This document summarizes a presentation on pharmacists working with local coalitions and prescription drug monitoring programs (PDMPs). It discusses Nicole O'Kane presenting on how pharmacists can utilize PDMPs to screen for safety concerns and optimize patient care. It also discusses Kristina Clark and Christina Merino presenting on how a local coalition in Coffee County, TN engaged pharmacists and other stakeholders to reduce prescription drug abuse through education, monitoring, and evaluation.

1. Pharmacy Track:
Pharmacists Working with
Local Coalitions and PDMPs
Presenters:
• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health
• Kristina Clark, CPS-II, Executive Director, Coffee County (TN)
Anti-Drug Coalition
• Christina Merino, CPS-II, Prevention Coordinator, Coffee County
(TN) Anti-Drug Coalition
Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director,
Health Policy, American Pharmacists Association, and Member, Rx
Summit National Advisory Board

2. Disclosures
• Nicole O'Kane, PharmD; Kristina Clark, CPS-II; Christina
Merino, CPS-II; and Michael H. Ghobrial, PharmD, JD, have
disclosed no relevant, real, or apparent personal or
professional financial relationships with proprietary entities
that produce healthcare goods and services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
– Carla Saunders – Speaker’s bureau: Abbott Nutrition

4. Learning Objectives
1. Identify ways pharmacists may contribute to the
reduction of Rx drug abuse, misuse and
diversion.
2. Explain the critical role for pharmacists in
collaborative and outreach efforts to reduce Rx
drug abuse, misuse and diversion.
3. Describe how pharmacists may utilize the PDMP
to screen for potential safety concerns.
4. Specify recommendations for optimizing
pharmacists’ use of the PDMP to improve
patient care.

5. Pharmacist’s Role in Addressing
Addiction and Diversion: PDMP as
an Important Clinical Tool
Nicole O’Kane, PharmD
Clinical Director
Acumentra Health

6. Disclosure Statement
Nicole O’Kane, PharmD, has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services.

7. Learning Objectives
1. Describe how pharmacists may utilize the
PDMP to screen for potential safety
concerns.
2. Specify recommendations for optimizing
pharmacists’ use of the PDMP to improve
patient care.

8. Outline
1. Introduction
2. The expanding role of pharmacists
3. Practitioner use of the Oregon Prescription
Drug Monitoring Program (PDMP)
4. Oregon initiatives

9. Acumentra Health
• Portland-based nonprofit consulting firm,
dedicated to improving quality, safety, and
effectiveness of health care
• Collaborate with practitioners in all care
settings, and with purchasers, community-
based organizations, professional associations,
policy makers, and consumers
www.acumentra.org

10. Use of Prescription Monitoring Programs
to Improve Patient Care and Outcomes
• 5-year grant (2012‒2017) to study effectiveness
of the Oregon Prescription Drug Monitoring
Program as a clinical decision tool for prescribers
of controlled substance medications
Supported by the National Institutes of Health, National Institute for
Drug Abuse through Grant # 1 R01 DA031208-01A1, and by the
National Center for Research Resources and the National Center for
Advancing Translational Sciences, through grant UL1RR024140

11. Study Aims
AIM 1:
Determine the prevalence and characteristics of PDMP
users and non-users
AIM 2:
Determine how providers use PDMP data; formulate
recommendations for clinical guidelines
AIM 3:
Determine whether PDMP use improves patient outcomes
and reduces apparent diversion/abuse

12. Pharmacists in Health Care
• Community pharmacies
• Hospital systems
• Primary care clinics
• Specialty care
• Home infusion
• Long-term care settings
• Health plans
• Public heath policy
12

13. Pharmacists in Health Care
Community pharmacists
Clinical pharmacists
The expanding role of pharmacists

14. Pharmacist Responsibility
The dispensing pharmacist is in the same
position as the practitioner who issued the
prescription and must exercise professional
judgment to determine whether a prescription
for a controlled substance was issued for a
legitimate reason.
DEA regulations (21 CFR §1306.04)
http://deachronicles.quarles.com/2013/08/a-pharmacists-obligation-corresponding-
responsibility-and-red-flags-of-diversion/

15. Pharmacist Responsibility
Assessment of each patient and prescription:
• Legitimate medical need
• Possible intent to divert or misuse controlled
substances
• Possible addiction that requires appropriate
referral and treatment

16. Pharmacist Survey Results
• PDMP perceived as a valuable screening tool
• Half report receiving training in identifying
prescription drug diversion, abuse, or
addiction
• Interest in screening and discussing misuse
Cobaugh, D. J., et al. Am J Health Syst Pharm, 2014;71(18), 1539-1554.
Gavaza, P., et al. Res Social Adm Pharm, 2014;10(2), 448-458.
Hagemeier, N. E., et al. Subst Use Misuse, 2013;48(9), 761-768.
Cochran G., et al. J Pharm Pract. 2014 Feb 13 [epub ahead of print]

17. Pharmacist Survey Results
• Potential safety concerns prompt additional
actions
– Contact prescriber
– Contact other pharmacies
– Specific patient counseling or referral
– Deny prescription

18. Pharmacist Use of PDMP
• New corporate policies include additional
requirements and documentation
– Prevent diversion or abuse
– Concerns about access for legitimate pain need
• Barriers to workflow integration
• Lack evidence on best practices
http://www.nabp.net/system/rich/rich_files/rich_files/000/000/209/original/consens
us-document.pdf

19. Oregon PDMP
This program seeks to promote public health
and welfare and help improve patient care. The
information helps healthcare providers and
pharmacists to better manage patients'
prescriptions to improve quality of care. It also
supports the appropriate use of prescription
drugs.
http://www.orpdmp.com

20. Oregon PDMP
• Program began data upload June 2011
• Oregon National Governor’s Association Task
Force on Prescription Drug Abuse 2012
• PDMP enhancements include allowing
delegate users starting January 2014
http://www.orpdmp.com

21. Cumulative Number of System
Accounts by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports:
http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

22. New System Accounts
by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports:
http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

23. Users Submitting Queries
by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports:
http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

24. Number of System Queries
by Discipline
Deyo, R. A., Irvine, J. M., et al. Clin J Pain. Nov 2014. Oregon PDMP home, reports:
http://www.orpdmp.com/quarterly-reports.html accessed February 23, 2015.

25. Oregon Initiatives
• Medically supervised lay person naloxone
rescue program
• Coordinating efforts across systems
– Methadone removed from state formulary
– Community take-back days
– Oregon Pain Guidance website:
www.southernoregonopioidmanagement.org
http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/
Documents/oregon-drug-overdose-report.pdf

26. A Socio-Ecological Model
Organizational
organizations,
social institutions
Individual
knowledge,
attitudes, skill
Interpersonal
family, friends,
social networks
Community
county, town,
neighborhood
Society & public policy
national, state, and local
laws and regulations
26

27. “To stem the tide of the unintended
consequences of the promotion of drug use it
will be necessary for health systems, clinicians,
academics, epidemiologists, patients,
pharmacists, communities, law enforcement,
and pain specialists to work together. “
- Drug Overdose Deaths, Hospitalizations, Abuse and
Dependency among Oregonians Report 2014
http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/
Documents/oregon-drug-overdose-report.pdf

28. Pharmacists Working with Local
Coalitions and PDMPs
Kristina Clark, Executive Director
&
Christina Merino, Prevention Coordinator
Coffee County Anti-Drug Coalition, Tennessee

29. Disclosure Statements
• Kristina Clark, CPS II, Executive Director, has
disclosed no relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care goods
or services.
• Christina Merino, CPS II, Prevention Coordinator,
has disclosed no relevant, real or apparent
personal or professional financial relationships
with proprietary entities that produce health care
goods or services.

30. Learning Objectives
1. Identify ways pharmacists may contribute to
the reduction of Rx drug abuse, misuse and
diversion.
2. Explain the critical role for pharmacists in
collaborative and outreach efforts to reduce
Rx drug abuse, misuse and diversion.

31. Strategic Prevention
Framework
5 steps of effective prevention

32. Assessment
The Problem: Non-Medical Use of Prescription Drugs

33. Contributing
Factors:
Community Based
A. Ease of Access
1. Home
2. School
B. Perception of Harm
1. of Parents
2. of Youth
Access Harm Abuse

34. Capacity & Planning
Medical Professional Forum
• Key Stakeholders
• Implements
• Time Constraints
Communication Plan
• Accountability for
Deliverables
• Strategic Targeting
- Pharmacies
- Doctors
- Dentists
• Action Planning
Focus
Groups
Plan
Team
Action!

35. Taking Rx Abuse Prevention One Step
Further than PDMP’s
Indicated
Selective
Universal

36. Community Level Change
Education
Written
Prescription
Consultation
Prescription
Obtained
Behavior
Change
Implementation

37. Evaluation
Dropped 30 day
prescription drug use by
approximately 25% in 6th,
8th, 10th, and 12th grades.*
Increased by 20%
the number of youth with
clear family rules
concerning alcohol,
tobacco, and other drugs.*
Increased by 18% the
number of 10th and 12th
graders reporting that it is
harder to get prescription
drugs.*
*2009 compared to 2012 Student Survey Data

38. Evaluation
Increased from 0% to
24% the number of
community members who
report locking up their
medications.*
Decreased by 24% the
number of community
members reporting keeping
prescription medications.*
Increased community
members tracking
medications from 0% to
21%.*
Decreased by 50% the
students reporting sharing
prescription drugs (2009
compared to 2012 Student
Survey Data).
*2009 compared to 2012 Drug Take Back Survey Data

39. Questions
Thank you for your time and attention.
Kristina Clark
kclark@ccantidrug.org
Christina Merino
cmerino@ccantidrug.org
Coffee County Anti-Drug Coalition
(931) 570-4484 – Office
(931) 570-2361 - Fax

40. Pharmacy Track:
Pharmacists Working with
Local Coalitions and PDMPs
Presenters:
• Nicole O'Kane, PharmD, Clinical Director, Acumentra Health
• Kristina Clark, CPS-II, Executive Director, Coffee County (TN)
Anti-Drug Coalition
• Christina Merino, CPS-II, Prevention Coordinator, Coffee County
(TN) Anti-Drug Coalition
Moderator: Michael H. Ghobrial, PharmD, JD, Associate Director,
Health Policy, American Pharmacists Association, and Member, Rx
Summit National Advisory Board