Prescription Drug M isuse and The North Carolina Controlled Substances Reporting System Joint Legislative Health Care Oversight Committee September 7, 2010 William Bronson, Drug Control Unit Division of Mental Health, Developmental Disabilities & Substance Abuse Services
Epidemics of unintentional drug overdose deaths in the U.S., 1970-2006* Prescription drugs 10 9 Crude rate per 100,000 8 7 6 Crack cocaine 5 Heroin 4 3 2 1 0 '70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 * 2006 rate is estimated. Year Len Paulozzi, M D, M PH National Center for Injury Prevention and Control Centers for Disease Control and Prevention
Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2008 2008 NSDUH Survey
Past M onth Nonmedical Use of Types of Psychotherapeutic Drugs among Persons Aged 12 or Older: 2002-2008 2008 NSDUH Survey
Unintentional drug overdose death rates and total sales of opioid analgesics in morphine equivalents by year in the U.S. Deaths/100,000 Opioid sales (mg/person) 8 800 7 700 6 600 5 500 4 400 3 300 2 200 1 100 0 0 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 Len Paulozzi, M D, M PH Centers for Disease Control and Prevention
Deaths vs M isuse Deaths/100,000 Opioid sales (mg/person) 8 800 7 700 6 600 5 500 4 400 3 300 2 200 1 100 0 0 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06
Unintentional Deaths in NC Due to Controlled Substances 2003-2009 900 798 826 844 800 708 700 650 636 589 600 500 466 DEATHS 400 300 200 100 0 2003 2005 2007 2009 2010 Data Extrapolated. J anuary – J une Deaths = 422 Source: NC State M edical Examiner’s Office
NC Admissions To Substance Abuse Treatment by % of Total 10 9 8 7 Other Opiates 6 Stimulants 5 4 Tranquilizers 3 Sedatives 2 1 0 2000 2002 2004 2006 2008 TEDS DATA
Controlled Substances Reporting System NCGS 90-113.70-76 • Passed in August 2005 • Reporting began July 2007 • Required all dispensers to report to a centralized data base • Reporting first year was 1x per month • Required reporting on the 15 th and 30 th per month (August 1, 2008) • Weekly reporting began 01/ 02/ 10
CSRS - Who has Access? State Shall Release Data to: • Persons authorized to prescribe or dispense for the purposes of providing medical care for THEIR patients • A person requesting their own data • The 21 Special Agents of the SBI pursuant to a bona fide investigation • Licensing Boards with jurisdiction over health care professionals- pursuant to an ongoing investigation
CSRS - Who has Access? (con’t) • Primary M onitoring Authorities from other states pursuant to an ongoing investigation • Division of M edical Assistance • DHHS must report “ Unusual Patterns of Prescribing” to the Attorney General – criteria set by a multidisciplinary advisory committee • Anonymous data for research and statistics • M edical Examiners (effective 8/ 9/ 09) • Practitioners may share & document (8/ 9/ 09)
CSRS Data Overview • Over 53,500,000 prescriptions in the database (started July 1, 2007) • Approx. 17 million per year • Over 1,000,000 queries have been made of the system • Over 7400 dispensers and practitioners currently registered to use the system • Averaging 2200 queries per day
CSRS Data J uly-December 2009 • 459,214 Individuals Received Prescriptions for Schedule II Drugs • 146,627,299 Doses (15.31 for each person in NC) • 1,306,915 Persons received RX for 255,359,099 Doses of Schedule II and Schedule III drugs • 2,488,186 persons received RX for 375,628,876 doses of Schedule II,III, and IV Drugs (39 doses for each person in NC - 27% population received at least 1 script)
Trends Schedule II 40 ber of Patients 35 30 Sch II => 10&10 25 Sch II => 15&15 20 15 Linear (Sch II => um 10 10&10) 5 N 0 8 9 0 8 9 0 0 0 0 1 0 0 0 0 0 2 2 2 2 2 t d t d t s s s n n 1 1 1 2 2 Patients with M ultiple Prescribers and Dispensers Source: NC CSRS
Trends Schedule II & III 180 ber of Patients 160 140 120 Sch II & III =>10 100 & 10 80 Sch II & III => 15 & 15 60 Num 40 20 0 1st 2008 2nd 2008 1st 2009 2nd 2009 1st 2010 Patients with M ultiple Prescribers and Dispensers Source: NC CSRS
Trends Schedule II, III & IV 250 atients 200 Sch II, III & IV => ber of P 150 10 &10 Sch II, III & IV => 100 15 &15 um 50 N 0 1st 2008 1st 2009 1st 2010 2nd 2008 2nd 2009 Patients with M ultiple Prescribers and Dispensers Source: NC CSRS
RECOM M ENDATIONS 1. Allow Law Enforcement Drug Investigation Units to Receive Information from the CSRS (But no Direct Access) • Special Software Available • M ust be pursuant to an Investigation • Attorney General Notification Required • SBI Diversion Unit Notification Required • Specialized Training Required
Recommendations (con’t) 2. Require and Record Photo ID from Person picking up prescription 3. Require Physician Dispensed M edication to be Reported into CSRS. • Exclude Hospital ED • Exclude Veterinarians
Recommendations (con’t) 4. Allow Delegated Accounts (Dr. or Pharmacist M ay designate someone in office to do CSRS look-up) • M ust be licensed personnel or Certified Pharmacy Tech • Prescriber or Pharmacist continues to have responsibility and liability
Recommendations (con’t) 5. Change penalty for improper use of the system to a crime. M ajor Breach – Felony. M inor infraction – M isdemeanor 6. Adopt Interstate Compact to allow interstate sharing of information (to be released late 2010)
Recommendations (con’t) 7. Explicitly Permit “Unsolicited Reporting” by DHHS to Prescribers and/ or Dispensers • Permit it but do not mandate • Allow it to be a report or an alert notification • Allow it up to the extent that resources are available • Hold the state immune for reporting or not reporting in good faith 8. Consider Closer Regulation of Pain Clinics
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