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Policies	
  and	
  Laws	
  for	
  Pharmacists	
  
    Dr.	
  Lynn	
  Rafferty,	
  Pharm.	
  D,	
  MBA,	
  N.D.,	
  
                       CNC,	
  CNHP.	
  
     Assistant	
  Professor	
  at	
  The	
  College	
  of	
  
    Medicine,	
  Nova	
  Southeaster	
  University	
  

                   Joel	
  Thornbury	
  
    President,	
  Kentucky	
  Board	
  of	
  Pharmacy	
  	
  
Learning	
  ObjecKves	
  
1.  Describe	
  the	
  relaKonship	
  between	
  federal	
  
    law,	
  state	
  law	
  and	
  other	
  regulatory	
  
    requirements	
  pertaining	
  to	
  diversion.	
  
2.  Outline	
  the	
  variables	
  to	
  consider	
  when	
  
    construcKng	
  a	
  strategy	
  for	
  diversion	
  
    prevenKon,	
  detecKon	
  and	
  remediaKon.	
  
3.  Formulate	
  an	
  effecKve	
  plan	
  of	
  acKon	
  when	
  
    diversion	
  is	
  discovered	
  or	
  suspected.	
  
Disclosure	
  Statement	
  
•  Lynn	
  Lafferty	
  has	
  no	
  financial	
  relaKonships	
  
   with	
  proprietary	
  enKKes	
  that	
  produces	
  health	
  
   care	
  goods	
  and	
  services.	
  	
  
•  Joel	
  Thornbury	
  has	
  no	
  financial	
  relaKonships	
  
   with	
  proprietary	
  enKKes	
  that	
  produces	
  health	
  
   care	
  goods	
  and	
  services.	
  	
  
Florida	
  Law	
  and	
  the	
  PracKce	
  of	
  
             Pharmacy	
  
             Lynn	
  Lafferty,	
  Pharm.D.,	
  N.D.	
  
                  Assistant	
  Professor	
  	
  
           College	
  of	
  Osteopathic	
  Medicine	
  
            Nova	
  Southeastern	
  University	
  
           *SPECIAL	
  THANKS	
  Dr.	
  James	
  Hall,	
  	
  
                 Broward	
  Task	
  Force	
  
Federal	
  Laws	
  
•  Title	
  21	
  United	
  States	
  Code	
  (21	
  U.S.C.)	
  801-­‐971	
  and	
  the	
  
   DEA	
  regulaKons,	
  Title	
  21,	
  Code	
  of	
  Federal	
  RegulaKons	
  
   (21	
  C.F.R.),	
  Parts	
  1300	
  to	
  End.	
  	
  
     –  On	
  line	
  Pharmacists	
  Manuel	
  
     –  Sec$on	
  1306.06	
  Persons	
  en$tled	
  to	
  fill	
  prescrip$ons	
  
“A	
  prescripKon	
  for	
  a	
  controlled	
  substance	
  may	
  only	
  be	
  
filled	
  by	
  a	
  pharmacist,	
  acKng	
  in	
  the	
  usual	
  course	
  of	
  his	
  
professional	
  pracKce	
  and	
  either	
  registered	
  individually	
  or	
  
employed	
  in	
  a	
  registered	
  pharmacy,	
  a	
  registered	
  central	
  
fill	
  pharmacy,	
  or	
  registered	
  insKtuKonal	
  pracKKoner.”	
  
     –  	
  
Florida	
  State	
  Law	
  
•  Title	
  XLVI,	
  Chapter	
  893	
  
•  A	
  pharmacist,	
  in	
  good	
  faith	
  and	
  in	
  the	
  course	
  
   of	
  professional	
  pracKce	
  only,	
  may	
  dispense	
  
   controlled	
  substances	
  upon	
  a	
  wriaen	
  or	
  oral	
  
   prescripKon	
  of	
  a	
  pracKKoner,	
  under	
  the	
  
   following	
  condiKons:	
  	
  
Prescription Drug-Related Deaths
          in Florida: 2011

   5,489 individuals died with one
   or more prescription drugs in their
   system. The drugs were at both
   lethal and non-lethal levels.

Source:	
  	
  Florida	
  Department	
  of	
  Law	
  Enforcement:	
  	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  Florida	
  Medical	
  Examiners	
  Commission	
  Report	
  2011
Physician	
  Dispensing	
  
•  Physicians	
  ordering	
  and	
  dispensing	
  
   prescripKon	
  medicaKons	
  
   –  Used	
  to	
  be	
  limited	
  to	
  emergency	
  supply	
  and	
  
      samples	
  
   –  Large	
  problems	
  with	
  limited	
  benefits	
  to	
  paKents.	
  
Physician	
  Dispensing	
  Pros	
  
•  Improved	
  paKent	
  access	
  to	
  medicaKons	
  
•  PaKent	
  convenience	
  
•  Generic	
  	
  and	
  therapeuKc	
  subsKtuKons	
  due	
  to	
  
   the	
  physician’s	
  enhanced	
  awareness	
  of	
  
   medicaKon	
  costs	
  
•  Possible	
  improved	
  paKent	
  adherence	
  with	
  
   medicaKon	
  regimens	
  
Physician	
  Dispensing	
  Cons	
  
•  Conflict	
  of	
  Interest	
  
    –  Large	
  Problem	
  with	
  narcoKc	
  dispensing	
  
•  Serious	
  medicaKon	
  safety	
  concerns	
  
    –  loss	
  of	
  a	
  crucial	
  second	
  check	
  by	
  a	
  pharmacist	
  and	
  use	
  
       of	
  sofware	
  to	
  detect	
  prescribing	
  errors	
  and	
  ,	
  	
  
    –  lack	
  of	
  regulatory	
  oversight	
  
         •    	
  lax	
  procedures	
  for	
  medicaKon	
  labeling	
  
         •    record-­‐keeping	
  
         •    storage	
  
         •    supervision	
  of	
  the	
  dispenser	
  
Top 25 Dispensing Practitioners of
         Oxycodone in the U.S.
             (All in Florida)
   October2008 – March 2009




ARCOS
Florida
 9,201,731
Dose Units
5,233,785
Dose Units
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Number	
  of	
  Oxycodone	
  Reports	
  Detected	
  	
  	
  	
  
              among	
  Decedents	
  in	
  Broward	
  County:	
  2007-­‐2011	
  
                             250	
  
                                                                 225	
             236	
  
                             200	
  
  NUMBER	
  of	
                                    171	
  
   Oxycodone	
                                                                                    174	
  
 OCCURRENCES	
               150	
  
    Including	
  	
  
  “Present”	
  	
  &	
  
“Cause	
  of	
  Death”	
  
                                                                 Broward	
  
                             100	
       119	
  

                               50	
  

                                 0	
  
                                         2007	
       2008	
      2009	
     2010	
          2011	
  


         	
  SOURCE:	
  Florida	
  Medical	
  Examiners	
  Commission	
  Report	
  2011	
  
Number	
  of	
  Alprazolam	
  Reports	
  Detected	
  	
  
             among	
  Decedents	
  in	
  Broward	
  County:	
  2007-­‐	
  2011	
  
                             300	
  
                                                                 245	
      235	
  
                             250	
  
  NUMBER	
  of	
                                    203	
  
   Alprazolam	
              200	
  
 OCCURRENCES	
  
    Including	
  	
  
                                                                                        199	
  
  “Present”	
  	
  &	
       150	
       133	
  
“Cause	
  of	
  Death”	
  
                             100	
  
                                                               Broward	
  
                               50	
  

                                 0	
  
                                         2007	
     2008	
       2009	
     2010	
     2011	
  

         	
  SOURCE:	
  Florida	
  Medical	
  Examiners	
  Commission	
  Report	
  2011	
  
Number	
  of	
  Emergency	
  Departments	
  Reports	
  	
  	
  	
  
by	
  Drug	
  in	
  Broward	
  &	
  Palm	
  Beach	
  Coun$es,	
  FL:	
  	
  	
  	
  2008,,2009	
  
                                       and	
  2010	
  
                           6,000
# of ED Report Estimates




                                             5,560
                           5,500
                           5,000
                                                             Cocaine	
  
                                                                            4,479
                           4,500
                                                                                                          4,081
                           4,000
                           3,500                                                                      3,299
                           3,000                                       2,913
                                                                                                       3,110
                                      2,351                            2,900
                           2,500
                                        2,274
                                                                             NMU	
  Benzodiazepines	
  
                           2,000
                                        2008                          2009                          2010
    Note:	
   	
   Cocaine	
   visits	
   had	
   sta$s$cally	
   significant	
   decreases	
   from	
   2008	
   to	
   2009.	
   Prescrip$on	
   Opioid	
  
    nonmedical	
   use	
   visits	
   had	
   sta$s$cally	
   significant	
   increases	
   from	
   2008	
   to	
   2010.	
   	
   No	
   sta$s$cally	
  
    significant	
  changes	
  were	
  noted	
  for	
  2008	
  or	
  2009	
  compared	
  with	
  2010	
  for	
  Benzodiazepines.	
  	
  


    SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 2008-2009.
Number	
  of	
  Emergency	
  Departments	
  Reports	
  	
  	
  	
  
by	
  Drug	
  in	
  Broward	
  &	
  Palm	
  Beach	
  Coun$es,	
  FL:	
  	
  	
  	
  2008,,2009	
  
                                       and	
  2010	
  
                           6,000
# of ED Report Estimates




                                             5,560
                           5,500
                           5,000
                                                             Cocaine	
  
                                                                            4,479
                           4,500
                                                                                                          4,081
                           4,000
                           3,500                                                                      3,299
                                          2,928                        2,913                             3,249
                           3,000
                           2,500
                                      2,351                           2,870           Marijuana	
  
                           2,000
                                        2008                          2009                          2010
    Note:	
   	
   Cocaine	
   visits	
   had	
   sta$s$cally	
   significant	
   decreases	
   from	
   2008	
   to	
   2009.	
   Prescrip$on	
   Opioid	
  
    nonmedical	
   use	
   visits	
   had	
   sta$s$cally	
   significant	
   increases	
   from	
   2008	
   to	
   2010.	
   	
   No	
   sta$s$cally	
  
    significant	
  changes	
  were	
  noted	
  for	
  2008	
  or	
  2009	
  compared	
  with	
  2010	
  for	
  Marijuana.	
  	
  


    SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 2008-2009.
Number	
  of	
  Heroin-­‐related	
  Deaths	
  	
  
                                                in	
  Florida:	
  2000	
  –2011	
  

                                      400
                                                              12	
  	
  ??	
  
                                                            20                       Florida
#	
  Lethal	
  Heroin	
  Deaths	
  




                                      350                                            Miami-Dade
                                      300
                                                                                     Broward
                                      250
                                      200
                                      150
                                      100
                                                                                                  62	
  
                                       50                                                         15	
  
                                        0                                                         3	
  




                                      SOURCE: Florida Medical Examiners Commission Reports 2000-2011
Sun	
  SenKnel	
  February	
  19,	
  2013	
  
•  “Heroin	
  taking	
  oxy's	
  place	
  for	
  more	
  addicts”	
  
    –  Heroin	
  increasing	
  	
  
    –  Lost	
  opportunity	
  to	
  get	
  people	
  into	
  treatment	
  
Number	
  of	
  Primary	
  Heroin	
  Treatment	
  Admissions	
  
                                                    Miami-­‐Dade	
  and	
  Broward	
  Coun$es,	
  FL:	
  2009-­‐2012	
  

                                                      350	
  
                                                                                                                                                          Broward	
                                       316	
  
#	
  of	
  primary	
  Treatment	
  Admissions	
  




                                                                      Miami-­‐Dade	
                                             308	
  
                                                      300	
  
                                                      250	
                                                   227	
  
                                                      200	
                                183	
  
                                                                        150	
                                                                                         156	
   169	
  
                                                      150	
  
                                                                                                                                                   105	
  
                                                      100	
  
                                                        50	
  
                                                          0	
  
                                                                   	
  	
  	
  2009	
  	
  	
  	
  2010	
  	
  	
  	
  2011	
  	
  	
  2012*	
  	
  	
  	
  	
  2009	
  	
  	
  	
  2010	
  	
  	
  	
  2011	
  	
  2012*
                                                                                1	
                 2	
                 3	
             4	
                     5	
                 6	
                 7	
          8	
     	
  
                                                                             *	
  2012	
  Admissions	
  based	
  on	
  2	
  x‘s	
  1st	
  Half	
  2012	
  
                                                                  SOURCE:	
  Florida	
  Department	
  of	
  Children	
  and	
  Families
                                                                                                                                      	
  
FL	
  House	
  Bill	
  7095	
  
                                 EffecKve	
  July	
  1,	
  2011	
  
•  PracKoners	
  no	
  longer	
  authorized	
  to	
  dispense	
  Schedule	
  II	
  or	
  III	
  
   controlled	
  substances.	
  
     –  Except:	
  Emergency	
  72	
  hr.	
  supply,	
  correcKons,	
  hospice,	
  clinical	
  trials,	
  surgical	
  
        procedures,	
  and	
  methadone	
  clinics	
  
•  Standards	
  Made	
  Clear	
  
     –    Complete	
  medical	
  history	
  
     –    Wriaen	
  individualized	
  RX	
  plan	
  
     –    Wriaen	
  controlled	
  substance	
  	
  agreement	
  
     –    Reg.	
  follow-­‐up	
  plan	
  
•  Must	
  designate	
  themselves	
  as	
  a	
  controlled	
  substance	
  
   prescribing	
  pracKKoner	
  
•  Counterfeit-­‐proof	
  Rx	
  pad	
  
Pharmacist	
  
•  Number	
  one	
  most	
  respected	
  professional	
  
•  Most	
  Accessible	
  
    –  More	
  paKent	
  contacts	
  than	
  any	
  other	
  health	
  care	
  
       professional	
  
•  Has	
  access	
  to	
  paKent,	
  doctor	
  and	
  informaKon	
  
•  CriKcized	
  not	
  taking	
  a	
  strong	
  role	
  in	
  addicKon	
  
   medicine	
  
Knowledge,	
  Aktudes	
  and	
  PracKces	
  of	
  Pharmacists	
  
Concerning	
  PrescripKon	
  Drug	
  Abuse,	
  Lafferty,	
  Hunter	
  and	
  
Marsh	
  

•    454	
  Pharmacists	
  QuesKoned	
  
•    65%	
  Retail,	
  16.5%	
  Hospital,	
  9%	
  Mail	
  order	
  
•    68%	
  B.S.,	
  25%	
  Pharm.D.	
  
•    65%	
  Male	
  and	
  35%	
  Female	
  
•    65%	
  over	
  45	
  years	
  old	
  
Results	
  
•  Knowledge	
  
   –  Most	
  did	
  not	
  answer	
  the	
  addicKon	
  quesKons	
  
      correctly	
  
       •  Only	
  28%	
  knew	
  the	
  standard	
  of	
  care	
  
       •  Less	
  than	
  half	
  said	
  they	
  knew	
  about	
  intervenKon	
  and	
  
          treatment	
  
•  EducaKon	
  
   –  Almost	
  30%	
  had	
  no	
  substance	
  abuse	
  educaKon	
  
   –  67.5%	
  had	
  less	
  than	
  2	
  hours	
  
Treatment	
  and	
  IntervenKon	
  
•  Although	
  most	
  had	
  not	
  intervened,	
  the	
  more	
  
   educaKon	
  they	
  had	
  the	
  more	
  confident	
  they	
  
   were	
  to	
  do	
  intervenKon	
  
•  They	
  were	
  also	
  more	
  likely	
  to	
  call	
  the	
  physician	
  
   to	
  speak	
  about	
  a	
  problem.	
  
EducaKon	
  Needed	
  
•  Pharmacists	
  can	
  help	
  by:	
  
    –  Calling	
  doctors	
  when	
  they	
  believe	
  there	
  is	
  a	
  
       problem	
  
    –  Speaking	
  to	
  alternaKves	
  to	
  paKent	
  
    –  Checking	
  and	
  making	
  sure	
  they	
  are	
  not	
  using	
  
       mulKple	
  pharmacies	
  and	
  doctors	
  
    –  Intervening	
  
Discussion	
  
•  Pharmacists	
  Role	
  
    –  CerKficaKon	
  program	
  
    –  EducaKon	
  needed	
  to	
  have	
  a	
  greater	
  role	
  
    –  Pain	
  pharmacy	
  
•  Society	
  at	
  Large	
  
    –  Oxycodone	
  vs.	
  Heroin	
  	
  
Abuse…a	
  problem….Hello?	
  
                  Yes,	
  
	
  Kentucky	
  Pharmacy	
  is	
  Here!!	
  

            April	
  2	
  –	
  4,	
  2013	
  
          Omni	
  Orlando	
  Resort	
  	
  
           at	
  ChampionsGate	
  
Policies and laws_for_pharmacists_final_rev
Topics	
  for	
  Discussion	
  
•  1.	
  Describe	
  what	
  SS-­‐HB1	
  has	
  done	
  to	
  affect	
  the	
  
   Profession	
  and	
  help	
  reduce	
  diversion.	
  
•  2.	
  Provide	
  an	
  update	
  on	
  issues	
  we	
  faced	
  and	
  what	
  Bill	
  
   has	
  just	
  passed	
  and	
  signed	
  to	
  correct	
  issues.	
  
•  3.	
  Formulate	
  an	
  effecKve	
  plan	
  of	
  acKon	
  when	
  
   diversion	
  is	
  discovered	
  or	
  suspected.	
  
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev
Policies and laws_for_pharmacists_final_rev

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Policies and laws_for_pharmacists_final_rev

  • 1. Policies  and  Laws  for  Pharmacists   Dr.  Lynn  Rafferty,  Pharm.  D,  MBA,  N.D.,   CNC,  CNHP.   Assistant  Professor  at  The  College  of   Medicine,  Nova  Southeaster  University   Joel  Thornbury   President,  Kentucky  Board  of  Pharmacy    
  • 2. Learning  ObjecKves   1.  Describe  the  relaKonship  between  federal   law,  state  law  and  other  regulatory   requirements  pertaining  to  diversion.   2.  Outline  the  variables  to  consider  when   construcKng  a  strategy  for  diversion   prevenKon,  detecKon  and  remediaKon.   3.  Formulate  an  effecKve  plan  of  acKon  when   diversion  is  discovered  or  suspected.  
  • 3. Disclosure  Statement   •  Lynn  Lafferty  has  no  financial  relaKonships   with  proprietary  enKKes  that  produces  health   care  goods  and  services.     •  Joel  Thornbury  has  no  financial  relaKonships   with  proprietary  enKKes  that  produces  health   care  goods  and  services.    
  • 4. Florida  Law  and  the  PracKce  of   Pharmacy   Lynn  Lafferty,  Pharm.D.,  N.D.   Assistant  Professor     College  of  Osteopathic  Medicine   Nova  Southeastern  University   *SPECIAL  THANKS  Dr.  James  Hall,     Broward  Task  Force  
  • 5. Federal  Laws   •  Title  21  United  States  Code  (21  U.S.C.)  801-­‐971  and  the   DEA  regulaKons,  Title  21,  Code  of  Federal  RegulaKons   (21  C.F.R.),  Parts  1300  to  End.     –  On  line  Pharmacists  Manuel   –  Sec$on  1306.06  Persons  en$tled  to  fill  prescrip$ons   “A  prescripKon  for  a  controlled  substance  may  only  be   filled  by  a  pharmacist,  acKng  in  the  usual  course  of  his   professional  pracKce  and  either  registered  individually  or   employed  in  a  registered  pharmacy,  a  registered  central   fill  pharmacy,  or  registered  insKtuKonal  pracKKoner.”   –   
  • 6. Florida  State  Law   •  Title  XLVI,  Chapter  893   •  A  pharmacist,  in  good  faith  and  in  the  course   of  professional  pracKce  only,  may  dispense   controlled  substances  upon  a  wriaen  or  oral   prescripKon  of  a  pracKKoner,  under  the   following  condiKons:    
  • 7. Prescription Drug-Related Deaths in Florida: 2011 5,489 individuals died with one or more prescription drugs in their system. The drugs were at both lethal and non-lethal levels. Source:    Florida  Department  of  Law  Enforcement:                      Florida  Medical  Examiners  Commission  Report  2011
  • 8. Physician  Dispensing   •  Physicians  ordering  and  dispensing   prescripKon  medicaKons   –  Used  to  be  limited  to  emergency  supply  and   samples   –  Large  problems  with  limited  benefits  to  paKents.  
  • 9. Physician  Dispensing  Pros   •  Improved  paKent  access  to  medicaKons   •  PaKent  convenience   •  Generic    and  therapeuKc  subsKtuKons  due  to   the  physician’s  enhanced  awareness  of   medicaKon  costs   •  Possible  improved  paKent  adherence  with   medicaKon  regimens  
  • 10. Physician  Dispensing  Cons   •  Conflict  of  Interest   –  Large  Problem  with  narcoKc  dispensing   •  Serious  medicaKon  safety  concerns   –  loss  of  a  crucial  second  check  by  a  pharmacist  and  use   of  sofware  to  detect  prescribing  errors  and  ,     –  lack  of  regulatory  oversight   •   lax  procedures  for  medicaKon  labeling   •  record-­‐keeping   •  storage   •  supervision  of  the  dispenser  
  • 11. Top 25 Dispensing Practitioners of Oxycodone in the U.S. (All in Florida) October2008 – March 2009 ARCOS
  • 17. Number  of  Oxycodone  Reports  Detected         among  Decedents  in  Broward  County:  2007-­‐2011   250   225   236   200   NUMBER  of   171   Oxycodone   174   OCCURRENCES   150   Including     “Present”    &   “Cause  of  Death”   Broward   100   119   50   0   2007   2008   2009   2010   2011    SOURCE:  Florida  Medical  Examiners  Commission  Report  2011  
  • 18. Number  of  Alprazolam  Reports  Detected     among  Decedents  in  Broward  County:  2007-­‐  2011   300   245   235   250   NUMBER  of   203   Alprazolam   200   OCCURRENCES   Including     199   “Present”    &   150   133   “Cause  of  Death”   100   Broward   50   0   2007   2008   2009   2010   2011    SOURCE:  Florida  Medical  Examiners  Commission  Report  2011  
  • 19. Number  of  Emergency  Departments  Reports         by  Drug  in  Broward  &  Palm  Beach  Coun$es,  FL:        2008,,2009   and  2010   6,000 # of ED Report Estimates 5,560 5,500 5,000 Cocaine   4,479 4,500 4,081 4,000 3,500 3,299 3,000 2,913 3,110 2,351 2,900 2,500 2,274 NMU  Benzodiazepines   2,000 2008 2009 2010 Note:     Cocaine   visits   had   sta$s$cally   significant   decreases   from   2008   to   2009.   Prescrip$on   Opioid   nonmedical   use   visits   had   sta$s$cally   significant   increases   from   2008   to   2010.     No   sta$s$cally   significant  changes  were  noted  for  2008  or  2009  compared  with  2010  for  Benzodiazepines.     SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 2008-2009.
  • 20. Number  of  Emergency  Departments  Reports         by  Drug  in  Broward  &  Palm  Beach  Coun$es,  FL:        2008,,2009   and  2010   6,000 # of ED Report Estimates 5,560 5,500 5,000 Cocaine   4,479 4,500 4,081 4,000 3,500 3,299 2,928 2,913 3,249 3,000 2,500 2,351 2,870 Marijuana   2,000 2008 2009 2010 Note:     Cocaine   visits   had   sta$s$cally   significant   decreases   from   2008   to   2009.   Prescrip$on   Opioid   nonmedical   use   visits   had   sta$s$cally   significant   increases   from   2008   to   2010.     No   sta$s$cally   significant  changes  were  noted  for  2008  or  2009  compared  with  2010  for  Marijuana.     SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 2008-2009.
  • 21. Number  of  Heroin-­‐related  Deaths     in  Florida:  2000  –2011   400 12    ??   20 Florida #  Lethal  Heroin  Deaths   350 Miami-Dade 300 Broward 250 200 150 100 62   50 15   0 3   SOURCE: Florida Medical Examiners Commission Reports 2000-2011
  • 22. Sun  SenKnel  February  19,  2013   •  “Heroin  taking  oxy's  place  for  more  addicts”   –  Heroin  increasing     –  Lost  opportunity  to  get  people  into  treatment  
  • 23. Number  of  Primary  Heroin  Treatment  Admissions   Miami-­‐Dade  and  Broward  Coun$es,  FL:  2009-­‐2012   350   Broward   316   #  of  primary  Treatment  Admissions   Miami-­‐Dade   308   300   250   227   200   183   150   156   169   150   105   100   50   0        2009        2010        2011      2012*          2009        2010        2011    2012* 1   2   3   4   5   6   7   8     *  2012  Admissions  based  on  2  x‘s  1st  Half  2012   SOURCE:  Florida  Department  of  Children  and  Families  
  • 24. FL  House  Bill  7095   EffecKve  July  1,  2011   •  PracKoners  no  longer  authorized  to  dispense  Schedule  II  or  III   controlled  substances.   –  Except:  Emergency  72  hr.  supply,  correcKons,  hospice,  clinical  trials,  surgical   procedures,  and  methadone  clinics   •  Standards  Made  Clear   –  Complete  medical  history   –  Wriaen  individualized  RX  plan   –  Wriaen  controlled  substance    agreement   –  Reg.  follow-­‐up  plan   •  Must  designate  themselves  as  a  controlled  substance   prescribing  pracKKoner   •  Counterfeit-­‐proof  Rx  pad  
  • 25. Pharmacist   •  Number  one  most  respected  professional   •  Most  Accessible   –  More  paKent  contacts  than  any  other  health  care   professional   •  Has  access  to  paKent,  doctor  and  informaKon   •  CriKcized  not  taking  a  strong  role  in  addicKon   medicine  
  • 26. Knowledge,  Aktudes  and  PracKces  of  Pharmacists   Concerning  PrescripKon  Drug  Abuse,  Lafferty,  Hunter  and   Marsh   •  454  Pharmacists  QuesKoned   •  65%  Retail,  16.5%  Hospital,  9%  Mail  order   •  68%  B.S.,  25%  Pharm.D.   •  65%  Male  and  35%  Female   •  65%  over  45  years  old  
  • 27. Results   •  Knowledge   –  Most  did  not  answer  the  addicKon  quesKons   correctly   •  Only  28%  knew  the  standard  of  care   •  Less  than  half  said  they  knew  about  intervenKon  and   treatment   •  EducaKon   –  Almost  30%  had  no  substance  abuse  educaKon   –  67.5%  had  less  than  2  hours  
  • 28. Treatment  and  IntervenKon   •  Although  most  had  not  intervened,  the  more   educaKon  they  had  the  more  confident  they   were  to  do  intervenKon   •  They  were  also  more  likely  to  call  the  physician   to  speak  about  a  problem.  
  • 29. EducaKon  Needed   •  Pharmacists  can  help  by:   –  Calling  doctors  when  they  believe  there  is  a   problem   –  Speaking  to  alternaKves  to  paKent   –  Checking  and  making  sure  they  are  not  using   mulKple  pharmacies  and  doctors   –  Intervening  
  • 30. Discussion   •  Pharmacists  Role   –  CerKficaKon  program   –  EducaKon  needed  to  have  a  greater  role   –  Pain  pharmacy   •  Society  at  Large   –  Oxycodone  vs.  Heroin    
  • 31. Abuse…a  problem….Hello?   Yes,    Kentucky  Pharmacy  is  Here!!   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  • 33. Topics  for  Discussion   •  1.  Describe  what  SS-­‐HB1  has  done  to  affect  the   Profession  and  help  reduce  diversion.   •  2.  Provide  an  update  on  issues  we  faced  and  what  Bill   has  just  passed  and  signed  to  correct  issues.   •  3.  Formulate  an  effecKve  plan  of  acKon  when   diversion  is  discovered  or  suspected.