Governors Opioid State Action Accountability Meeting Oversight of Controlled Substance Prescribing J. David Wuest, Deputy Executive Secretary, Nevada Board of Pharmacy Edward Cousineau, Executive Director, Nevada Board of Medical Examiners Sandra Reed, Executive Director, Nevada Board of Osteopathic Medicine Cathy Dinauer, Executive Director, Nevada Board of Nursing 1 Objectives Past Present Governors Task Force Meeting (May 2015) Senate Bill 459 (2015) Comprehensive Planning Meeting (June 2016) Governors Summit (August 2016) Assembly Bill 474 (2017)
Senate Bill 59 (2017) Future 2 Past Collaboration, Partnerships, and Information Sharing Naloxone 3 Collaborative activities not focused on controlled substances (CS) Only available by prescription Few doses ever dispensed for outpatient use Public had very little knowledge of the medication Past PMP
4 Only contained prescription data Only identified doctor shoppers and notified prescribers through unsolicited reports No data pushing capabilities Only 20% of prescribers registered Past Prescriber education/guidance on prescribing CS Disciplinary action against a licensee for inappropriate CS prescribing 5
CDC guidelines (March 2016) No statutory or regulatory mandates No CE requirements on the misuse and abuse of CS Infrequent complaints of CS practices Minimal regulatory guidance regarding CS prescribing practices Lower investigative priority Present 6 Governors Prescription Drug Abuse Summit Report Prescribing Guidelines Prescriber Education Discharge Planning & Procedures
Oversight of Pain Management Clinics Track 1: Prescriber Education & Guidelines Track 2: Treatment Options & Third Party Payers Track 4: Criminal Justice Interventions Track 3: Data Collection & Intelligence Sharing Deterrents for Criminal Activity Prescription Drug Disposal Law Enforcement Data Sharing Sequential Intercept Model 7
Opioid Management Coverage for Non Opioid Pain Management Therapies Early Intervention Overdose Education & Naloxone Distribution Prescription Monitoring Program Empowerment of Nevadas Occupational Licensing Boards Public Health Data Track 1: Prescriber Education & Guidelines Track 1: Prescriber Education & Guidelines Track 2: Treatment Options & Third Party Payers
Track 3: Track 4: Criminal Justice Data Collection Interventions & Intelligence Sharing 8 Prescribing Guidelines Prescriber Education Track 2: Treatment Options & Third Party Payers Track 1: Prescriber Education & Guidelines Track 2: Treatment Options & Third Party Payers Track 4: Track 3: Criminal Justice Data Collection & Intelligence Interventions Sharing
9 Opioid Management Early Intervention Overdose Education & Naloxone Distribution Track 3: Data Collection & Intelligence Sharing Track 1: Track 2: Prescriber Treatment Options Education & & Third Party Guidelines Payers Track 4: Criminal Justice Interventions 10 Track 3: Data Collection & Intelligence Sharing
Prescription Monitoring Program (PMP) Empowerment of Nevadas Licensing Boards Law Enforcement Data Sharing Public Health Data Track 4: Criminal Justice Interventions Track 1: Track 2: Prescriber Treatment Options Education & & Third Party Guidelines Payers Track 4: Criminal Justice Interventions 11 Track 3: Data Collection & Intelligence Sharing
Deterrents for Criminal Activity Law Enforcement Data Sharing Prescription Drug Disposal Collaboration, Partnerships, and Information Sharing Past Collaborative activities not focused on CS Present Licensing boards quarterly meetings AB 474 White Paper SB 59 Law enforcement, medical examiners and coroners reporting to the PMP Violations of NRS 453
Overdoses (fatal and non-fatal) Reports of stolen prescription drugs Grants DHHS CDC grant Providing PMP data (monthly downloads) for: Trend analysis Dashboard Geomapping Reno Police Department- Harold Rogers Grant 12 Fraudulent/altered prescriptions
Illegal possession of illicit drugs or prescription CS Sales or trafficking of CS Others Linking prescription opioid use to heroin arrests Naloxone Past Only available by prescription Few doses ever dispensed for outpatient use Public had very little knowledge of the medication Present Available without prescription through updated pharmacy regulations Worked with Governors office and manufacturers to procure at reduced price
Department of Public Safety (DPS) able to obtain at a reduced cost Many doses dispensed for outpatient use Education CEs Newsletter 13 Shared information with providers, community groups, not-for-profit agencies regarding naloxone availability Reached out to 8,500 pharmacists educating them on new rules regarding furnishing naloxone PMP Past
Only contained prescription data Only identified doctor shoppers and notified prescribers through unsolicited reports No data pushing capabilities Only 20% of prescribers registered 14 Present Will contain prescription, law enforcement, medical examiners, and coroner data. Identifies doctor shoppers, and high prescribers and provides unsolicited reports to prescribers, licensing boards, and law enforcement
PMP can push data to prescribers AB 474 provides uniform method for investigating PMP reports Email capabilities, PMP announcements can be provided directly from PMP to prescribers Prescriber registration will be 100% with AB 474 Prescriber Education/Guidance on Prescribing CS Past CDC guidelines (March 2016) No statutory or regulatory mandates No CE requirements on the misuse and abuse of CS
15 Present AB 474 Prescribing guidelines For initial prescriptions (limited to 14 days), treatment after 30, 90, 365 days Enforce illegality of samples 2 hour mandatory CE requirement Licensing boards working together and have conducted CEs for MDs, DOs, dentists, RNs, APRNs, optometrists, pharmacists and federal and state law enforcement. Disciplinary Action Against a Licensee for Inappropriate CS Prescribing Past
Infrequent complaints of CS practices Minimal regulatory guidance regarding CS prescribing practices Lower investigative priority 16 Present Licensing boards will adopt necessary regulations Nevada State Board of Medical Examiners Education and Outreach
KnowYourPainMeds.com (February 21, 2017) AB 474 White paper to website and e-blasted to all our licensees. Finalizing brochures to distribute to licensees in both English and Spanish, which include information on how to obtain Naloxone (available through prescription or pharmacist). Presenting to residents at the University Medical Center on October 24, 2017. We are also planning a joint presentation with Dr. DiMuro to our licensees. Scheduling a radio interview with Lotus radio group to explain to the public the new requirements for prescribing CS. Working with the Nevada State Medical Association on joint outreach for licensees. Working with Project ECHO, University of Nevada School of Medicine in promoting educational clinics regarding pain management. Enforcement 17 Now have a dedicated attorney, investigator, and staffer focusing exclusively on prescribing cases. Held a workshop to update our regulations to require additional CMEs, as required by AB 474. Staff has received authority from the Board at the September 8, 2017 Board meeting to
implement regulations for discipline to be imposed for prescribing violations, and the proposed regulation has been sent to the LCB. 18 19 Nevada State Board of Osteopathic Medicine Currently, the BOM oversees the following: Total licensees as of September 18, 2017: 1,570 Active DOs (Doctors of Osteopathic Medicine): 1,142 Active PAs (Physician Assistants): 140 Inactive DOs: 75 Special Licenses (Residents): 209 DOs Special from adjoining states: 4 Workshop/Hearing for AB 474: Will hold a workshop on October 10, 2017 and a hearing on December 12, 2017, for the regulations
currently being written to comply with the above laws. Regulations would consist of the following: Addressing CE requirements regarding prescribing CS No regulation will be written regarding Sec. 41 of AB 474 because the process set out in AB 474 contains good guidance and authority that will supplement the already robust existing enforcement regime regarding inappropriate prescribing of opioids by the Boards licensees. Outreach: 20 Placed links to a helpful table of provisions of AB474 and links to AB474 on web site. Sent a newsletter in July outlining the legislation, and will send in email blasts to licensees in September 2017, the information sheets summarizing the requirements of AB474. Will hold several informational webinars in November 2017 to licensees regarding AB474. Nevada State Board of Nursing Background Number of APRNs licensed in Nevada: 1657 Number of APRNs with prescribing privileges: 1517 Prescriber Education
Distribution of AB 474 White Paper to all licensee holders Two live legislative update to APRNs Multiple emails of materials to APRNs Multiple presentations regarding SUDS and legislative update to various stakeholders Education to licensees regarding Naloxone Common Agenda / Continuous Communication Meetings with Governors office and other stakeholders Multiple meetings with boards regarding AB 474 implementation Prescription Monitoring Report Reports received and investigations opened Hired APRN consultant Regulations Regulations currently contained in NAC Chapter 632 regarding investigation and discipline adequately provide for enforcement of AB 474 Nevada Board of Pharmacy Is in the process of adopting regulations to ensure compliance with AB 474 and SB 59. 22
Future Implementation of AB 474 (January 1, 2018) Continue collaboration and improvement in communication Continuing education for practitioners Shared measurements PMP software enhancements and improvements to meet requirements of AB 474 and SB 59 Timely adoption of necessary regulations Solicitation of grants 23 CONTACT INFORMATION Nevada Board of Pharmacy
J. David Wuest, Deputy Executive Secretary Email: [email protected] Phone: 775-850-1440 Nevada Board of Nursing 24 Cathy Dinauer, Executive Director Nevada Board of Medical Examiners Edward Cousineau, Executive Director Email: [email protected] Phone: 775-688-2559
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