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Governor's Office of Youth, Faith and Family
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Strategy 2

Reduce illicit acquisition and diversion

of prescription drugs.

Prevention

Working ourselves out of a job one drug free person at a time

LEARN MORE ABOUT PREVENTION

Treatment

Because you’re worth saving

LEARN MORE ABOUT TREATMENT

Recovery

Loving your future one day at a time

LEARN MORE ABOUT RECOVERY

Wellness & Recovery

Everyone has a role in reducing prescription drug misuse and abuse.  As some of the most trusted individuals in our community, Healthcare providers can have a huge impact in fighting this epidemic.  The materials in this section are designed to give providers tools that can be applied universally as a standard of care for all patients receiving pain treatment (or treatment involving controlled substance). The material in this section includes but are not limited to information on the importance of using the Controlled Substance Prescribing Program (CSPMP), how to sign-up a delegate to utilize the CSPMP, draft informed consent forms for prescribing opioids, and the Arizona Prescriber Guidelines. Community coalitions are vital in ensuring that pharmacists, physicians, dentists and other healthcare providers receive this information and in creating a community norm that supports safe prescribing practices

There are many actions within Strategy 3 that Healthcare providers and/or community groups such as coalitions can take that play a major role in combating the prescription drug misuse and abuse epidemic. Here are three tips to keep in mind while implementing and planning activities around this strategy:

  1. Awareness: Reach out to the hospital - Administration staff, pharmacists, veteran's clinics and hospitals, veterinarians and dentists in your area and let them know about the Rx Drug Misuse and Abuse Initiative. Use the materials in Strategy 2 to inform them on education materials available to Healthcare providers and patients on CSPMP delegate sign-up, drafts of informed consent, FREE AMA PRA Category 1 credit through VLH on safe prescribing practices, disposal, and pain management therapies. 
  2. Action: Develop a door-to-door, letter writing, or e-mail campaign to prescribers. You will want to: Find a healthcare champion, request a list of prescribers in your area from the Board of Pharmacy, send information to all prescribers on the importance of utilizing the CSPMP and information on how prescribers can signup a delegate, ask prescribers to inform patients on the risks associated with prescribed painkillers and have patients sign an informed consent, and provide a copy of the Arizona Prescribing Guidelines to all prescribers in your area. 
  3. Outcomes: Once you have started your work, check-in with the Board of Pharmacy to see if the number of queries prescribers are making and see if there is.a change in the number of prescriptions and pills per prescription. Keep track of the amount of information that you are disseminating in your community. 

Strategy 2 Materials

To begin implementing this strategy, simply select files that you are interested in implementing and click the Download button. If you or your community group would like additional guidance in using this or any of the strategies, complete the request a training form below.

Training Resources

Arizona CSPMP Tutorials

AZ CSPMP MyRx AZ 07/02/2018

AZ CSPMP Registering for an Account 07/02/2018

AZ CSPMP Patient Request 07/02/2018

AZ CSPMP Registering a Delegate AZ 07/02/2018

AZ CSPMP Bulk Patient Search 07/02/2018

AZ CSPMP Patient Report 07/02/2018

Commonly Asked Questions

Who is required to review a patient record in the Controlled Substance Prescription Monitoring Program (PMP)?

Dispensing pharmacists, beginning April 26, 2018, will be required to review the PMP record of a patient receiving a schedule II controlled substance for the preceding 12 months at the beginning of each new course of treatment. (A.R.S. 36-2606)

As of October 16, 2017, prescribers are required to check the PMP before prescribing an opioid analgesic or benzodiazepine controlled substance listed in schedule II, III or IV for a patient, shall obtain a patient utilization report regarding the patient for the preceding 12 months from the controlled substances prescription monitoring program's central database tracking system at the beginning of each new course of treatment and at least quarterly while that prescription remains a part of the treatment.

Both pharmacists and prescribers register for the PMP online at https://arizona.pmpaware.net.

Can prescribers continue to dispense controlled medication out of the office?

Beginning April 26, 2018, prescribers who treat humans can no longer dispense schedule II opioids, except for medication-assisted treatment (MAT) for substance abuse. Other controlled medications can be dispensed as specified by the prescriber’s licensing board.

What are the new limits regarding the length of time opioids may be prescribed?

Beginning April 26, 2018, a health professional shall limit the initial prescription for a schedule II opioid to not more than a five-day supply, except an initial opioid prescription following a surgical procedure is limited to a 14- day supply. (A.R.S. 32-3248)

The initial prescription 5-day supply limitation does not apply if:

  1. The prescription is following a surgical procedure. Surgical procedure prescriptions are limited to a 14-day supply

  2. The patient has an active oncology diagnosis;

  3. The patient has a traumatic injury, excluding a surgical procedure;

  4. The patient is receiving hospice care, end-of-life care, palliative care, treatment for burns or skilled nursing care;

  5. The patient is receiving MAT for a substance use disorder; or

  6. The patient is an infant being weaned off opioids at the time of hospital discharge.

What is the maximum morphine milligram equivalents (MME) a prescription may be written for?

The Opioid Epidemic Act prohibits a health professional who is authorized to prescribe controlled substances from issuing a new prescription for a schedule II opioid that exceeds 90 morphine milligram equivalents (MMEs).

A health professional who believes a patient requires more than 90 MMEs per prescription must consult with a licensed physician who is a board-certified pain specialist. A health professional is permitted to prescribe in excess of the 90 MME limitation if the consulting physician is not available for a consult within 48 hours, and provides that the consultation may occur subsequent to the prescription being issued.

A health professional may write for a prescription that is more than 90 MME per day if it is:

  1. A continuation of a prior prescription order issued within the previous 60 days;
  2. An opioid with a maximum approved total daily dose in the labeling as approved by the U.S. Food and Drug Administration (FDA);
  3. For a patient who has an active oncology diagnosis or a traumatic injury, not including a surgical procedure;
  4. For a patient who is hospitalized;
  5. For a patient who is receiving hospice care, end-of-life care, palliative care, skilled nursing facility care or treatment for burns; or
  6. For a patient who is receiving MAT for a substance use disorder.
I heard all controlled substance prescriptions will need to be prescribed electronically, is that true?

The Act requires an electronic prescription to a pharmacy for a schedule II drug that is an opioid in Maricopa, Pima, Pinal, Yavapai, Mohave and Yuma counties beginning January 1, 2019. However, for Greenlee, La Paz, Graham, Santa Cruz, Gila, Apache, Navajo, Cochise, and Coconino counties the requirement in the Act does not begin until July 1, 2019.

Are pharmacies impacted by the Act?

Yes, pharmacies are impacted by the act. Dispensers of out-patient schedule II opioids will need to use red caps on the containers containing the medication and include a warning label. The Arizona State Board of Pharmacy (ASBP) has issued the following information:

Beginning April 26, 2018, all out-patient dispensers of schedule II opioids will:

  1. Have an action plan and policies and procedures written out regarding the implementation of the red caps and new labeling requirements on out-patient opioid dispenses.

  2. If red caps are not readily available due to production delays, the ASBP will recognize the use of RED stickers to be placed on top of existing caps. The red sticker will cover most, if not all, of the cap.

  3. Implement red caps immediately upon availability.

Long-term, pharmacy owners need to be ready to accept electronic prescriptions in 2019. The Opioid Epidemic Act requires an electronic prescription to a pharmacy for a schedule II drug that is an opioid in Maricopa, Pima, Pinal, Yavapai, Mohave and Yuma counties beginning January 1, 2019. However, for Greenlee, La Paz, Graham, Santa Cruz, Gila, Apache, Navajo, Cochise, and Coconino counties the requirement in the Act does not begin until July 1, 2019.

Are veterinarians now required to check the PMP?

No, veterinarians are not required to check the PMP. However, beginning April 26, 2018:

  1. A veterinarian who reasonably suspects or believes that a client or person is trying to obtain controlled substances with an intent other than to treat the patient animal shall report that suspicion, or cause a report to be made, to local law enforcement within forty-eight hours after the treatment or examination. The report shall include the name and address of the client or person who sought the examination or treatment. The veterinary records pertaining to the investigation initiated pursuant to the report to law enforcement under this subsection shall be provided to local law enforcement on request for any further criminal investigation.
  2. A veterinarian who files a report or causes a report to be filed pursuant to subsection a of this section is immune from civil liability with respect to any report made in good faith. (A.R.S. 32-2239.01) 

Why is informed consent important when prescribing opioids?

Some individuals who are prescribed opioid medications for the treatment of pain will encounter significant problems with opioid therapy, including the potential for misuse and abuse, and significant morbidity and mortality.  Informed consent can be used as an important component of opioid treatment agreements to promote the safe use of opioids by clearly informing patients of risk, and to allow for discussion of risk factors and side effects, along with potential benefits and limitations.  Important components of managing risk include discussion of agreed upon treatment goals and the circumstances for continuation or discontinuation of opioid medication. Other beneficial points of discussion are alternative pain management and self-management strategies.  http://www.jpsmjournal.com/article/S0885-3924(11)00772-X/fulltext

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