This document outlines a conference for building cases across state lines related to pharmaceutical drug crimes. It discusses the roles of various practitioners, authorities, investigators and prosecutors involved in these types of cases. It also covers the evolution of the prescription drug epidemic and how prescription drug monitoring programs can aid in multi-state investigations. The document identifies common roadblocks to effective multi-state investigations and the prosecutor's role in working with investigators during early case development.
This document summarizes a national dialogue on drug-impaired driving that took place in April 2012. It discusses policy goals of identifying impaired drivers and distinguishing impairment from medication use. Statistics show that in 2009, over 13,000 drivers who died in crashes tested positive for drugs. The document outlines the dangers of drug-impaired driving and different state laws addressing this issue. It also notes challenges with drug evaluation programs and drug testing. Suggestions are made to improve prevention of drug-impaired driving.
This document summarizes key points from a conference on building multi-state cases related to pharmaceutical drug crimes. It discusses the roles of various practitioners, agencies, and prosecutors and how to collaborate across states. It outlines strategies for using prescription drug monitoring programs and issues to consider from a prosecutor's perspective. Tips are provided on working with pharmacists, regulatory authorities, out-of-state partners, and the DEA to strengthen multi-state investigations.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
This document summarizes a presentation on combining prescription drug monitoring program (PDMP) data with other data sources to combat prescription drug abuse. The presentation includes three speakers and a moderator. It outlines learning objectives around identifying reasons and methods for combining PDMP data, evaluating a study combining laboratory and PDMP data, and describing a San Diego project combining PDMP and medical examiner data. The presentation then reviews a case study approach and nationwide study results showing the effectiveness of combining these data sources to identify high-risk patients. It also summarizes findings from a 2013 analysis in San Diego that linked PDMP and medical examiner prescription drug death records.
This document discusses a presentation on whether pharmacists should fill opioid prescriptions or not. It includes the presenters, learning objectives, and disclosures. It then summarizes Karen Ryle's presentation on red flags pharmacists should watch out for when dispensing controlled substances like opioids. These include things like "cocktailed" prescriptions, no individualized dosing, early refills, out-of-area doctors and patients, and mostly cash prescriptions. It also discusses integrating prescription drug monitoring program data into pharmacy workflows to more easily check for signs of abuse or diversion.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
This document summarizes a national dialogue on drug-impaired driving that took place in April 2012. It discusses policy goals of identifying impaired drivers and distinguishing impairment from medication use. Statistics show that in 2009, over 13,000 drivers who died in crashes tested positive for drugs. The document outlines the dangers of drug-impaired driving and different state laws addressing this issue. It also notes challenges with drug evaluation programs and drug testing. Suggestions are made to improve prevention of drug-impaired driving.
This document summarizes key points from a conference on building multi-state cases related to pharmaceutical drug crimes. It discusses the roles of various practitioners, agencies, and prosecutors and how to collaborate across states. It outlines strategies for using prescription drug monitoring programs and issues to consider from a prosecutor's perspective. Tips are provided on working with pharmacists, regulatory authorities, out-of-state partners, and the DEA to strengthen multi-state investigations.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
This document summarizes a presentation on combining prescription drug monitoring program (PDMP) data with other data sources to combat prescription drug abuse. The presentation includes three speakers and a moderator. It outlines learning objectives around identifying reasons and methods for combining PDMP data, evaluating a study combining laboratory and PDMP data, and describing a San Diego project combining PDMP and medical examiner data. The presentation then reviews a case study approach and nationwide study results showing the effectiveness of combining these data sources to identify high-risk patients. It also summarizes findings from a 2013 analysis in San Diego that linked PDMP and medical examiner prescription drug death records.
This document discusses a presentation on whether pharmacists should fill opioid prescriptions or not. It includes the presenters, learning objectives, and disclosures. It then summarizes Karen Ryle's presentation on red flags pharmacists should watch out for when dispensing controlled substances like opioids. These include things like "cocktailed" prescriptions, no individualized dosing, early refills, out-of-area doctors and patients, and mostly cash prescriptions. It also discusses integrating prescription drug monitoring program data into pharmacy workflows to more easily check for signs of abuse or diversion.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document summarizes a presentation on drugs to watch including tramadol, hydrocodone, and naloxone. It includes:
- Disclosures from presenters declaring no conflicts of interest.
- Learning objectives focused on analyzing the impact of schedule changes for tramadol and hydrocodone, educating on tramadol dangers, and evaluating pharmacist perspectives on naloxone.
- Information presented on the drugs including their classifications, potencies, risks of abuse and addiction, and impacts of rescheduling hydrocodone and tramadol in California. Data showed decreased hydrocodone prescriptions but increased tramadol and overall opioid prescriptions, as well as increased over
This document summarizes a presentation on best practices for treating opioid addiction in the criminal justice population. It outlines the challenges of treatment in this population and identifies best practices for using medication-assisted treatment (MAT) and behavioral therapy. The presentation reviews key points from the ASAM National Practice Guideline, including that MAT is the standard of care for opioid use disorder and should be continued, initiated, or made available for inmates. Discontinuing treatment can be dangerous and contradicts evidence-based practices. The implications discussed are that the guideline supports higher quality care for inmates and a rehabilitative approach, while also helping to address the opioid epidemic.
This document summarizes a presentation given by Demetra Ashley of the DEA about regulations and efforts to address the prescription drug abuse epidemic. It discusses how most prescription drug abuse involves obtaining medications from friends and family, not through criminal means. The DEA works with various groups to educate on responsible prescribing and dispensing through initiatives like take-back events and conferences. The goal is to curb abuse while ensuring access to needed medications through enforcement as well as prevention and treatment efforts.
This document discusses laws enacted as a result of parental advocacy around substance abuse issues. It summarizes Casey's Law, a law passed in Kentucky that allows involuntary substance abuse treatment. It was inspired by the death of Matthew Casey Wethington from a heroin overdose at age 23. The law allows parents, relatives or friends to petition the court to require someone to undergo treatment if they are unable to recognize their need for treatment due to impairment. It outlines the petition process, required evidence, evaluations, hearings, and possible outcomes including court-ordered treatment. The presenters aim to help advocates identify laws in their states, explain their components, and apply successful models elsewhere.
The document discusses the issue of drug diversion, which is defined as the diversion of legally prescribed drugs for illegal purposes. It notes that drug diversion costs the US healthcare system an estimated $72.5 billion per year. Veterinary practices are at risk of drug diversion due to their access and storage of controlled and non-controlled substances. Diversion can occur through various means and at different points in the distribution process. The document outlines regulatory requirements and penalties for diversion violations to emphasize the importance of compliance for veterinary practices.
The panel discussion focused on how workers' compensation formularies can reduce opioid prescriptions. Formularies in states like Texas, Ohio, Oklahoma, and Washington were examined. The panel identified best practices for designing and implementing an effective formulary, and discussed stakeholders affected by formularies. Key factors in Texas' successful formulary were identified, as were lessons that can be learned from other states' experiences. The discussion addressed challenges like treating chronic pain if opioids are prescribed less and managing "legacy claims."
This lecture discusses health policy related to curbing abuse of controlled substances - like narcotics. This article discusses several steps Utah has made to decrease the number of opiate-related deaths.
This document discusses prescriber viewpoints on how mandating prescription drug monitoring program (PDMP) compliance is working. It provides an overview of presentations from three physicians on their experiences with PDMP mandates in Kentucky, West Virginia, and New York. The physicians evaluate the impact of mandates requiring prescribers to check the PDMP before prescribing opioids. They describe changes in prescribing patterns, attitudes towards the mandates, and recommendations for other states.
Substance abuse in the workplace ppt (sflpp version)oliviaenny
This document outlines a state loss prevention program on substance abuse in the workplace. It discusses the scope and costs of substance abuse, how alcohol and drugs impair job performance, and how to recognize substance abuse problems. It also covers company policies on substance abuse, including prohibiting drug and alcohol possession and being under the influence at work. The document encourages understanding substance abuse risks, getting help for problems, and addressing issues promptly to maintain workplace safety and productivity.
This document discusses dangerous opioid prescribing practices observed in workers' compensation claims and strategies to address them. It provides an overview of opioid use and outcomes in workers' compensation populations. Specific cases are presented that exemplify dangerous prescribing patterns, including high doses and long-term use. Approaches used by organizations to identify at-risk patients and claims are outlined, such as monitoring prescription data and conducting urine drug screens. Initiatives to resolve issues include education, implementing prescribing guidelines, interdisciplinary treatment teams, and coordinating care for patients needing detoxification or behavioral health support.
A powerpoint about the issue revolving around marijuana use and legalization. More specifically about how it effects the economy and people when you legalize it's recreational use, but classify it as an illicit drug in drug tests.
ARTICLE -- Why Doesn't Every State Mandate ...Alix Michel
Prescription drug overdoses have increased four-fold over the past decade, resulting in over 16,500 deaths per year from opioids alone. Prescription drug monitoring programs (PDMPs) can help address this issue by allowing prescribers and pharmacists to identify patients receiving multiple prescriptions or "doctor shopping." While 49 states have PDMPs, less than half mandate their use by prescribers. States that require use, such as Tennessee, Virginia, New York and Ohio, have seen significant reductions in doctor shopping and overdoses. However, not all states mandate use due to concerns over increased workload for providers, lack of interconnectivity between state PDMPs, and insufficient resources and staffing of the programs.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes a presentation on legislative and medication trends impacting third-party payers. It discusses several topics: physician dispensing and repackaged medications, opioid utilization, treatment guidelines and closed formularies, and compounded medications. For each topic, it outlines related legislative strategies and regulatory approaches taken by different states to influence costs and utilization for third-party payers. The presentation aims to identify issues relevant to third-party payers and explain how they can shape legislative and regulatory outcomes.
This document discusses the need for a five-year recovery standard for evaluating substance abuse treatment outcomes. It presents evidence from studies of Physician Health Programs which show that extending treatment and monitoring to five years leads to much higher rates of long-term abstinence compared to typical short-term treatment programs. The brain science of addiction demonstrates that substance use disorders are chronic relapsing conditions, so treatment needs to provide sustained support over multiple years to achieve stable recovery.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
The document discusses new developments in prescription drug monitoring programs (PDMPs) in California, Colorado, and Minnesota. It provides an overview of presentations given on upgrades to the PDMP systems in each state. Key points include: Colorado's PDMP has enhanced data reporting requirements and streamlined data retrieval; Minnesota's PDMP has focused on improving data quality and compliance; and California's upgraded PDMP (CURES 2.0) features automated registration, delegation of authority, patient flagging, peer-to-peer communication on patient safety, and de-identified data sets.
The document discusses Baltimore Substance Abuse Systems' (BSAS) efforts to address opioid addiction in Baltimore through expanding access to medication-assisted treatment (MAT) options like buprenorphine and methadone, improving coordination between behavioral health and criminal justice agencies, and developing a recovery-oriented system of care. BSAS aims to ensure high quality substance abuse prevention and treatment services in Baltimore through strategic planning, advocacy, and creating coordinated networks of community-based recovery services.
This document discusses the financial impact of opioid abuse on employers. It identifies the primary causes of increased healthcare costs related to opioid abuse as well as simple steps employers can take to reduce risks and costs. The document explains that prescription drug abuse can impact employers even if they are not currently dealing with issues in their workplace. It provides context on the costs of chronic pain and revenue from opioids. The document examines how cultural factors led to increased opioid prescribing and abuse. It discusses challenges in predicting outcomes for different patients prescribed opioids. Finally, it outlines guiding principles for employers to address opioid abuse, including education, enforcement, oversight, and statutory action if needed.
This document summarizes a presentation given by Demetra Ashley of the DEA about regulations and efforts to address the prescription drug abuse epidemic. It discusses how most prescription drug abuse involves obtaining medications from friends and family, not through criminal means. The DEA works with various groups to educate on responsible prescribing and dispensing through initiatives like take-back events and conferences. The goal is to curb abuse while ensuring access to needed medications through enforcement as well as prevention and treatment efforts.
This document discusses laws enacted as a result of parental advocacy around substance abuse issues. It summarizes Casey's Law, a law passed in Kentucky that allows involuntary substance abuse treatment. It was inspired by the death of Matthew Casey Wethington from a heroin overdose at age 23. The law allows parents, relatives or friends to petition the court to require someone to undergo treatment if they are unable to recognize their need for treatment due to impairment. It outlines the petition process, required evidence, evaluations, hearings, and possible outcomes including court-ordered treatment. The presenters aim to help advocates identify laws in their states, explain their components, and apply successful models elsewhere.
The document discusses the issue of drug diversion, which is defined as the diversion of legally prescribed drugs for illegal purposes. It notes that drug diversion costs the US healthcare system an estimated $72.5 billion per year. Veterinary practices are at risk of drug diversion due to their access and storage of controlled and non-controlled substances. Diversion can occur through various means and at different points in the distribution process. The document outlines regulatory requirements and penalties for diversion violations to emphasize the importance of compliance for veterinary practices.
The panel discussion focused on how workers' compensation formularies can reduce opioid prescriptions. Formularies in states like Texas, Ohio, Oklahoma, and Washington were examined. The panel identified best practices for designing and implementing an effective formulary, and discussed stakeholders affected by formularies. Key factors in Texas' successful formulary were identified, as were lessons that can be learned from other states' experiences. The discussion addressed challenges like treating chronic pain if opioids are prescribed less and managing "legacy claims."
This lecture discusses health policy related to curbing abuse of controlled substances - like narcotics. This article discusses several steps Utah has made to decrease the number of opiate-related deaths.
This document discusses prescriber viewpoints on how mandating prescription drug monitoring program (PDMP) compliance is working. It provides an overview of presentations from three physicians on their experiences with PDMP mandates in Kentucky, West Virginia, and New York. The physicians evaluate the impact of mandates requiring prescribers to check the PDMP before prescribing opioids. They describe changes in prescribing patterns, attitudes towards the mandates, and recommendations for other states.
Substance abuse in the workplace ppt (sflpp version)oliviaenny
This document outlines a state loss prevention program on substance abuse in the workplace. It discusses the scope and costs of substance abuse, how alcohol and drugs impair job performance, and how to recognize substance abuse problems. It also covers company policies on substance abuse, including prohibiting drug and alcohol possession and being under the influence at work. The document encourages understanding substance abuse risks, getting help for problems, and addressing issues promptly to maintain workplace safety and productivity.
This document discusses dangerous opioid prescribing practices observed in workers' compensation claims and strategies to address them. It provides an overview of opioid use and outcomes in workers' compensation populations. Specific cases are presented that exemplify dangerous prescribing patterns, including high doses and long-term use. Approaches used by organizations to identify at-risk patients and claims are outlined, such as monitoring prescription data and conducting urine drug screens. Initiatives to resolve issues include education, implementing prescribing guidelines, interdisciplinary treatment teams, and coordinating care for patients needing detoxification or behavioral health support.
A powerpoint about the issue revolving around marijuana use and legalization. More specifically about how it effects the economy and people when you legalize it's recreational use, but classify it as an illicit drug in drug tests.
ARTICLE -- Why Doesn't Every State Mandate ...Alix Michel
Prescription drug overdoses have increased four-fold over the past decade, resulting in over 16,500 deaths per year from opioids alone. Prescription drug monitoring programs (PDMPs) can help address this issue by allowing prescribers and pharmacists to identify patients receiving multiple prescriptions or "doctor shopping." While 49 states have PDMPs, less than half mandate their use by prescribers. States that require use, such as Tennessee, Virginia, New York and Ohio, have seen significant reductions in doctor shopping and overdoses. However, not all states mandate use due to concerns over increased workload for providers, lack of interconnectivity between state PDMPs, and insufficient resources and staffing of the programs.
This document provides a summary of a presentation on the risks of medical marijuana and marijuana legalization. It begins with disclosures from the presenters and outlines six learning objectives. It then discusses concerns that marijuana is addictive, especially for those who start using it early, and impacts adolescent brain development. The document notes the lack of evidence that marijuana is effective for the conditions it is claimed to treat. It also discusses the risks of increased diversion of marijuana to youth and greater social acceptance of marijuana use negatively impacting public health. The document concludes with messages on how to discuss these issues with the public.
This document summarizes a presentation on legislative and medication trends impacting third-party payers. It discusses several topics: physician dispensing and repackaged medications, opioid utilization, treatment guidelines and closed formularies, and compounded medications. For each topic, it outlines related legislative strategies and regulatory approaches taken by different states to influence costs and utilization for third-party payers. The presentation aims to identify issues relevant to third-party payers and explain how they can shape legislative and regulatory outcomes.
This document discusses the need for a five-year recovery standard for evaluating substance abuse treatment outcomes. It presents evidence from studies of Physician Health Programs which show that extending treatment and monitoring to five years leads to much higher rates of long-term abstinence compared to typical short-term treatment programs. The brain science of addiction demonstrates that substance use disorders are chronic relapsing conditions, so treatment needs to provide sustained support over multiple years to achieve stable recovery.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
This document summarizes a presentation on using prescription drug monitoring program (PDMP) data for public health purposes. State and local health officials in Washington State work with de-identified PDMP data to coordinate opioid abuse prevention and mitigation efforts. Examples are given of data reports generated for counties, including opioid prescribing rates, concurrent opioid and benzodiazepine prescriptions, and changes over time. Challenges with PDMP data are discussed, such as de-duplicating patient records and processing large datasets. The goal is to provide actionable information to local jurisdictions to inform resource allocation and policies.
The document discusses new developments in prescription drug monitoring programs (PDMPs) in California, Colorado, and Minnesota. It provides an overview of presentations given on upgrades to the PDMP systems in each state. Key points include: Colorado's PDMP has enhanced data reporting requirements and streamlined data retrieval; Minnesota's PDMP has focused on improving data quality and compliance; and California's upgraded PDMP (CURES 2.0) features automated registration, delegation of authority, patient flagging, peer-to-peer communication on patient safety, and de-identified data sets.
The document discusses Baltimore Substance Abuse Systems' (BSAS) efforts to address opioid addiction in Baltimore through expanding access to medication-assisted treatment (MAT) options like buprenorphine and methadone, improving coordination between behavioral health and criminal justice agencies, and developing a recovery-oriented system of care. BSAS aims to ensure high quality substance abuse prevention and treatment services in Baltimore through strategic planning, advocacy, and creating coordinated networks of community-based recovery services.
This document discusses the financial impact of opioid abuse on employers. It identifies the primary causes of increased healthcare costs related to opioid abuse as well as simple steps employers can take to reduce risks and costs. The document explains that prescription drug abuse can impact employers even if they are not currently dealing with issues in their workplace. It provides context on the costs of chronic pain and revenue from opioids. The document examines how cultural factors led to increased opioid prescribing and abuse. It discusses challenges in predicting outcomes for different patients prescribed opioids. Finally, it outlines guiding principles for employers to address opioid abuse, including education, enforcement, oversight, and statutory action if needed.
This document appears to be a presentation about the financial impact of prescription opioid abuse on payers. The presentation identifies prescription drug diversion and abuse as causing increased healthcare costs of up to $27 billion annually. It outlines strategies for payers to address this issue, such as monitoring prescription patterns, using prescription drug monitoring programs, and increasing investigations and prosecutions. While some progress has been made in reducing diversion, the problem remains significant.
This document summarizes a presentation on medication-assisted treatments for substance use disorders. It discusses the use of medications to treat tobacco, alcohol, and opioid addiction. For tobacco, varenicline is recommended to reduce cravings and prevent relapse. For alcohol, disulfiram, naltrexone, and acamprosate are FDA-approved medications to prevent relapse. Characteristics and considerations for each medication are provided. The benefits of screening and brief interventions in primary care settings are also summarized.
This document discusses the use of poison center data to track trends in prescription drug abuse and overdoses. It shows that between 1999-2011, prescription opioid exposures reported to poison centers increased over 150% in the US and 164% in Kentucky. Specific opioids like oxycodone, hydrocodone, and tramadol also increased substantially. Poison center data can provide real-time surveillance to identify emerging problems and formulate strategies to address them.
This document summarizes a presentation by Dr. Ileana Arias from the CDC on prescription drug overdoses from a public health perspective. It describes current trends in overdose deaths involving opioid pain relievers, populations most at risk, and the CDC's strategic focus areas and policy recommendations to address the problem using a public health approach. The CDC aims to enhance surveillance, improve clinical practice, and inform policy to help reduce overdose deaths while ensuring appropriate pain treatment.
This document summarizes a presentation by Dr. Nora Volkow on the growing problem of prescription drug abuse in the United States. Some key points:
- Use and abuse of commonly prescribed opioid and stimulant drugs like Vicodin, OxyContin, Adderall, and Ritalin has been increasing, as seen in rising trends of past year initiation and past month use among Americans aged 12 and older.
- The number of opioid and stimulant prescriptions dispensed by U.S. retail pharmacies has skyrocketed in recent decades, increasing the availability of these potent and addictive medications.
- Younger age groups are particularly at risk, as dentists and emergency physicians are the
C te l-georgia partnership for telehealth march 2014Samantha Haas
The document discusses the legal and regulatory issues facing telehealth practitioners, including licensure, prescribing medication, credentialing, and reimbursement. It summarizes regulations and requirements in different states regarding these issues. For example, most states require medical licensure in the state where the patient is located. Some states have special telemedicine licenses. The document also discusses credentialing by proxy, rules around establishing a physician-patient relationship through telemedicine, and prescribing medication via telehealth. Overall, it aims to outline the major legal and regulatory hurdles to telehealth and provide guidance on navigating different state requirements.
Ethics of advising medical marijuana practitioners 4.13.18Darshan Kulkarni
This document discusses the ethics of advising medical marijuana practitioners. It begins with legal basics on federal and state laws regarding medical marijuana. Under federal law, marijuana remains a Schedule I drug, though the DOJ has said prosecuting state-compliant medical marijuana cases is not a priority. It then details Pennsylvania's medical marijuana program requirements, including for physicians, dispensaries, forms of marijuana, and record keeping. Scenarios discuss ethical issues attorneys may face, such as using medical marijuana themselves, advising dispensary clients, and investing in dispensaries. Attorneys must be aware of conflicts between state medical marijuana laws and ABA rules regarding illegal conduct.
This document discusses prescription drug monitoring programs (PDMPs) and issues related to prescription drug abuse in Missouri. It defines a PDMP as an electronic database that collects data on controlled substance prescriptions to help doctors identify potential "doctor shopping" or dangerous drug interactions. It notes that Missouri has a problem with doctor shopping and rising overdose rates. The bill discussed would expand Missouri's PDMP to monitor Schedule 2, 3, and 4 controlled substances. It also discusses how prescription drug abuse can lead to heroin use, populations affected, proper drug disposal, and funding sources for PDMPs.
The document outlines state responses to prescription drug and heroin abuse presented at an advocacy track session. It includes presentations from officials in Arizona, Virginia, and New Mexico on their state's strategies. Arizona's presentation focuses on the state's prescriber report cards. Virginia's presentation discusses the governor's task force recommendations and a new health and criminal justice data committee. New Mexico's presentation describes the state's high overdose rates and model of stakeholder collaboration to reduce overdose deaths.
This document summarizes information about telemedicine legal issues in Idaho, including licensure, credentialing, and the new Idaho Telehealth Access Act. For licensure, the telemedicine provider must generally be licensed in the state where the patient is located. Idaho allows a consultation exception. The new Act allows establishment of a provider-patient relationship via telehealth. For credentialing, Medicare Conditions of Participation allow hospitals to accept credentialing done by a distant site for telemedicine providers. Medical staff bylaws may need updating to address telemedicine credentialing and privileges.
This document summarizes a presentation on combining PDMP and other data to combat prescription drug abuse. It discusses the problems with isolated pharmacy and laboratory databases and outlines two patient case studies. It then describes a nationwide study that evaluated combining laboratory and PDMP data to identify patients not taking medications responsibly, finding inconsistent test results in 70.9% of high-risk patients. Finally, it summarizes a San Diego collaborative project that combined PDMP and medical examiner data on 254 prescription-related deaths in 2013.
This document summarizes a presentation on combining prescription drug monitoring program (PDMP) data with other data sources to combat prescription drug abuse. The presentation includes three speakers and a moderator. It outlines learning objectives around identifying reasons and methods for combining PDMP and other data, evaluating a study combining laboratory and PDMP data, and describing a San Diego project combining PDMP and medical examiner data. The presentation then reviews a case study approach combining PDMP and toxicology results, and evaluates a nationwide study showing a high degree of inconsistent test results when combining pharmacy and laboratory data on high-risk patients. It concludes that combining these data sources is effective for identifying high-risk opioid users.
This document summarizes a panel discussion on lessons learned from prescription drug supply-side interventions. The panel included experts from Brown University, a policy advocacy group, and a law firm. They discussed research evaluating the impact of Florida's crackdown on "pill mills" that distributed oxycodone. Preliminary findings suggest supply-side interventions reduced drug availability and increased prices, with no evidence of recovery in supply. There was also no increase in other drugs, and interventions may have reduced abuse and improved public health. The panel then outlined strategies to protect consumers from black market prescription drugs, such as educating prescribers, reducing available supply of drugs for abuse, and developing abuse-deterrent formulations.
This document provides an overview of state strategies to address the prescription drug abuse epidemic, focusing on New Mexico's experience. It outlines how New Mexico built a statewide coalition including healthcare organizations, government agencies, community groups and legislators to reduce overdose death rates. This coalition implemented strategies targeting prescribers, medical facilities, educators and other stakeholders based on New Mexico's successes. These strategies included education, prescribing guidelines, prescription drug monitoring programs, pain clinic regulation, and increasing access to naloxone to reverse overdoses. The presentation aims to identify effective intervention and policy approaches as well as resources for advocacy.
Legalization of Marijuana Webinar- Impact for Drug Testing Employers Eliassen Group
This document discusses the impact of legalizing marijuana and drug testing in the workplace. It notes that 23 states have legalized medical marijuana, creating challenges for employers maintaining drug-free workplaces. Ohio ballot issue 3 proposes legalizing medical and recreational marijuana use for those over 21. The document outlines employers' responsibilities regarding drug policies, noting they are not required to accommodate marijuana use given its federal illegality. It provides best practices for employers, such as maintaining consistent drug policies prohibiting impairment from any illegal substances.
Drug information slideshare by P. vara lakshmiVaram18
This document provides information on drug information services. It defines drug information as current and critically examined data about drugs and their use for patients or situations. It discusses the history of drug information centers, noting the first was established in 1960 in the US. It outlines the need for such services due to the increasing number and complexity of drugs. The aims of drug information include optimizing decision making and developing guidelines. Sources of drug information are described, and skills, staffing, and operations of drug information centers are covered. The document concludes with examples of common drug information questions.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
Criminal Law Compliance For Healthcare Professionals - Painkiller LawMeister Law Offices
Steve Meister, an attorney from Los Angeles, gives a detailed explanation of the Painkiller Law purpose which is to help healthcare providers and professionals to verify, achieve and maintain compliance with the criminal laws of prescribing controlled substances.
June 19, 2013: This presentation to highlight the dangers of counterfeit drugs to Maine patients was given to the Bangor Dept. of Health Public Advisory committee
This document summarizes the history of drug regulation laws in the United States from the early 1900s to present day. It covers major acts like the 1906 Pure Food and Drug Act, the 1970 Controlled Substances Act, and amendments that strengthened safety requirements for clinical drug trials and approval processes. Key topics discussed include scheduling of controlled substances, exceptions for fast-tracking new drugs, switching drugs from prescription to over-the-counter status, advertising regulations, and strategies for preventing drug abuse through education, treatment programs, and drug testing.
This document summarizes the history of drug regulation laws in the United States from the early 1900s to present day. It covers major milestones like the 1906 Pure Food and Drug Act, the 1970 Controlled Substances Act, and exceptions for drug approval like orphan drugs and fast-tracking. Key issues discussed are balancing public health with criminalization, determining appropriate drug schedules, and strategies for preventing drug abuse like education, treatment, and drug testing.
The document discusses the regulatory process for investigational new drugs (INDs) and new drug applications (NDAs) in the United States. It provides details on the types of INDs (investigator, emergency use, treatment), categories (commercial, research), required contents of an IND application, and FDA's Pre-IND consultation program. It also summarizes the purpose and required contents of an NDA to obtain approval to market a new drug in the US. Laws, regulations, guidance documents, and procedures that FDA follows in regulating drugs are also referenced.
The document discusses Investigational New Drug Applications (INDs), New Drug Applications (NDAs), Abbreviated New Drug Applications (ANDAs), and Supplemental New Drug Applications (SNDAs). It provides details on the purpose and requirements of each application type, including necessary contents, guidelines, and the laws and regulations that govern the FDA drug approval process.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Web only rx16 pharma-wed_330_1_shelley_2atwood-harlessOPUNITE
This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
Web only rx16-adv_tues_330_1_elliott_2brunson_3willis_4deanOPUNITE
This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document summarizes a presentation on youth performance-enhancing drugs and ADHD medication. It discusses trends in misuse of these substances among young people. The presentation is given by representatives from various organizations focused on prevention, health promotion, and substance abuse issues among youth and college students. The presentation covers types of performance-enhancing drugs and their potential side effects. It also discusses trends in attitudes towards these substances and risks of misuse. Strategies are presented for helping adolescents pursue their goals without these drugs. The document concludes by outlining plans for addressing misuse of ADHD medication among college students through education and collaboration between various stakeholder groups.
Web only rx16 pharma wed_200_1_hagemeier_2fleming_3vernachioOPUNITE
Community pharmacists are well positioned to help address the growing problem of opioid and benzodiazepine addiction but face challenges. Early identification of at-risk patients, supportive benefit structures, and intervention training could empower pharmacists. While many recognize their responsibility, behavioral engagement in prevention is often lacking due to practice barriers, lack of patient information, and fear of responses. Standardizing communication expectations and screening tools could help pharmacists better fulfill their role on the treatment team.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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2. Learning Objectives:
1) Evaluate the roles of practitioners, regulatory
authorities, state and federal investigators and
prosecutors in pharmaceutical drug crime cases, with
an emphasis on how individuals and agencies can
collaborate to achieve common goals.
2) Describe the evolution of the prescription pill epidemic
and outline the uses and limitations of prescription
drug monitoring programs to aid in multi-state
investigations.
3) Identify problem areas and common roadblocks to
effective multi-state investigations from a prosecutor’s
perspective, with a discussion of the prosecutor’s role
in working with the investigator in early case
development.
3. Disclosure Statement
• All presenters for this session, Agent
Bruce DiVincenzo and AAG Vernon
Stejskal, have disclosed no relevant,
real or apparent personal or
professional financial relationships.
4. Medical Practitioners
• They are Law Enforcement partners, not adversaries, in most
instances, such as in cases of doctor shopping and
prescription fraud
• Like lawyers and police, the worst 1% give the profession a
bad reputation
• On the front lines – first hand observation of addiction/drug-
seeking, and first ones with the ability to do something
• As an investigator, make friends with at least one pharmacist
or medical provider who will take your calls and answer
questions – don’t use that person as a witness, and don’t
overload them
5. Medical Practitioners
• One of the first things to do in every investigation is to
determine who is the problem/target. Is it the doctor,
someone working in the doctor’s office, or the
“patient”?
• That determination will effect how records are
requested from a medical practitioner.
6. Medical Practitioners
HIPPA does not prohibit sharing patient
information with law enforcement
• There are a number of exceptions that permit law enforcement
officials to access protected health information. These exceptions
bypass the requirement that the individual consent or be given an
opportunity to decide whether his or her protected health
information will be disclosed.
• Crime on premises: If a covered entity believes in good faith that
protected health information is evidence of criminal conduct that
occurred on the premises of the covered entity, it may disclose
the information to a law enforcement official.
7. Medical Practitioners
May require a subpoena to obtain patient
information
Restricted access for administrative requests: An administrative
subpoena may be used to obtain protected health information.
In order to use an administrative subpoena, however, the
following criteria must be met:
1) the information sought must be relevant and material to a
legitimate investigation,
2) the request must be specific and limited in scope to meet its
intended purpose, and
3) information that does not reveal the individual’s identity could
not reasonably be substituted for the information sought.
8. Medical Practitioners
• Most medical practitioners are willing to cooperate
with law enforcement as long as they won’t get into
legal trouble over confidentiality
• The ones that aren’t cooperative may have
something to hide themselves
9. Medical Practitioners
Check the PDMP
• Medical providers should check the
Controlled Substance Database to
see whether a patient is getting any
controlled substances from any other
source before prescribing controlled
substances to that person. A
database check is not a legal
requirement, but is strongly
encouraged.
10. Medical Practitioners
• The second doctor is NOT prohibited from prescribing
controlled substances. Rather the law is intended to
allow doctors to make informed decisions on whether
controlled substances are medically necessary, and to
avoid unintentional overprescribing and/or addiction.
• We are not in the business of making medical decisions.
11. Medical Practitioners
• People starting out with legitimate injuries
or pain issues become dependent or
addicted and become doctor shoppers
seeking more pills.
• No informed consent to patients that
controlled substances can be addictive
and have unwanted side-effects.
– Are unscrupulous or untrained
doctors creating addicts?
12. Regulatory Authorities
• In Utah, the Division of Professional Licensing (“DOPL”)
investigates professionals and grants or denies,
suspends, revokes, or places limitations on medical/
pharmacy professionals’ licenses
• The Drug Enforcement Administration (“DEA”) grants
or denies, revokes, suspends, or places limitations on
controlled substance prescribing/dispensing
registration
13. Regulatory Authorities
• Even if a criminal charge cannot be filed, at times a
licensing action, Controlled Substance registration
restriction, or civil fine can be imposed on medical
professionals who are in violation of the applicable
requirements
14. State Investigators
• Use State PDMP’s
• Build partnerships with Pharmaceutical drug crime
investigators in neighboring states
• Assist other investigators within the limits of your state
PDMP
15. State Prosecutors
• Work with officers in the investigation stage – Don’t wait
for a prosecution packet and then decline to prosecute
because something is weak or missing.
• Don’t be afraid to contact federal prosecutors if a case
involves jurisdictional issues which make it difficult to
prosecute in a state district court.
16. Federal Investigators
• Concentrate on the cases involving large scale drug
diversion, and cases that cannot be prosecuted in a
single state or county because of jurisdiction/venue
issues
• If resources are limited, focus on the most egregious
offenders. Successful prosecution may have a deterrent
effect.
17. Federal Prosecutors
• Break down state boundaries, like we do in other drug
cases. Charge a conspiracy when applicable.
• Work with officers on the investigation, making sure
everything necessary for prosecution is obtained.
18. Prescription Drug Monitoring
Programs (PDMP’s)
• According to the Alliance of States with Prescription Monitoring
Programs, (www.pmpalliance.org) as of October 16, 2011, 37
states have operational PDMPs that have the capacity to receive
and distribute controlled substance prescription information to
authorized users. States with operational programs include:
– Alabama, Arizona, California, Colorado, Connecticut, Florida,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky,
Louisiana, Maine, Massachusetts, Michigan, Minnesota,
Mississippi, Nevada, New Mexico, New York, North Carolina,
North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode
Island, South Carolina, Tennessee, Texas, Utah, Vermont,
Virginia, West Virginia, and Wyoming.
19. Prescription Drug Monitoring
Programs (PDMP’s)
– Eleven states (Alaska, Arkansas, Delaware, Georgia, Maryland,
Montana, Nebraska, New Jersey, South Dakota, Washington,
and Wisconsin) and one U.S. territory (Guam), have enacted
legislation to establish a PDMP, but are not fully operational.
– If your state doesn’t have one, make it priority #1 to get one.
• Each state designates a state agency to oversee its PDMP, which
may include health departments, pharmacy boards, or state law
enforcement. The Alliance of States with Prescription Monitoring
Programs www.pmpalliance.org maintains a list of state contacts.
20. UTAH’s PDMP
• Anyone licensed to prescribe a controlled substance is
required to register with DOPL to use the database
• Failure to comply is grounds for refusal to issue or renew
a license, or to revoke, suspend, restrict, or place on
probation, any license
21. UTAH’s PDMP
• Access is given to:
– DOPL investigators
– Dept. of Health
– Licensed Practitioners with CS privileges
(and designated employees)
– Licensed Pharmacists
– Law Enforcement (and Prosecutors)
o Assigned to investigate drug crimes
o Insurance Fraud + Medicaid/Medicare Fraud
22. UTAH’s PDMP
• Pharmacies are required to report information to the
database every 7 days
• Patient name and address
• Prescribing physician
• Dispensing Pharmacy & Date Filled
• Drug, # of pills, and duration of Prescription
23.
24. PDMP Uses
• All of the information for each state is compiled in an
easily accessible place
• Can track multi-state activity using your computer, fax,
and telephone
• No prohibitions on sharing information with other law
enforcement working jointly on a case
25. PDMP Limitations
• Each state maintains their own info and imposes
different restrictions on access – know the rules
• Information in PDMP’s is not evidence – Investigators
must obtain the prescriptions from the reporting
pharmacies
26. Jurisdictional Issues
• Have drug enforcement agents conducted multi-state
investigations involving other drugs?
• What makes pharmaceutical drug crimes different?
• No PDMP database for meth, heroin, or cocaine
• Old fashioned investigation
– Physical surveillance
– GPS tracking
– Telephone interception
– Confidential Sources/Cooperators
– Confessions
27. Jurisdictional Issues
• Any offense begun in one jurisdiction and completed in
another, or committed in more than one jurisdiction, may
be inquired of and prosecuted in any jurisdiction in
which such offense was begun, continued, or
completed
• 18 U.S.C. § 3237
• Look for federal charges such as Conspiracy or
Medicaid/Medicare Fraud which can be charged in
any state where some of the charged activity occurred
28. Jurisdictional Issues
• Cooperate with law enforcement partners in other
states
• Help them, they’ll help you. Stone wall them, guess
what you can expect in return.
• Use DEA Diversion as a resource. They have expertise
on Internet cases and have a form on their website.
29. Pill Mills
• In order to be legal, a controlled
substance prescription must:
– Be issued by a registered
practitioner
– Be for a legitimate medical
purpose
– Be issued in the usual course of
professional practice
30. Pill Mills
Model Policy for the Use of Controlled Substances
for the Treatment of Pain
• The Model Policy provides that: the prescribing of
controlled substances for pain will be considered to be for a
legitimate medical purpose if based on sound clinical
judgment. All such prescribing must be based on clear
documentation of unrelieved pain. To be within the usual
course of professional practice, a physician-patient
relationship must exist and the prescribing should be based
on a diagnosis and documentation of unrelieved pain.
Compliance with applicable state or federal law is required.
31. Pill Mills
• Look for documentation in a patient’s medical record of tests
conducted to
– diagnose the source of pain or injury;
– a specific diagnosis; and
– a treatment plan designed to address the pain.
• The offender records I have looked at frequently have no
tests, or in some cases an x-ray at the beginning, but nothing
but controlled substances for many years after that.
• There is always some diagnosis, but that diagnosis is often not
supported by any tests, documentation, or clinical notes.
There may also be a pattern where multiple controlled
substance-receiving patients have the exact same diagnosis.
(Lumbar Degenerative Disc is popular.)
32. Pill Mills
A regular regimen of controlled substances
without anything else is not a treatment plan.
• The Model Policy also provides that:
a medical history and physical examination must be
obtained, evaluated, and documented in the medical
record. The medical record should document the nature
and intensity of the pain, current and past treatments for
pain, underlying or coexisting diseases or conditions, the
effect of the pain on physical and psychological function,
and history of substance abuse. The medical record should
also document the presence of one or more recognized
medical indications for the use of a controlled substance.
33. Pill Mills
• A treatment plan is required to:
state objectives that will be used to determine
treatment success, such as pain relief and
improved physical and psychosocial function, and
should indicate if any further diagnostic evaluations
or other treatments are planned. [The physician
should also] periodically review the course of pain
treatment and any new information about the
etiology of the pain or the patient’s state of health.
34. Pill Mills
• Doctor guilty if he dispensed “other than in good faith for
detoxification” of patients. Doctor not guilty if he “merely
made an ‘honest effort’ to prescribe . . . In compliance
with an accepted standard of medical practice.”
• Good faith exception protects physicians who dispense
prescriptions in good faith in the course of reasonable
legitimate medical practice. “Some latitude must be
given to doctors trying to determine the current
boundaries of accepted medical practice.”
• U.S. v. Hurwitz, 459 F.3d 463 (4th Cir. 2006)
35. Pill Mills
• “Evidence regarding the applicable standard of care is
not offered to establish malpractice, but rather to
support the absence of any legitimate medical
purpose.”
• “Knowing how doctors generally
ought to act is essential for a jury to
determine whether a practitioner
has acted not as a doctor, or even
a bad doctor, but as a ‘pusher’
whose conduct is without legitimate
medical justification.”
• U.S. v. Feingold, 454 F.3d 1001, 1007 (9th Cir. 2006)
• U.S. v. Alerre, 430 F.3d 681, 691 (4th Cir. 2005)
36. Pharmacist’s Responsibility
“The responsibility for the proper prescribing and dispensing of
controlled substances is upon the prescribing practitioner, but a
corresponding responsibility rests with the pharmacist who fills the
prescription.” 21 C.F.R. § 1306.04(a).
• Government needs to show that :
1) the prescription filled by pharmacist
was not issued for a legitimate
medical purpose; and
2) pharmacist knew the prescription
was invalid
OR
• pharmacist should have known that the prescription was invalid,
but deliberately closed his eyes to what would have otherwise
been obvious.
• U.S. v. Leal, 75 F.3d 219 (6th Cir. 1996)
37. Pharmacist’s Responsibility
• Pharmacist argued that he did not have any
reasonable means to fulfill duty of establishing that
doctor who issued the prescription did so in the usual
course of medical treatment; that the most he could
do to verify the bona fides of a prescription is to check
with the issuing physician.
• “The pharmacist is not required to have a
‘corresponding responsibility’ to practice medicine. . .
a pharmacist can know that prescriptions are issued for
no legitimate medical purpose without his needing to
know anything about medical science.”
• U.S. v. Hayes, 595 F.2d 258, 261 (5th Cir. 1979)
38. Deliberate Ignorance
• “The key element of knowledge may be
shown by proof that the defendant
deliberately closed his eyes to the true
nature of the prescription.”
• “Lawson willingly ignored every signal that
he should question the volume of controlled
drugs being dispensed from his
pharmacies.” U.S. v. Lawson, 682 F.2d 480,
482-3 (4th Cir. 1982)
• New or clarifying law in CVS pharmacy case
in Florida.
39. Clinic Owner
• Owner was intimately involved in virtually
every facet of administering the clinic,
including the hiring and firing of the
doctors and the staff, the recording of the
receipts and the prescriptions, and the
supervision of the employees who
actually handed out the prescriptions and
received the payments. Guilty of aiding
and abetting the doctor.
• U.S. v. Johnson, 831 F.2d 124 (6th Cir. 1987)
• U.S. v. Armstrong, 2007 U.S. Dist. LEXIS 18023 (E.D. La.,
Mar. 14, 2007)
40. Prosecutor’s Role
• Engages qualified expert to review doctor cases
• Coordinates between investigators and prosecutors in
multi-jurisdiction cases (Like SOD)
• Cross-designation as state/federal prosecutor when
available
41. Prosecutor’s Role
Overcoming defenses:
• Just trying to help people in pain.
• I just took the patient’s word for it. Why would they lie to me?
• Just a sloppy record keeper.
• Maybe malpractice, but not criminal.
• Look at all of my “good patients”.
• How dare you second guess my medical judgment.
• I guess I didn’t keep up on the latest pain management techniques.
• Somebody has to be the highest prescriber.
• I seem to get all of the chronic pain patients.
• What else could I have done?
42. Roadblocks to Prosecution
1) ID offender. (Element is “acquired or obtained
possession of” the controlled substance.)
To prove who “acquired or obtained possession of” the controlled
substance, we can look to several things.
1) Sometimes pharmacies have video recordings of the counter showing
who picked up controlled substances from that pharmacy.
2) Occasionally pharmacy employees can ID the receiver of the
controlled substance from memory.
3) Insurance billing may provide evidence of who obtained the controlled
substance.
4) Suspects may also admit to prescription fraud when confronted. Ask for
ID when interviewing.
5) Utah statute requires a D.L. # and a signature.
43. Roadblocks to Prosecution
2) Getting Medical Professionals to give a
Statement and Testify in Court.
3) They should take the case in (another
jurisdiction).
4) Others??