Experience of Health Care Reform An overview of SB 459 GOO OOD S SAMARITAN D DRUG O OVERDOS OSE E ACT Laurie e Squartsoff NV V Department o of f Health a and d Human S Servi vice ces
Roadmap o of P Prese esentation n Origin and Development of Successful Reform Implementation Outcomes State Contacts / Additional Resources 2
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Origin a and D Development o t of S Succe ccessful l Reform m NEVAD NE ADA D A DATA • 2nd h high ghest t for hydrocodone prescriptions (ARCOS) • 2nd h high ghest t for oxycodone prescriptions (ARCOS) • 4th h high ghest t for methadone prescriptions (ARCOS) • 7th h high ghest t for codeine prescriptions (ARCOS) • 4th h high ghest t drug overdose mortality rate (Vital Statistics) • Over 19% of Nevada High Schools students report that they have taken prescription drugs without a doctor’s prescription (YRBS) 4
Origin a and D Development o t of S Succe ccessful l Reform m The goal al of the NGA Prescription Drug Abuse Prevention program is is, with improved coordination of statewide resources, to o reduce ce t the e inci cidence o of i inappropriate e controlled s d substan ance u use b by y Nevad adan ans. . 5
Origin a and D Development o t of S Succe ccessful l Reform m • Data Defined Goals • Reduce overall prescriptions of hydrocodone and oxycodone (ARCOS data) as well as expansion of MAT providers (DEA) and prescribers (SAPTA) and assurance to access to comprehensive, fully integrated treatment (Medicaid data to access) • Reduce the number of overdose deaths (Vital Statistics, Coroner data) • Reduce number of high school students that have used a prescription drug without a prescription (YRBS) 6
Origin a and D Development o t of S Succe ccessful l Reform m Timeline Date Milestone July 2014 Announced as Rx Drug Policy Academy Co-Lead September 2014 First meeting with National Governors Association (NGA) staff and other states Ongoing Stakeholder meetings, core team subcommittee meetings April 2015 Legislative hearings May 5, 2015 Stakeholder meetings, SB459 Signed into Law June 2015 Reconvening of all states at NGA meeting in Vermont September 2015 Report turned over to Chief of Staff at Governor’s office 7
Origin a and D Development o t of S Succe ccessful l Reform m Mandatory Use PDMP PDMP Prescriber Education ID Requirement Requirement Support for Doctor Shopping Naloxone Use Law Support for Good Samaritan Substance Use Law Services Pharmacy Lock-In Physical Exam Program Requirement Source linked at end of presentation. Teal slices were TFAH/ASTHO strategies already in place in Nevada and orange slices were added by SB 459. 8
Key c components of of SB 45 459 9 • Mandatory Use of PMP • Prescriber Education Requirement • Good Samaritan Law • Support for Naloxone use
Roadmap o of P Presentation n Origin and Development of Successful Reform Implementation Outcomes State Contacts / Additional Resources 10
Implementa ntation n • Data collection • Community Education • Provider Education • Law Enforcement • Assessment and Treatment 11
Implementation n • The Nevada DHHS, Substance Abuse and Prevention Agency (SAPTA) and the Multidisciplinary Prevention Advisory Committee (MPAC) and the State Epidemiologic Workgroup (SEW) were selected to manage implementation. • MPAC is a partner advisory group with the SEW, both of which advise SAPTA. The SEW collects and analyzes the data and the MPAC 's role is to create recommendations on strategies and funding in relation to the information the SEW presents. The MPAC also receives Coalition updates. • The MPAC meetings provide regular updates on statewide efforts. SAPTA tracks progress and shares information with Governor’s office. 12
Roadmap o of P Presentation n Origin and Development of Successful Reform Implementation Outcomes State Contacts / Additional Resources 13
Key c components of of SB 45 459 9 • Mandatory Use of PMP • Prescriber Education Requirement • Good Samaritan Law • Support for Naloxone use
Outcomes Mandatory access and use by practitioners of Prescription Monitoring Program(PMP) • Practitioners are required to obtain a PMP report before initiating some prescriptions for a controlled substance
Outcomes PRESCRIPTION MONITORING PROGRAM • Prescription is for a controlled substance (Schedule II,III, or IV) • Patient is a new patient for the practitioner; or • The prescription is for more than 7 days and is part of a new course of treatment for the patient
Outcomes PRESCRIPTION MONITORING PROGRAM • Practitioners are obligated to actually review the PMP reports • NRS639.23507(1) does not apply to inpatient chart orders ; it does apply to prescriptions written for out-patients by practitioners working in a hospital emergency department
Outcomes PRESCRIPTION MONITORING PROGRAM • Periodic training for practitioners concerning the misuse and abuse of controlled substances • The language in sections 15.1 through 15.9 is permissive, not mandatory:
Outcomes PRESCRIPTION MONITORING PROGRAM • The language in sections 15.1 through 15.9 is permissive, not mandatory: Each Board “may, by regulation, require…who is registered to dispense controlled substances pursuant to NRS 453.231 to complete at least 1 hour of training relating specifically to the misuse and abuse of controlled substances during each period of licensure. Any such holder of a license may use such training to satisfy 1 hour of any continuing education requirement established by the Board.”
Outcomes ADDITIONAL PROVISIONS IN SB459 • Ability for practitioners to “Red Flag” Doctor Shoppers – Section 13 • Next Day reporting to the PMP Database Section -13(2)
Outcomes GOOD SAMARITAN OVERDOSE ACT • Authority to Prescribe and Dispense to Non-Patients
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 7 of SB459 applies to a health care professional otherwise authorized to prescribe an opioid antagonist may directly or by standing order, prescribe and dispense and opioid antagonist to a person other than the patient.
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 7 describes other persons as “a family member, friend or other person in a position to assist such a person at risk of experiencing an opioid-related drug overdose.”
Outcomes GOOD SAMARITAN OVERDOSE ACT • Significant departure from traditional pharmacy law. Outside the scope of SB459, prescriptions must be written for the patient in a prescriber-patient relationship. See NRS 639.235(2) and (4). Prescribers cannot generally write prescriptions for persons who are merely related to or associated with the patient.
Outcomes GOOD SAMARITAN OVERDOSE ACT • Per the statute, such prescriptions are to be regarded as “being issued for a legitimate medical purpose in the usual course of professional practice.” Section 7(1) • Prescribers who write such a prescription in good faith and with care are immune from civil or criminal prosecution directly associated with writing the prescription. Section 7(2)
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 7(3), not withstanding any other provision of law, any person may possess and administer an opioid antagonist to another person who he or she reasonable believe is experiencing an opioid-related drug overdose.
Outcomes GOOD SAMARITAN OVERDOSE ACT • Any person is undefined, but the statute specifically states that law enforcement personnel, EMTs, advanced emergency medical technicians or paramedics are included, as being able to possess and administer an opioid antagonist
Outcomes GOOD SAMARITAN OVERDOSE ACT • Persons who act in good faith and with reasonable care in administering an opioid antagonist- although they would have no legal authority to administer other medications-are immune from criminal prosecution, civil liability and sanction from professional licensing boards. Section 7(4)
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 7(5) does not create a duty to prescribe or dispense an opioid antagonist. A prescriber who declines to prescribe the medication for any reason is immune from criminal, civil and administrative proceedings
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 8 Authority of unlicensed persons to store, possess and administer opioid antagonists
Outcomes GOOD SAMARITAN OVERDOSE ACT • Section 8 allows non-registered persons to store and dispense opioid antagonists pursuant to a standing order from a properly authorized prescriber. The caveat is that ‘those activities [must be] undertaken without charge or compensations.” Where the person has a standing order from a prescriber, the person can possess and dispense without charge without a license from the Board of Pharmacy pursuant to NRS Chapter 639.
Outcomes GOOD SAMARITAN OVERDOSE ACT • Authority of pharmacists to dispense opioid antagonists in accordance with standardized procedures or protocols developed and approved by the State Board of Pharmacy • Recent workshop held on October 15, 2015 • Another workshop scheduled for December 2015 • Pending regulations will be forwarded to LCB before adoption
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