Safe Prescribing and Use of Opioids National Rx Drug Abuse Summit 4-11-12

1. Safe Prescribing and
Use of Opioids
April 10-12, 2012
Walt Disney World Swan Resort

2. Accepted Learning Objectives:
1. Analyze current professional education
programs on safe use of opioids and new
programs under development.
2. Explain a potentially transformative on-line
educational tool for health professionals that
enable them to train by interacting with “virtual
patients.”
3. Describe a Massachusetts program for training
physicians on safe opioid prescribing, and the
curriculum developed to teach residents
and faculty.

3. Disclosure Statement
• Dr. Daniel P. Alford and Sarah Ball have
disclosed no relevant, real or apparent
personal or professional financial
relationships.
• Benjamin Lok has disclosed that he has
a relationship with Shadow Health, Inc.

4. The South Carolina
Opioid Safe Use Initiative
(SCOSI)
Blending academic detailing
and a prescription drug monitoring program
to reduce opioid misuse and
optimize opioid safe use in pain management
Sarah Ball, Pharm.D.
Program Director for Academic Detailing
and Assistant Professor
South Carolina College of Pharmacy
University of South Carolina (USC)/Medical University of SC
April 11, 2012

5. SCOSI
• FDA planning grant to improve safe use
of opioids
– Awarded to the South Carolina College of
Pharmacy (SCCP) at USC
• Three major components
– Academic Detailing (SCORxE)
– Prescription Drug Monitoring (SCRIPTS) data
– Stakeholder Involvement

6. SCOSI
Given the risks of opioid abuse/
misuse, diversion, addiction, tolerance
and drug side effects, physician
education and engagement is key in
handling pain management and
appropriate use of opioids in patients
of all ages

7. Academic Detailing:
Social marketing for
better clinical practice
Evidence Practice
– Frank May MAppSci(Pharm), FISPE, DATIS Service Director

8. Academic Detailing:
A ‘New’ Old Concept
― Avorn J, Soumerai SB. Improving drug-therapy
decisions through educational outreach: a
randomized controlled trial of academically based
detailing. N Engl J Med 1983;308:1457-63.
― “Sound data on clinical pharmacology and cost
issues could be used to improve physicians’
prescribing decisions if that information were
presented in an educational outreach program that
was rooted in established principles of behavioral
science, market research, and communications
theory.”

9. Academic Detailing
Personalized support for good clinical
decision-making through:
― Periodic face-to-face encounters
• Trained health professionals visit clinicians in their
practice settings, often one-to-one
• Discuss topics of interest
• Deliver key evidence-based messages to facilitate
better patient care
• Unbiased by commercial or other extraneous
interests
― Useful support services between visits
Goal – to optimize practice patterns

10. Academic Detailing:
Does it Work?
Median adjusted
Comparison Outcomes
risk difference (RD)
Compliance with desired
practice 5.6% (IQR* = 3-9%)
Academic (n =34)
Dichotomous
detailing and no
(n = 37) Prescribing (n =17) 4.8% (3-6.5%)
intervention
Non-prescribing (n = 17) 6% (IQR 3.6-16%)
Comparison Outcomes Median difference
Academic
Continuous Improvement from
detailing and no 21% (IQR 11-41%)
(n = 19) baseline (n = 17)
intervention
*IQR = interquartile range
O’Brien et al. Cochrane Database of Systematic Reviews 2007, Issue 4.

11. Academic Detailing
Trusting Relationships formed between
academic detailers,
physicians and other
healthcare practitioners
can become the spearhead
for many clinical practice
improvement strategies

12. What is SCORxE?
Academic Detailing Service implemented by SCCP in
Nov 2007 through grant funding provided by SC DHHS
― Visits from trained clinical pharmacists on clinically
relevant topics
― Address barriers to change in practice and
prescribing
― Promote optimal, evidence-based treatment
decisions, regardless of medication coverage plans
― Resource available to research and answer any
medication-related question
Can focus on any clinically relevant topic to address
gaps between evidence-based treatment and
practice
SC DHHS: South Carolina Department of Health and Human Services

13. SCORxE Snapshot
• Interactive office visits on 5 Provider participation*
clinical topics
Ave visit: 30.9 minutes
• Development of scientifically
sound, user-friendly provider 46.7% asked questions
packets on 6 clinical topics requiring follow-up
– Physicians ‘love the materials’
• Expansion from 6 to 18 20% completed CME
counties 99% agreed to next
• Reinforcement through visit**
subsequent visits * Nov 2007 – Sept 15, 2011
– “Follow-up on topic is good. It ** Providers visited on a topic agree to a
return visit
helps keep me motivated.”

14. Prescription Monitoring Program (PMP)
State program that collects data, stores data, and
generates reports on some set of controlled
prescription drugs
― Also referred to as Prescription Drug Monitoring
Program (PDMP)
― Data collection includes patient, prescriber,
dispenser and drug information available on a
prescription
― Report generation differs across state programs
(may be proactive or reactive)
Offers unique opportunity to inform physicians of
the scope and magnitude of prescription drug
abuse and “doctor shopping”
Carnevale and Associates, LLC. (2011). Policy Brief. Available at:
http://www.carnevaleassociates.com/pmp_brief_4-13-11.pdf

15. Prescription Monitoring Program
An Untapped Resource
The potential value of PMPs in
helping physicians make more
informed decisions for prescribing
opioids has been
accepted by many stakeholders in the
pain management, substance abuse
and public health and
safety arenas.

16. What is SCRIPTS
The South Carolina PMP legislated by the SC General
Assembly in 2006 to respond to prescription drug abuse
― Went into effect Feb 2008
― Established and maintained by the Bureau of Drug
Control at SC DHEC
― Tracks all dispensed controlled substances in Schedules
II, III and IV
― As of Mar 2012, over 40.3 million dispensing records in
the database
Intent is to identify and stop diversion of prescription
drugs without impeding appropriate use of licit
controlled substances
SC DHEC: South Carolina Department of Health and Environmental Control

17. SCOSI Stakeholders
• Interdisciplinary team with interest in opioid
safety who offer collective expertise in:
– De-identified data analyses and evaluation
– Academic detailing
– PMPs (includes Brandeis University PMP COE)
– Prescription drug abuse
– Medical education on opioid use and pain
management
• Unique opportunity to identify cost-effective
public health and safety strategy that
addresses both opioid abuse and
appropriate, safe opioid use
COE: Center of Excellence

18. SCOSI Will Develop an Academic Detailing
Strategy to Optimize Pain Management and
Increase Utility of PMPs
• Develop user-friendly, evidence-based academic
detailing materials on pain management and opioid use
– Data driven research from SCRIPTS data can refine intervention
strategy and selection of key messages
• Interactive office visits to promote best treatment
decisions about pain management and opioid
prescribing
• Increase physicians’ awareness of SCRIPTS
• Engage physicians in the use of the SCRIPTS database
– Offer Performance Improvement Continuing Medical Education (CME) for opioid
prescribing self-audits

19. Blending Two Unique and Useful Strategies
for Safe Prescribing and Use of Opioids
SCORxE SCRIPTS
Effective interactive technique to Does not offer latest scientific
deliver physician education on optimal knowledge on medication use and
pain management and opioid patient care decisions
prescribing
Rarely has access to real-time data Provides real-time data to monitor for
potential opioid abuse
Increase physicians’ awareness of An untapped resource that is
SCRIPTS and assist with access/use of underutilized
SCRIPTS data reports
Address barriers to change in practice Data resource to track changes in
and prescribing practice patterns

20. A Blueprint to Serve as a National Model
for Safe Prescribing and Use of Opioids
Academic Detailing PMP or PDMP
Effective interactive technique to Does not offer latest scientific
deliver physician education on optimal knowledge on medication use and
pain management and opioid patient care decisions
prescribing
Rarely has access to real-time data Provides real-time data to monitor for
potential opioid abuse
Increase physicians’ awareness of An untapped resource that is
PMP/PDMP and assist with access/use underutilized
of PMP/PDMP data reports
Address barriers to change in practice Data resource to track changes in
and prescribing practice patterns