Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director Arizona State Board of Pharmacy

Controlled Substances Prescription Monitoring Program

Dean Wright, RPhCSPMP Director

Arizona State Board of Pharmacy


Faculty Disclosure Declaration:

I have no actual or potential conflict of interest in relation to this program or presentation.

•Describe the prevalence, roles and limitations of Controlled Substance Monitoring programs•Explain how to gain access and general information about the AZ Controlled Substance Prescription Monitoring Program (AZ CSPMP)•Review information on last year’s usage of the system•Describe learning lessons from AZ CSPMP screenings


Learning Objectives:


Arizona’s Forty-eighth Legislature passed H.B. 2136 establishing a Controlled Substances Prescription Monitoring Program (CSPMP). The bill was signed by the Governor on July 2, 2007 and become effective on September 19, 2007.

The new statutes, A.R.S. Title 36, Chapter 28 are available on the Board’s website www.azpharmacy.gov under the “CS-Rx Monitoring Program” link. Our proposed rules are also available under the same link.


• A.R.S. § 36-2602 requires the ASBP to establish a controlled substances prescription monitoring program that:

Includes a computerized central database tracking system track the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances in Arizona,

Assists law enforcement in identifying illegal activity related to the prescribing, dispensing, and consumption of Schedule II, III, and IV controlled substances,

Provides information to patients, medical practitioners, and pharmacists to help avoid the inappropriate use of Schedule II, III, and IV controlled substances, and

Is designed to minimize inconvenience to patients, prescribing medical practitioners and pharmacies while effectuating the collection and storage of information.


Purpose of the monitoring program: Improve the State’s ability to identify controlled substance

abusers or misusers and refer them for treatment Identify and stop diversion of prescription controlled

substance drugs

Primary function of the Arizona State Board of Pharmacy: Provide a central repository of all prescriptions dispensed

for Schedule II, III, and IV controlled substances in Arizona


A.R.S. § 36-2604 Use and release of confidential informationC. The board may release data collected by the program to the following: 1. A person who is authorized to prescribe or dispense a controlled substance to assist

that person to provide medical or pharmaceutical care to a patient or to evaluate a patient..

2. An individual who requests the individual's own prescription monitoring information pursuant to section 12-2293.

3. A professional licensing board established pursuant to title 32, chapter 7, 11, 13, 14, 15, 16, 17, 18, 21, 25 or 29. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting board states in writing that the information is necessary for an open investigation or complaint.

4. A local, state or federal law enforcement or criminal justice agency. Except as required pursuant to subsection B of this section, the board shall provide this information only if the requesting agency states in writing that the information is necessary for an open investigation or complaint.

5. The Arizona health care cost containment system administration regarding persons who are receiving services pursuant to chapter 29 of this title. Except as required pursuant to subsection B of this section, the board shall provide this information only if the administration states in writing that the information is necessary for an open investigation or complaint.

6. A person serving a lawful order of a court of competent jurisdiction.

Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program

• October 2008: Arizona began collecting data from resident and nonresident pharmacies. The first reports were due on or before Friday October 17, 2008 for the week ending October 11, 2008. Pharmacies were required to report their controlled substance data retroactively to April 1, 2008.

• October 2009: Began collecting data for dispensing practitioners.

• There are about 1691 resident and nonresident pharmacies reporting data and about 3800 dispensing practitioners reporting data.

• Database access as of February 6, 2013: Practitioners: 4436 (20.1%) Pharmacists: 1928 (31.2%) Law Enforcement Investigators: 293 Board Investigators: 50

• Practitioners, pharmacists, and law enforcement and board investigators from another state may also request access.


Who is using the database?

Practitioners make 82.5% of the queries

Pharmacists make 17.3% of the queries

Law Enforcement make 0.13% of the queries

Healthcare Boards make 0.07% of the queries


Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring ProgramQueries - By Quarter for 2010Period RPh Practitioner LE

Board1/1/10-3/31/10 10709 69183 147 864/1/10-6/30/10 12731 91616 255 607/1/10-9/30/10 13668 113749 222 4510/1/10-12/31/10 9516 120130 302 42Queries – By Quarter for 2011Period RPH Practitioner LE

Board1/1/11-3/31/11 9280 128796 338 544/1/11-6/30/11 9954 145456 344 1107/1/11-9/30/11 13058 168562 233 10110/1/11-12/31/11 14150 174802 231 73Queries – By Quarter for 2012Period RPH Practitioner LE

Board1/1/12-3/31/12 15744 199264 368 1204/1/12-6-30-12 20532 232372 180 807/1/12-9/30/12 27422 167709 245 18910/1/2012 36585 174230 240 131


How often is the database being used?

Practitioners average 1936 queries per day.Pharmacists average 407 queries per day.Law enforcement agents average 2.7 queries per day.Healthcare Boards average 1.5 queries per day.

Interstate Queries?

Practitioners made 1034 and Pharmacists made 803 in 4th Quarter 2012


Unsolicited Reports Sent to Practitioners8/09 126-41 5/11 92-139/09 179-34 7/11 89-1110/09 121-19 8/11 116-1512/09 177-25 9/11 115-151/10 142-24 10/11 157-212/10 154-24 11/11 67-93/10 98-15 12/11 70-104/10 134-18 1/12 152-185/10 123-17 2/12 180-217/10 140-22 3/12 143-168/10 135-21 4/12 195-239/10 159-26 5/12 154-1910/10 127-18 6/12 143-15 11/10 201-25 7/12 191-2012/10 183-23 9/12 99-10 1/11 133-16 10/12 105-13 2/11 107-14 11/12 188-23 3/11 93-9 12/12 105-12 4/11 90-11

Practitioner/Pharmacist Procedures for Requesting Access

Online Training Course

• Once we receive a practitioner’s completed access request paperwork, we will assign the practitioner to our 20-minute online training course. The practitioner will receive an email from our training course at @careermap.net.

• Once, the practitioner completes the training course, the practitioner will receive two emails from our tech staff at @hidinc.com with the practitioner’s user name and the database web link and the practitioner’s PIN number, temporary password, login instructions, and an 866 help desk phone number.

Access Notification• Welcome to the AZ CSPMP Database: for Practitioners

• This e-mail confirms you are APPROVED by the Arizona Board of Pharmacy to access the Controlled Substance Prescription Monitoring Program database. * To access the Practitioner/ Pharmacist website, click on the database link : https://azpmpph.hidinc.com

• Your username is your DEA Registration # with a prefix of AZ;• AZ----- * User login and password accounts are never to be shared. All

user account deletions, additions, access, permissions, and changes must be submitted in writing to:

Dean Wright, CSPMP Director Arizona State Board of Pharmacy 1700 W. Washington, suite 250

Glendale, AZ 85007(602) 771 2744 fax (602) 771 2748

• You should receive a second email, within 4 hours, that will contain your account pin number, temporary password, login instructions, and a tech support phone number.

Access notification• Arizona State Board of Pharmacy• Controlled Substance Prescription Monitoring Program (CSPMP)• Second email

• This is your temporary password: [kse93DbJg]

• Click on the Database link in the first email, click on login, enter your user name and temporary password. Click on Practitioner/Pharmacist Query and in the popup box create a permanent password. Then login with your new permanent password.

• This email confirms that your PIN # is [8776].

• This number is required if you call our support center to assist you with forgotten passwords.

• The number to call for this assistance is 1-866-792-3149.

• It is recommended that you keep this PIN # in a secure, retrievable location.

• If you do not know your PIN # when you call for assistance we will not be able to help you and you will be required to contact AZ CSPMP and start the application process from the beginning again.

PMP QueriesPMP Queries

Multi-State access is here. Allows Multi-State access is here. Allows access to data from other states and access to data from other states and AZ in one report. Click on Multi-State AZ in one report. Click on Multi-State Query to make a request. Pick AZ and Query to make a request. Pick AZ and other states needed. Put in patient other states needed. Put in patient name and DOB and time-frame for name and DOB and time-frame for search. Note: DO NOT use Multi-State search. Note: DO NOT use Multi-State Query, if you only need data for Query, if you only need data for Arizona, use Practitioner/Pharmacist Arizona, use Practitioner/Pharmacist Query.Query.

PMP ReportPMP Report

OnlyOnly one one factorfactor in in prescriberprescriber’’s s evaluation of evaluation of patient patient history.history.

















Other Factors that Other Factors that should be documentedshould be documented

• Diagnosis (pain is a symptom)Diagnosis (pain is a symptom)

• Chief complaint at visitChief complaint at visit

• Changes since last visitChanges since last visit

• Urine/Blood Drug screen resultsUrine/Blood Drug screen results

• Compliance with treatment planCompliance with treatment plan

• Other medical conditions and drugs Other medical conditions and drugs prescribedprescribed

• Other known prescribers for this patientOther known prescribers for this patient

Review the patientReview the patient’’s history s history and patterns of drug useand patterns of drug use

•What a patient received What a patient received over the last 6-12 months over the last 6-12 months is more important than is more important than what they got last week. what they got last week.

•Most abuse did not start Most abuse did not start within the last 10 days.within the last 10 days.

PMP ReportsPMP Reports

Use the PMP report as a tool.Use the PMP report as a tool.

• Review any additional records Review any additional records availableavailable

• Compare with patient chartsCompare with patient charts

• Validate unexpected informationValidate unexpected information

• Contact prescribers or pharmacies Contact prescribers or pharmacies listed, for more detailslisted, for more details

Problems with PMPsProblems with PMPs

Patient identityPatient identity

•No unique identifier for all personsNo unique identifier for all persons

•Common names, same DOBCommon names, same DOB

•Computer search functionsComputer search functions

•Michael/Michelle; Terry/TerriMichael/Michelle; Terry/Terri

Pharmacy data entry errorsPharmacy data entry errors

•Date of dispensing entered in Date of Date of dispensing entered in Date of Birth fieldBirth field

•Wrong prescriber selectedWrong prescriber selected


Issue is ALWAYS Issue is ALWAYS Appropriate Medical Appropriate Medical

Care. Care.

Quantity alone is Quantity alone is nevernever the issue. the issue.

Scenario 4PMH: cancer increasing pain and out of pain medication early

Prescription data base search alerted provider that patient was obtaining controlled substances from multiple sources

Provider discussion with patient that for safety all his pain medication should be coming from one location.

New treatment plan for pain control developed.

Importance of contacting provider when pain not controlled with current medication emphasized.

Learning Lesson: talk with your patient closely & frequently

QUESTIONS?

Arizona State Board of PharmacyWeb page: www.azpharmacy.gov

Dean Wright, CSPMP DirectorArizona State Board of Pharmacy

1700 W. Washington, Suite 250Phoenix, AZ 85007

602-771-2744Fax: 602-771-2748

[email protected]

QUESTIONS?

Arizona State Board of PharmacyWeb page: www.azpharmacy.gov

Dean Wright, CSPMP DirectorArizona State Board of Pharmacy

1616 W. Adams, Suite 120P.O. Box 18520

Phoenix, AZ 85005602-771-2744

Fax: [email protected]

Documents

Controlled Substances Prescription Monitoring Program Dean Wright, RPh CSPMP Director Arizona State Board of Pharmacy