substance Prescribing 2013

Cabinet for Health and Family Services

controlled substance usage 2013
Controlled Substance Usage 2013

Cabinet for Health and Family Services

house bill 1 impact study
House Bill 1 Impact Study
  • Comprehensive assessment of HB1’s impact on patients, prescribers, and other stakeholders
  • Overall goals:
    • Evaluate the impact of HB1 on reducing prescription drug abuse and diversion in Kentucky
    • Identify unintended consequences associated with implementation of HB1 that impact patients, providers and citizens of the Commonwealth
    • Develop recommendations to improve effectiveness of HB1 and mitigate identified unintended consequences
  • Final study report planned for July 2014

Cabinet for Health and Family Services

slide32

Kentucky Pharmacists

Non-KYPharmacists

slide34

Stakeholder interviews were conducted to inform the development of a KASPER registrant survey instrument

    • Board of Pharmacy
    • Board of Nursing
    • Board of Medical Licensure
    • Board of Dentistry
    • Kentucky Coalition of Nurse Practitioners and Nurse Midwives
    • Kentucky Dental Association
    • Kentucky Pharmacists Association
    • Kentucky Medical Association
    • Operation UNITE
    • National Association Drug Diversion Investigators (NADDI)
    • Medicaid, Office of Inspector General
    • Kentucky Sheriff’s Association
    • Kentucky Narcotic Officers Association
initiatives to combat prescription drug abuse in kentucky a n update on kasper1
Initiatives to Combat Prescription Drug Abuse in Kentucky:

an Update on KASPER

Van Ingram

Executive Director

Office of Drug Control Policy

Kentucky Justice and Public Safety Cabinet

The Different Faces of Substance Abuse

January 28, 2014

contents1
Contents
  • Legislative Update
  • 2013 National Survey on Drug Use and Health
  • HB1 Provider Training
  • Kentucky Overdose Data

Justice & Public Safety Cabinet

hb 1 pain management facilities
HB 1 – Pain Management Facilities
  • Physician ownership requirement on all pain management facilities (PMF)
  • Exception for those health facilities operating as a PMF on April 24, 2012
  • No sanctions or convictions imposed on facility or employees

Justice & Public Safety Cabinet

pmf oversight
PMF Oversight
  • KBML responsible for licensure standards for physician-owned pain management facilities.
  • OIG, Division of Health Care is responsible for licensure standards for existing pain management facilities that qualify for the physician-ownership exemption of HB 1.

Justice & Public Safety Cabinet

non physician owned pmfs
Non-Physician Owned PMFs
  • 29 non-physician owned PMFs were identified  April 24, 2012 (HB1 passage date) 
  • 8 closed prior July 20, 2012 (HB1 effective date)
  • 12 closed after the HB1 effective date
  • 2 illegal or non-physician owned PMFs discovered after HB 1 effective date
  • 4 PMFs were sent cease and desist letters
  • 7 PMFs are being reviewed for compliance and certification by the Cabinet for Health and Family Services

Justice & Public Safety Cabinet

kasper reporting krs 218a 202
KASPER Reporting KRS 218A.202
  • Controlled substance administration or dispensing must be reported within one day effective July 1, 2013

Justice & Public Safety Cabinet

kasper accounts krs 218a 202
KASPER Accounts – KRS 218A.202
  • KASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans.

Justice & Public Safety Cabinet

kasper prescriber usage krs 218a 172
KASPER Prescriber Usage - KRS 218A.172
  • Query KASPER for previous 12 months of data:
    • 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
    • Review data before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone
  • Additional rules/exceptions included in licensure board regulations

Justice & Public Safety Cabinet

kasper regulations licensure boards
KASPER Regulations – Licensure Boards
  • 201 KAR 5:130
    • Kentucky Board of Optometric Examiners KASPER requirements
  • 201 KAR 8:532
    • Kentucky Board of Dentistry KASPER requirements
  • 201 KAR 9:230, 201 KAR 9:260
    • Kentucky Board of Medical Licensure KASPER requirements
  • 201 KAR 20:057
    • Kentucky Board of Nursing KASPER requirements
  • 201 KAR 25:090
    • Kentucky Board of Podiatry KASPER requirements.

Justice & Public Safety Cabinet

kasper institutional accounts krs 218a 202
KASPER Institutional Accounts - KRS 218A.202
  • Hospitals and long term care facilities can establish “facility” KASPER accounts
    • eKASPER institutional master account established by Chief Medical Officer or designated employee
    • If no CMO, a designated physician employee may create master account
    • 79 institutional master accounts currently established

Justice & Public Safety Cabinet

kasper prescriber reports krs 218a 202
KASPER Prescriber Reports – KRS 218A.202
  • CS prescribers can obtain a KASPER report on themselves:
    • To review and assess the individual prescribing patterns
    • To determine the accuracy and completeness of information contained in KASPER
    • To identify fraudulent prescriptions

Justice & Public Safety Cabinet

providing reports to patients krs 218a 202
Providing Reports to Patients – KRS 218A.202
  • KASPER reports can be shared with the patient or person authorized to act on the patient’s behalf
  • KASPER 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

Justice & Public Safety Cabinet

federal actions hydrocodone
Federal Actions - Hydrocodone
  • Hydrocodone combination products to be rescheduled from CIII to CII
    • Approved by FDA
    • Pending recommendation to HHS and approval by HHS and DEA
  • FDA approved CII pure hydrocodone product
    • Zohydrotm ER manufactured by Zogenix, Inc.
    • Available 1Q 2014
    • Not abuse-resistant formulation

Justice & Public Safety Cabinet

national trends
NATIONAL TRENDS

States with Rates between 5.33 and 6.37

1 Oregon 6.37 5.25-7.71

2 Colorado 6.00 4.96-7.24

3 Washington 5.75 4.76-6.92

4 Idaho 5.73 4.74-6.91

5 Indiana 5.68 4.68-6.89

6 Arizona 5.66 4.60-6.94

7 Nevada 5.62 4.57-6.89

8 Delaware 5.61 4.61-6.82

9 Arkansas 5.55 4.60-6.68

10 New Mexico 5.45 4.47-6.64

Justice & Public Safety Cabinet

national trends1
NATIONAL TRENDS

States with Rates between 4.80 and 5.32

11 Alaska 5.32 4.41-6.42

12 Oklahoma 5.19 4.26-6.30

13Rhode Island 5.18 4.26-6.27

14 Vermont 5.13 4.24-6.19

15 Michigan 5.11 4.57-5.72

16 Ohio 5.00 4.49-5.56

17 Tennessee 5.00 4.14-6.02

18 Louisiana 4.87 4.09-5.80

19 Montana 4.84 4.02-5.80

20 Missouri 4.83 4.03-5.78

Justice & Public Safety Cabinet

national trends2
NATIONAL TRENDS

States with Rates between 4.46 and 4.79

21 West Virginia 4.79 3.97-5.75

22 California 4.68 4.13-5.30

23District of Columbia 4.68 3.79-5.76

24 Wyoming 4.68 3.85-5.68

25 South Carolina 4.62 3.81-5.59

26 Virginia 4.60 3.79-5.58

27 Minnesota 4.57 3.79-5.49

28 New Hampshire 4.57 3.77-5.53

29 Kansas 4.56 3.77-5.50

30 Wisconsin 4.51 3.68-5.52

31 Kentucky 4.48 3.70-5.41

Justice & Public Safety Cabinet

national trends3
NATIONAL TRENDS

Among persons aged 18 to 25, the rates

of past year nonmedical use of pain relievers declined in 14 states:

Florida, Kentucky, Louisiana, Maine,

Massachusetts, Michigan, New Hampshire, New York, Ohio, Oklahoma, Rhode Island, Texas, Utah, and West Virginia.

Justice & Public Safety Cabinet

hb 1 trainings
HB 1 TRAININGS
  • ODCP, OPERATION UNITE and KENTUCKY COALITION OF NURSE PRACTITIONERS/NURSE MIDWIVES HAVE SPONSORED 4 TRAININGS

Justice & Public Safety Cabinet

hb 1 trainings1
HB 1 TRAININGS

Overview of HB1 and Regulations

C. Lloyd Vest, JD

How to Recognize Drug Abuse and Dependence in Patients

Gregory Jones, MD

How to Discuss Drug Issues with a Patient

Gregory Jones, MD

An Update on KASPER - Post House Bill 1

David Hopkins

Opioid Therapy: Risks vs. Rewards

Gregory Jones, MD

Justice & Public Safety Cabinet

hb 1 trainings2
HB 1 TRAININGS

MOREHEAD

119 TRAINEES

83 PRESCRIBERS

PAINTSVILLE

147 TRAINEES

55 PRESCRIBERS

BOWLING GREEN

239 TRAINEES

170 PRESCRIBERS

MANCHESTER

110 TRAINEES

80 PRESCRIBERS

Justice & Public Safety Cabinet

hb 1 trainings3
HB 1 TRAININGS
  • 615 TOTAL TRAINEES
  • 388 PRESCRIBERS
  • AVAILABLE ONLINE
  • MEETS LICENSING BOARDS REQUIREMENTS

Justice & Public Safety Cabinet

hb 1 trainings4
HB 1 TRAININGS

Justice & Public Safety Cabinet

the good bad and ugly of addiction
The Good, Bad, and Ugly of Addiction

Justice & Public Safety Cabinet

2012 overdose data
2012 OVERDOSE DATA
  • 1004 OVERDOSE FATALATIES IN 2012
  • 19 FEWER THAN 2011. THE FIRST DECLINE IN OVER A DEACDE
    • 888 UNINTENTIONAL
    • 59 SUICIDES
    • 57 UNDETERMINED

Justice & Public Safety Cabinet

2012 overdose data1
2012 OVERDOSE DATA
  • LARGEST INCREASE CAMPBELL COUNTY. FROM 25 IN 2011 TO 54 IN 2012
  • LARGEST DECREASE, FLOYD COUNTY WITH 23 FEWER DEATHS IN 2012 THAN 2011
  • MOST PER 100,000 LESLIE COUNTY WITH RATE OF 85 PER 100,000

Justice & Public Safety Cabinet

2012 overdose data2
2012 OVERDOSE DATA
  • DEATHS ATTRIBUTABLE TO HEROIN ROSE 550%
  • ALPROZOLAM MOST DETECTED SUBSTANCE AT 41.44% OF ALL MEDICAL EXAMINER CASES

Justice & Public Safety Cabinet

2012 overdose data3
2012 OVERDOSE DATA
  • YOUNGEST OD DEATH AGE 16
  • OLDEST 72
  • AVERAGE AGE 40
  • MALE 58%
  • FEMALE 42%

Justice & Public Safety Cabinet

first 3 quarters of 2013
FIRST 3 QUARTERS OF 2013
  • 639 TOTAL OVERDOSE DEATHS REPORTED DURING three quarters OF 2013
  • 170 OR 26% HAVE HEROIN IN THE TOXICOLOGY REPORT
  • OVERWHELMING MAJORITY POLY DRUG

Cabinet for Health and Family Services

slide67
2013
  • JEFFERSON 94
  • FAYETTE 26
  • KENTON 26
  • BOONE 20
  • CAMPBELL 8
  • FRANKLIN 5
  • 17 COUNTIES 1 or 2
  • 97 COUNTIES NONE

Cabinet for Health and Family Services

heroin
HEROIN

Cabinet for Health and Family Services

heroin1
HEROIN

Cabinet for Health and Family Services

how did we get here
HOW DID WE GET HERE?
  • LONG HISTORY OF OPIOD/PAINKILLER ABUSE
  • INCREASING NUMBERS OF IV DRUG USAGE
  • ABUSE DETERRANT FORMULATIONS
  • CRACKDOWN ON ROUGUE PAIN CLINICS
  • GREATER AWARENESS FROM PRESCRIBERS
  • ESTABLISHED DRUG CARTELS RECOGNIZING DEMAND

Cabinet for Health and Family Services

how did we get here1
HOW DID WE GET HERE?

PRICE

AVAILABILITY

PERCEPTION OF RISK

PUBLIC ATTITUDES

Cabinet for Health and Family Services

how do we address it
HOW DO WE ADDRESS IT?
  • PUBLIC EDUCATION
  • INCREASED ACCESS TO TREATMENT
  • ENHANCED PENALTIES FOR MAJOR TRAFFICKERS
  • GREATER ACCESS TO NALOXONE

Cabinet for Health and Family Services

slide73

QUESTIONS?

Van Ingram

Kentucky Justice and Public Safety Cabinet

125 Holmes Street

Frankfort, KY 40601

502-564-8291

Van.Ingram@ky.gov

David 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