Prescription drug abuse

Saturday, March 01, 2014 11:21 AM

CMS forms new committee to guide policy

Kate Alfano, CMS contributing writer

The Colorado Medical Society has convened a new committee to more closely focus on a critical issue to physicians, patients and the public in Colorado: prescription drug abuse. CMS leaders were so concerned about opioid misuse in Colorado that they created the CMS Committee on Prescription Drug Abuse for the sole purpose of addressing the matter. 

“Prescription drug abuse is a rapidly evolving crisis in Colorado medicine,” said committee chair John Hughes, MD. “CMS needs this committee to stay ahead of the challenges that this crisis poses.”

A fact sheet on prescription drug abuse compiled by the Prescription Drug Abuse Prevention Program and released earlier this year revealed sobering statistics.

• Yearly deaths in Colorado due to drug-related poisoning more than doubled from 2000 (351) to 2012 (807). Deaths involving the use of opioid analgesics more than tripled in the same time period, from 87 to 295.
• More than twice as many people in Colorado died from poisoning due to opioid analgesics in 2012 (295) than from drunk-driving related fatalities (133).
• Oxycodone prescriptions for Colorado residents increased 54.3 percent from the third quarter of 2007 through the third quarter of 2013.

The CMS House of Delegates approved the formation of the committee in September 2013 and the board approved the initial committee roster in January 2014.

The committee will focus on three categorical areas in 2014:

1. Coordinating and working collaboratively with the Governor’s Colorado Consortium to Reduce Prescription Drug Abuse;
2. Addressing public policy issues – legislative or regulatory – that might arise that are not contemplated or are inconsistent with the CMS Platform on Prescription Drug Abuse passed by the 2013 House of Delegates; and
3. Coordinating with the appropriate state agencies and stakeholders on any changes to the Prescription Drug Monitoring Program to assure that the voice of the physician is heard and considered.

The Colorado Consortium on Prescription Drug Abuse Prevention serves as the lead for the governor’s Colorado Plan to Reduce Prescription Drug Abuse. The consortium provides a cooperative, interagency-interuniversity network to enable the health care community, state agencies and others to work together to implement a strategic plan that targets six areas of the prescription drug abuse issue – the Prescription Drug Monitoring Program (PDMP), treatment, prescriber and provider education, safe disposal, public awareness, and data/analysis. The consortium assigned a workgroup to each focus area.

“I think we’re making very meaningful progress in each of our focus areas,” said Robert Valuck, PhD, RPh, director of the consortium and professor in the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. “Each work group is generating a variety of deliverables – from legislation to new permanent drop box locations, to educational programs, to public awareness/PSA campaigns – each of which is a critical element in our overall strategy to address the problem in our state.” He encourages CMS-member physicians to volunteer to serve on one of the consortium work groups to provide the physicians’ perspective.

Valuck will speak about prescription drug abuse at the 2014 CMS Spring Conference in May, using a combination of stories and movie clips to raise awareness of the problem of prescription drug abuse in Colorado. He will generate discussion and sharing among physicians regarding possible ways they can promote safe use, safe storage and safe disposal of medications, and offer an overview of what is happening at the state level with the consortium, the attorney general’s substance abuse trend and response task force, and various community coalitions.

The CMS Prescription Drug Abuse committee held its first meeting on Tuesday, Jan. 21 to discuss legislation under consideration by the Colorado General Assembly. HB14-1283, Modify Prescription Drug Monitoring Program, was introduced in the House in mid-February by Rep. Beth McCann (D), Sen. Linda Newell (D) and Sen. John Kefalas (D), and assigned to the House Committee on Health, Insurance and Environment.

HB14-1283 would permit delegated access to the PDMP, allowing a physician or pharmacist to delegate query tasks to registered delegates. It also authorizes functionality to provide unsolicited reports to notify prescribers and pharmacists of potential problems. It requires physicians to register for the PDMP – but does not mandate usage. It allows use of PDMP data for public health reporting and health care coordination. And it requires daily uploading of data from pharmacies to the PDMP system, which represents an administrative change from the current two-week requirement.

Though the bill will likely have amendments as it moves through the legislative process, the committee’s initial review showed that it is largely consistent with CMS policies on the PDMP and members unanimously voted to recommend support of the bill to the CMS Council on Legislation. Important work to upgrade the functionality of the PDMP through an upgrade to the program software will be the focus of a future story.

Another bill under consideration, HB14-1207 or Household Medication Take-back Bill, would create the necessary infrastructure for a permanent take-back program. It would establish a household medication take-back program to collect and dispose of unused household medications, pending final rules from the U.S. Drug Enforcement Agency (DEA) to allow pharmacies to take back controlled substances.

The committee will meet in person every other month and conduct business by e-mail between meetings. Members will continually review the CMS platform on prescription drug abuse and make recommendations to the Board of Directors when amendments to the platform are needed. They will also guide CMS’ effort to increase physician and public awareness of the problems surrounding prescription drug abuse, and work to improve data on the issue so solutions are reflective of the need in Colorado.

Members with interest in the issue can still join the CMS Prescription Drug Abuse Committee. Contact terry_boucher@cms.org.

Hughes described the desired composition of the group: “It is important that the committee have physician members with a diverse array of perspectives and backgrounds. These include primary care physicians, where there are differing perspectives from each: Emergency medicine, family medicine and occupational medicine.

“Another perspective is from physicians advising medical insurance companies, the Colorado Division of Workers’ Compensation, as well as physicians advising medical malpractice carriers. Key specialists include chronic pain specialists, neurologists, toxicologists, palliative care physicians and addiction specialists. Finally, the committee should have physician educators as well as physicians in educational programs from Colorado educational institutions.”