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Daniel M Alexander, RPhBS Clinical Chemistry Michigan State Univ.BS Pharmacy Ferris State Univ.President/CEO Lakeshore Pha...
 I have no financial relationships to disclose
 Why do we need tools to monitor patients? Discuss the most common pharmaceuticals ofabuse Identify a useful tool to id...
U.S. Drug Overdose Deaths By Major Drug Type, 1999-2010OpioidsBenzo’sHeroinCocaineSource CDC/NCHS, NVSS
Prescription Drug AbuseMore Americans abuse prescription drugs than the numberof:Cocaine, Hallucinogen, Heroin, and Inhala...
Teen Prescription Drug Abuse- One in four teens (24%) reports having misused orabused a prescription drug at least once in...
Teen Prescription Drug Abuse•One-Third of teens (33%) say they believe “it’s okay to useprescription drugs that were not p...
New Initiates 2011 -12 Years and olderNote: Numbers refer to persons who used a specific drug for the first time in the pa...
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Source: CDC/NCHS, National Vital Statistics System
Vital Signs is there a fifth Vital Sign?TemperatureHeart RateBlood PressureRespirationPain?
MAPSMichigan AutomatedPrescription System
 Health Professional Boards. Investigation Employee or agent of the Department State, Federal, or Municipal employee or...
 Received $20,000 grant to implementautomated letter generation. March 2012: 2144 letters. April 2012: 1799 letters 20...
 October 15, 2008  «Company»«FirstName» «Last Name»«Address1»«City», «State»  «Postal Code»Dear «Title»: The Michigan Auto...
 New formulation by Purdue Patients calling for old formula. Canada Used callous shaver to “peel” tablets. Snorting ne...
 Oxymorphone long acting Expensive 10,770 Scripts in 2010 47,979 scripts in 2011
 50% to Florida 31,689 Scripts in 2010 113,973 Scripts 1n 2011
 Used for decades to treat drug addiction Increasingly prescribed for pain As increased use for pain so has methadone r...
 Fentanyl Patches, Fentanyl Citrate berry flavored lollipop Fentanyl 100 times more potent than morphine Intended to be...
 alprazolam 1mg 539,215 Scripts in 2010 alprazolam 1mg 582,656 Scripts in 2011 alprazolam 2mg 139,400 Scripts in 2010 ...
 One in Eight Teens (about 2.7 million) now report havingmisused or abused prescription stimulants at least oncein their ...
 Popular in street culture Purp, Spritz, Wholesale price $11.00 Pint (480ml) Pharmacy sells for $300.00 Pint Dealer s...
 264,210 Scripts in 2010 298,492 Scripts in 2011 Most scripts are for a Pint (480ml)
 Schedule IV in January 2012 Reportable to MAPS Popular with hydrocodone combos(Trinity, alprazolam) Higher dose appea...
 Eventually NABP wants to collect data. Leverage PMP’s with chains to run data reportsautomatically when script dispense...
 Interstate data sharing is included in MAPS! Ohio now operational. Hub operated by NABP (National Association ofBoards...
 Lack of knowledge. False beliefs (time consuming, staff) Laziness. Don’t want to be bothered. Stubborn. Practiced for...
Prescription for Methadone 10mg #240 12/23MAPS for New Patient-Eight physicians have been writing for drug-Noticed MAPS re...
Patient enters pharmacy with prescription forMethylpenidate 5mg #270 SIG: 3 t.i.d.MAPS for new patient:-Two physicians pre...
 Department of Licensing and Reg. Affairs Bureau of Health Professions Health Investigation Division www.michigan.gov/...
Please Login or Sign-Up to use Single Sign-On WARNING: To maintain your login session, make sure that your browser isconf...
The MAPS Report Information:_____________________________________________________________________________________Patient’s...
 Q. Do practitioners have to dispense controlledsubstances to be able to register to MAPS Online? A. No. All practitioner...
 Q. Can a practitioner request a MAPSreport on other practitioners?A. No. Practitioners may not request reports onother p...
 Q. What is the definition of a "dispensingpractitioner"?A. A dispensing practitioner is a practitioner who gives aprescr...
 Q. If a practitioner dispenses controlled substances anddoes not have online computer capabilities, how does thepractiti...
Safe Prescribing Practices Conference for Medical Professionals, June 2013
Safe Prescribing Practices Conference for Medical Professionals, June 2013
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Safe Prescribing Practices Conference for Medical Professionals, June 2013

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Participants will:
Report their intent to support and/or actively work towards incorporating best practices in responsible prescribing guidelines into their everyday practice of medicine.
Report an increased knowledge of the Michigan Automated Prescription System (MAPS) and the benefits of reporting regularly to MAPS.
Report intent to support and/or actively work towards incorporating consistent use of the MAPS into their everyday practice of prescribing controlled substances.
Report that at the training they received easy to use tools that can help them to better educate their patients on the importance of taking medications as prescribed.
Gain an increased knowledge of local, state, and national substance abuse and mental health treatment resources.

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  • Introduction
  • Note number of famous people that have died due to combinations of pain medications and also those that admit abuse including Rush Limbaugh, Federal Judge Jack Camp, Billy Mays, Thomas Kinkade New York Rangers Derek Boogard
  • First four are objective and the last subjective………Where did this come from? The drug companies?
  • Dr. Shopper Letter
  • Transcript of "Safe Prescribing Practices Conference for Medical Professionals, June 2013"

    1. 1. Daniel M Alexander, RPhBS Clinical Chemistry Michigan State Univ.BS Pharmacy Ferris State Univ.President/CEO Lakeshore Pharmacies, Inc.
    2. 2.  I have no financial relationships to disclose
    3. 3.  Why do we need tools to monitor patients? Discuss the most common pharmaceuticals ofabuse Identify a useful tool to identify those who manybe abusing and diverting prescription medications(MAPS) MAPS its use and information to the health careprovider The MAPS Report MAPS Limitations
    4. 4. U.S. Drug Overdose Deaths By Major Drug Type, 1999-2010OpioidsBenzo’sHeroinCocaineSource CDC/NCHS, NVSS
    5. 5. Prescription Drug AbuseMore Americans abuse prescription drugs than the numberof:Cocaine, Hallucinogen, Heroin, and Inhalant abusersCombined!!!
    6. 6. Teen Prescription Drug Abuse- One in four teens (24%) reports having misused orabused a prescription drug at least once in theirlifetime, which is approximately 5 million teens.-In comparison, 18% of teens in 2008 and 24% of teens in 2012reported the same- Of those kids who said they abused prescriptionmedications, one in five (20%) has done it beforeage 14.-More than a quarter of teens (27%) mistakenlybelieve that misusing and abusing prescriptiondrugs is safer than using street drugs.-One in four teens (25%) says there is little or no riskin using prescription pain relievers without aprescription.Source:2012 Partnership Attitude Tracking Study, Published 4/23/2013
    7. 7. Teen Prescription Drug Abuse•One-Third of teens (33%) say they believe “it’s okay to useprescription drugs that were not prescribed to them to dealwith an injury, illness, or physical pain”•One in five teens (20%) says prescription pain relievers arenot addictive•Almost one in four teens (23%) say their parents don’t careas much if they are caught using prescription drugs withouta doctor’s prescription, compared to getting caught withillegal drugs.DEA Operations Division :Source 2012 Partnership Attitude Tracking Study, Published 04/23/2013
    8. 8. New Initiates 2011 -12 Years and olderNote: Numbers refer to persons who used a specific drug for the first time in the past year, regardless ofwhether initiation of other drug use occurred prior to that year. Source 2011 NSDUH
    9. 9. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Source: CDC/NCHS, National Vital Statistics System
    10. 10. Vital Signs is there a fifth Vital Sign?TemperatureHeart RateBlood PressureRespirationPain?
    11. 11. MAPSMichigan AutomatedPrescription System
    12. 12.  Health Professional Boards. Investigation Employee or agent of the Department State, Federal, or Municipal employee or agentwhose duty is to enforce drug laws. State operated Medicaid program. Practitioner or pharmacist who certifies info is fortreatment of bona fide current patient. Insurance Company “Patient Safety” “Fraud”
    13. 13.  Received $20,000 grant to implementautomated letter generation. March 2012: 2144 letters. April 2012: 1799 letters 2011 Shopper list at 6 or more: 530. 2011 Shopper list at 10 or more: 49 2012 Shopper list at 6 for more: 251 2012 Shopper list at 10 or more: 9
    14. 14.  October 15, 2008  «Company»«FirstName» «Last Name»«Address1»«City», «State»  «Postal Code»Dear «Title»: The Michigan Automated Prescription System (MAPS) program has identified your patient «Patient», «DOB», «Address2», who appears to be seeking treatment from multiple physicians and obtaining controlled substance prescriptions of a similar nature from these practitioners.    It is suggested that you obtain controlled substance prescription data on the patient identified above and communicate with other health care providers who are treating this patient. You may access MAPS data via a link on our website at: www.michigan.gov/healthlicense and click on the MAPS link. Enclosed please find a listing of physicians in Michigan that provide an office based treatment program for opiate addiction that may be shared with the patient. There are other options available in addition to opioid treatment such as referral to a pain specialist, or requiring the patient to enter into an agreement which limits their treatment to a specific physician and pharmacy. Please consider all of the options that are available to you and your patient. If you have any questions or need additional information, please contact our office at the phone number listed below, or at our e-mail address:  mapsinfo@michigan.gov.     Sincerely, Bureau of Health ProfessionsHealth Investigation Division(517) 373-1737 
    15. 15.  New formulation by Purdue Patients calling for old formula. Canada Used callous shaver to “peel” tablets. Snorting new formula leaves a paste or gel. Oxy IR 30mg is popular. 50% to Florida Seeing Opana increase. Phenergan with Codeine (Purple)
    16. 16.  Oxymorphone long acting Expensive 10,770 Scripts in 2010 47,979 scripts in 2011
    17. 17.  50% to Florida 31,689 Scripts in 2010 113,973 Scripts 1n 2011
    18. 18.  Used for decades to treat drug addiction Increasingly prescribed for pain As increased use for pain so has methadone related fatal overdoses. Cheapest Narcotic Pain Reliever (Synthetic) Insurance companies love it The Problem? CDC Vital Signs Report July 2012. Almost one-third of prescriptionpainkiller overdose deaths involve methadone Six times as many people died of methadone overdoses in 2009 than a decade before. Methadone accounts for only 2 percent of painkiller prescriptions in the U.S. but isinvolved in more than 30 percent of prescription painkiller overdose deaths.
    19. 19.  Fentanyl Patches, Fentanyl Citrate berry flavored lollipop Fentanyl 100 times more potent than morphine Intended to be used for chronic cancer pain and opioid tolerantpeople Abused for its intense euphoric effects Laws changed in dispensing lollipops Must be on at least60mg of morphine daily or 50MCG/Fentanyl Transdermaldaily. Used for breakthrough pain only. Pharmacists must sign off on following these guidelines topurchase and dispense transmucosal immediate releasefentanyl called TIRF REMS This program is required to prescribe, distribute, or dispensetransmucosal immediate release fentayl
    20. 20.  alprazolam 1mg 539,215 Scripts in 2010 alprazolam 1mg 582,656 Scripts in 2011 alprazolam 2mg 139,400 Scripts in 2010 alprazolam 2mg 188,134 Scripts in 2011
    21. 21.  One in Eight Teens (about 2.7 million) now report havingmisused or abused prescription stimulants at least oncein their lifetime. 9% of teens (1.9 million) report having misused orabused these prescription stimulants in the past year 6% of teens (1.3 million) report abuse of theseprescription stimulants in the past month One in four teens (actually 26%) believe that prescriptionstimulants can be used as a study aid More than one in five teens (22% say there is littleor no risk in using Ritalin/Adderall without aprescription Source 2012 Partnership Attitude Tracking Study, published 4/23/2013
    22. 22.  Popular in street culture Purp, Spritz, Wholesale price $11.00 Pint (480ml) Pharmacy sells for $300.00 Pint Dealer sells for $35-40 an ounce. Mixed with hydrocodone Grape Jolly Rancher
    23. 23.  264,210 Scripts in 2010 298,492 Scripts in 2011 Most scripts are for a Pint (480ml)
    24. 24.  Schedule IV in January 2012 Reportable to MAPS Popular with hydrocodone combos(Trinity, alprazolam) Higher dose appears to be alcohol.
    25. 25.  Eventually NABP wants to collect data. Leverage PMP’s with chains to run data reportsautomatically when script dispensed. Incorporate into EMR open automatically. Talk of adding non-controlled drugs for disastersand other emergencies such as visit to ER whenunconscious.
    26. 26.  Interstate data sharing is included in MAPS! Ohio now operational. Hub operated by NABP (National Association ofBoards of Pharmacy) located in Chicago Illinois. VA, IN, SC, WVA added. More coming
    27. 27.  Lack of knowledge. False beliefs (time consuming, staff) Laziness. Don’t want to be bothered. Stubborn. Practiced for years w/o database. Fear that knowledge will require action. Lack of reimbursement. Time consuming.
    28. 28. Prescription for Methadone 10mg #240 12/23MAPS for New Patient-Eight physicians have been writing for drug-Noticed MAPS report showed Medicaid-Using CHAMPS looked up Medicaid Number-Billed Claim to Medicaid and Rejected (Too Soon)-Claim for drug filled other pharmacy other Dr. two daysprevious same quantity.-Called other pharmacy to verify picked RX up-Confronted Patient and Kept Prescription, handdelivered prescription to prescribing physician
    29. 29. Patient enters pharmacy with prescription forMethylpenidate 5mg #270 SIG: 3 t.i.d.MAPS for new patient:-Two physicians prescribing medication-Paying cash with one physician’s prescription-Pharmacy Billing Private Insurance with otherIndividual was very popular hair stylist. Nevera problem obtaining clients. Co-workerscouldn’t understand why so popular,not the best stylist in the salon.
    30. 30.  Department of Licensing and Reg. Affairs Bureau of Health Professions Health Investigation Division www.michigan.gov/healthlicense www.michigan.gov/mimapsinfo 517-373-1737
    31. 31. Please Login or Sign-Up to use Single Sign-On WARNING: To maintain your login session, make sure that your browser isconfigured to accept Cookies.  Login  User ID:    Password:      Forgot Password?  If you have forgotten your password, click Need Password.       Single Sign-On system will email you a new temporary  password.    Sign-Up  If you are a new user to Single Sign-On, click Register to         create your User ID and Password.  Michigan.gov Home | Help/FAQs | Contact UsMaps Login Page
    32. 32. The MAPS Report Information:_____________________________________________________________________________________Patient’s Name Date of Birth Medication Name Rx Number Practitioner DispenserAddress Issue Date Form/ Quantity RX TYPE Transmission DEA DEAFill Date Strength Auth Refills Payment Address Address_____________________________________________________________________________________Doe, John 01/01/1990 Hydrocodone/Acetam 4600001 Bad, Joe Narcotics R US123 Anywhere 06/14/2013 TAB / 120.00 Original Written AB1234563 AN123456306/14/2013 5mg/500mg 0 Medicaid 123rdSt Easy Way DR.Holland, MI 49423 Holland, MI Holland, MI_____________________________________________________________________________________Doe, John 01/01/1990 Hydrocodone/Acetam 6874512 Bad, Joe Cartel Apothecary123 Anywhere 06/14/2013 TAB / 120.00 Original Faxed AB1234563 AC123456306/14/2013 5mg/500mg 0 Private Pay 123rdSt South BorderHolland, MI 49423 Holland, MI Holland, MI______________________________________________________________________________________Doe, John 01/01/1990 Hydrocodone/Acetamin 9876541 Fix, I Can Fill’em Now RX123 Anywhere 06/13/2013 TAB / 240.00 Refill Written AF1234563 AF126073406/13/2013 5mg /325mg 4 Private Pay 56 Michigan Skid RowHolland, MI 49423 Holland, MI Holland, MI_______________________________________________________________________________________Page 1 of 30
    33. 33.  Q. Do practitioners have to dispense controlledsubstances to be able to register to MAPS Online? A. No. All practitioners who prescribe controlled substances havethe ability to register to MAPS Online to request patient reports ontheir patients.Q. If a practitioner requests a MAPS reportand detects possible illegal activity, can the practitionergive the MAPS report to a law enforcement agency?A. No, the practitioner cannot give a MAPS report toanyone. The practitioner can call their local law enforcementagency and state their concerns. Law enforcement agencies havethe ability to request MAPS reports for cases that involve illegalactivity, ie, drug diversion. Q. Can a practitioner request a MAPS report on anyindividual?A. No. MAPS reports can only be requested for individuals that area bona fide current patient of the practitioner.
    34. 34.  Q. Can a practitioner request a MAPSreport on other practitioners?A. No. Practitioners may not request reports onother practitioners. Q. Is MAPS compliant with the HIPAAPrivacy Act?A. Yes. All data is received and transmitted behindthe State of Michigan firewall, which allowspractitioners to comply with HIPAA securityrequirements. All data in the MAPS database isprotected and only released to practitioners whocertify they are treating the patient.
    35. 35.  Q. What is the definition of a "dispensingpractitioner"?A. A dispensing practitioner is a practitioner who gives aprescription drug to a patient (to be consumed at a laterdate) in a container with written labeling instructions as tousage. Dispensing practitioners who dispense controlledsubstances in Schedules 2-5 must report this prescriptiondata to MAPS. Q. Does a practitioner that administers controlledsubstances need to report to MAPS?A. No. When a practitioner administers a prescriptiondrug, the full dose of the prescription drug is administeredin the practitioners office; no doses of the prescriptiondrug leave the practitioners office with the patient.
    36. 36.  Q. If a practitioner dispenses controlled substances anddoes not have online computer capabilities, how does thepractitioner report dispensed controlled substances toMAPS?A. A MAPS waiver form is available for practitioners who do nothave online computer capabilities. If the waiver is approved, a paperclaim form is completed by the dispensing practitioner for eachcontrolled substance that is dispensed, which is then mailed to theMAPS program for manual entry into the MAPS database. Waiversare only granted for practitioners in remote areas and/or who do nothave computer equipment. Q. How often do pharmacies and dispensing practitionersreport prescription data to MAPS?A. Submission of prescription data are currently required on the 1stand 15th of every month. Pharmacies and practitioners may reportmore frequently than twice a month, for example, weekly or daily. 
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