Experience of Health Care Reform An overview of SB 459 Laurie Squartsoff NV Department of Health and Human Services GOOD SAMARITAN DRUG OVERDOSE ACT

Experience of Health Care ReformAn overview of SB 459

Laurie SquartsoffNV Department of Health and Human Services

GOOD SAMARITAN DRUG OVERDOSE ACT

Origin and Development of Successful Reform

Implementation

Outcomes

State Contacts / Additional Resources

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Roadmap of Presentation

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NEVADA DATA

• 2nd highest for hydrocodone prescriptions (ARCOS)

• 2nd highest for oxycodone prescriptions (ARCOS)

• 4th highest for methadone prescriptions (ARCOS)

• 7th highest for codeine prescriptions (ARCOS)• 4th highest drug overdose mortality rate

(Vital Statistics)• Over 19% of Nevada High Schools students

report that they have taken prescription drugs without a doctor’s prescription (YRBS) 4

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The goal of the NGA Prescription Drug Abuse Prevention program is, with improved coordination of statewide resources, to reduce the incidence of inappropriate controlled substance use by Nevadans.

• Data Defined Goals

• Reduce overall prescriptions of hydrocodone and oxycodone (ARCOS data) as well as expansion of MAT providers (DEA) and prescribers (SAPTA) and assurance to access to comprehensive, fully integrated treatment (Medicaid data to access)

• Reduce the number of overdose deaths (Vital Statistics, Coroner data)

• Reduce number of high school students that have used a prescription drug without a prescription (YRBS)

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Timeline

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Date Milestone

July 2014 Announced as Rx Drug Policy Academy Co-Lead

September 2014 First meeting with National Governors Association (NGA) staff and other states

Ongoing Stakeholder meetings, core team subcommittee meetings

April 2015 Legislative hearings

May 5, 2015 Stakeholder meetings, SB459 Signed into Law

June 2015 Reconvening of all states at NGA meeting in Vermont

September 2015 Report turned over to Chief of Staff at Governor’s office

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PDMP

ID Requirement

Doctor Shopping Law

Support for Sub-stance Use Services

Physical Exam RequirementPharmacy Lock-In Program

Good Samaritan Law

Support for Naloxone Use

Prescriber Educa-tion Requirement

Mandatory Use PDMP

Source linked at end of presentation. Teal slices were TFAH/ASTHO strategies already in place in Nevada and orange slices were added by SB 459.

• Mandatory Use of PMP• Prescriber Education Requirement• Good Samaritan Law• Support for Naloxone use

Key components of SB 459


Implementation

Outcomes


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• Data collection

• Community Education

• Provider Education

• Law Enforcement

• Assessment and Treatment

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Implementation

• The Nevada DHHS, Substance Abuse and Prevention Agency (SAPTA) and the Multidisciplinary Prevention Advisory Committee (MPAC) and the State Epidemiologic Workgroup (SEW) were selected to manage implementation.

• MPAC is a partner advisory group with the SEW, both of which advise SAPTA. The SEW collects and analyzes the data and the MPAC 's role is to create recommendations on strategies and funding in relation to the information the SEW presents. The MPAC also receives Coalition updates.

• The MPAC meetings provide regular updates on statewide efforts. SAPTA tracks progress and shares information with Governor’s office.

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Implementation


Implementation

Outcomes


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• Mandatory Use of PMP• Prescriber Education Requirement• Good Samaritan Law• Support for Naloxone use

Key components of SB 459

Outcomes

Mandatory access and use by practitioners of Prescription Monitoring Program(PMP)

• Practitioners are required to obtain a PMP report before initiating some prescriptions for a controlled substance

Outcomes

PRESCRIPTION MONITORING PROGRAM• Prescription is for a controlled substance (Schedule II,III, or IV)

• Patient is a new patient for the practitioner; or• The prescription is for more than 7 days and is part of a new course of

treatment for the patient

Outcomes

PRESCRIPTION MONITORING PROGRAM• Practitioners are obligated to actually review the PMP reports

• NRS639.23507(1) does not apply to inpatient chart orders; it does apply to prescriptions written for out-patients by practitioners

working in a hospital emergency department

Outcomes

PRESCRIPTION MONITORING PROGRAM• Periodic training for practitioners concerning the misuse and abuse of

controlled substances• The language in sections 15.1 through 15.9 is permissive, not

mandatory:

Outcomes

PRESCRIPTION MONITORING PROGRAM• The language in sections 15.1 through 15.9 is permissive, not

mandatory: Each Board “may, by regulation, require…who is registered to dispense controlled substances pursuant to NRS 453.231 to complete at least 1 hour of training relating specifically to the misuse and abuse

of controlled substances during each period of licensure. Any such holder of a license may use such training to satisfy 1 hour of any

continuing education requirement established by the Board.”

ADDITIONAL PROVISIONS IN SB459

• Ability for practitioners to “Red Flag” Doctor Shoppers – Section 13

• Next Day reporting to the PMP Database Section -13(2)

Outcomes

GOOD SAMARITAN OVERDOSE ACT

• Authority to Prescribe and Dispense to Non-Patients

Outcomes

GOOD SAMARITAN OVERDOSE ACT• Section 7 of SB459 applies to a health care professional otherwise

authorized to prescribe an opioid antagonist may directly or by standing order, prescribe and dispense and opioid antagonist to a

person other than the patient.

Outcomes


• Section 7 describes other persons as “a family member, friend or other person in a position to assist such a person at risk of

experiencing an opioid-related drug overdose.”

Outcomes

GOOD SAMARITAN OVERDOSE ACT• Significant departure from traditional pharmacy law. Outside the

scope of SB459, prescriptions must be written for the patient in a prescriber-patient relationship. See NRS 639.235(2) and (4).

Prescribers cannot generally write prescriptions for persons who are merely related to or associated with the patient.

Outcomes


• Per the statute, such prescriptions are to be regarded as “being issued for a legitimate medical purpose in the usual course of professional

practice.” Section 7(1)• Prescribers who write such a prescription in good faith and with care are immune from civil or criminal prosecution directly associated with

writing the prescription. Section 7(2)

Outcomes


• Section 7(3), not withstanding any other provision of law, any person may possess and administer an opioid antagonist to another person who he or she reasonable believe is experiencing an opioid-related

drug overdose.

Outcomes


• Any person is undefined, but the statute specifically states that law enforcement personnel, EMTs, advanced emergency medical

technicians or paramedics are included, as being able to possess and administer an opioid antagonist

Outcomes


• Persons who act in good faith and with reasonable care in administering an opioid antagonist- although they would have no legal authority to administer other medications-are immune from criminal prosecution, civil liability and sanction from professional

licensing boards. Section 7(4)

Outcomes


• Section 7(5) does not create a duty to prescribe or dispense an opioid antagonist. A prescriber who declines to prescribe the medication for

any reason is immune from criminal, civil and administrative proceedings

Outcomes


• Section 8 Authority of unlicensed persons to store, possess and administer opioid antagonists

Outcomes


• Section 8 allows non-registered persons to store and dispense opioid antagonists pursuant to a standing order from a properly authorized prescriber. The caveat is that ‘those activities [must be] undertaken without charge or compensations.” Where the person has a standing order from a prescriber, the person can possess and dispense without charge without a license from the Board of Pharmacy pursuant to NRS Chapter 639.

Outcomes

GOOD SAMARITAN OVERDOSE ACT• Authority of pharmacists to dispense opioid antagonists in accordance

with standardized procedures or protocols developed and approved by the State Board of Pharmacy

• Recent workshop held on October 15, 2015• Another workshop scheduled for December 2015

• Pending regulations will be forwarded to LCB before adoption

Outcomes


• Section 12 addresses protections for persons who seek medical assistance for another person who is experiencing a drug or alcohol

overdose

Outcomes

GOOD SAMARITAN OVERDOSE ACTSection 12(1) says that if a person seeks aid in good faith on behalf of himself/herself, or for another, that person “may not be arrested, charged, prosecuted or convicted, or have his or her property subjected to forfeiture” or other penalty.

Outcomes

GOOD SAMARITAN OVERDOSE ACTEven in cases where immunities in subsection 12(1) do not apply, the Court, before sentencing, “shall consider in mitigation any evidence or information that the defendant, in good faith, sough medical assistance for a person in connection with the events that led to the violation.” Section 12(2).

Outcomes

ISSUES STILL AT HAND• Section 10: DHHS MAY MONITOR/WATCH CHANGE

TRENDS IN RISK FACTORS AND PUBLISH ANNUAL REPORT

Outcomes

IMPORTANT TO ASSURE THAT “PAIN” PATIENTS RECEIVE APPROPRIATE TREATMENT WITHOUT

BARRIERS

Outcomes


Implementation

Outcomes

State Contacts / More Information

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State Contacts

Larry Pinson, Pharm.D., Nevada State Board of Pharmacy; [email protected]; 775-850-1440

Tracey Green MD, Chief Medical Officer: [email protected], 775-684-3215

Dena Schmidt, Deputy Director, DHHS: [email protected], 775-684-4015

Laurie Squartsoff, R.Ph, DPBH: [email protected], 725-500-2913

More Information

Nevada Legislature: http://www.leg.state.nv.us/

SB459: https://www.leg.state.nv.us/App/NELIS/REL/78th2015/Bill/2161/Text

SAPTA: http://mh.nv.gov/Meetings/SAPTA_Program_Page/

Trust for America’s Health Report: http://healthyamericans.org/reports/drugabuse2013/

Data Resources: http://dpbh.nv.gov/Programs/OPHIE/Public_Health_Informatics_and_Epidemiology_-_Home/

YRBS data for NV: https://dhs.unr.edu/chs/research/yrbs

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State Contacts / More Information

mailto:[email protected]



http://www.leg.state.nv.us/

https://www.leg.state.nv.us/App/NELIS/REL/78th2015/Bill/2161/Text

http://mh.nv.gov/Meetings/SAPTA_Program_Page/

http://mh.nv.gov/Meetings/SAPTA_Program_Page/

http://healthyamericans.org/reports/drugabuse2013/

http://dpbh.nv.gov/Programs/OPHIE/Public_Health_Informatics_and_Epidemiology_-_Home/

https://dhs.unr.edu/chs/research/yrbs

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Thank you!

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Documents

Experience of Health Care Reform An overview of SB 459 Laurie Squartsoff NV Department of Health and Human Services GOOD SAMARITAN DRUG OVERDOSE ACT