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JohnKarwoski,RPh,MBAJDJConsul;ngSeptember19,2016

Narco&cDiversionPreven&on

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•  Isdefinedasthetransferofanylegallyprescribedcontrolledsubstancefromtheindividualforwhomitwasprescribedtoanotherpersonforanyillicituse

ADDICTION•  Aprimarychronicdiseasereflectedbyanindividualpathologicallypursuingreward/reliefbysubstanceuse

•  Addic;onischaracterizedbytheinabilitytoabstainfromthesoughtsubstance

DRUGDIVERSION

•  WhatpromptedtheDEAtore-writeregula;on,begintaskforces,andoffertrainingtohealthcareprofessionals?

•  Increaseinnumberofdeathscausedbyprescrip;ondrugdiversion/abuse

•  Over-prescribingofprescrip;onpainkillers•  In4yearsofmedicalschoolphysiciansonlyreceiveanavgof11

hoursoftrainingonuseofpainmedica;ons•  Physiciansareunabletocouncilpa;entsonthecorrectuseand

disposalofpainmedica;ons

•  Prescrip;ondrugabusefeedsintoopioidabuse

THEOPIOIDABUSEEPIDEMIC

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•  Prescrip;onandopioidabusehasemergedfromtheurbanse\ng

•  DEAandlocallawenforcementareseeingabuseclimbdrama;callyinsuburbanareas

•  Everyone’sstoryisthesame…Theygotaddictedtoprescrip0onpainkillers,andthen…(Whenprescrip0onmedica0onsbecomeunavailable,Heroinebecomesthealterna0ve)

•  NowtheDEAisfocusingontheoriginoftheissue…prescrip;onmedica;onsandthefacili;eswherethey’recomingfrom

•  Over-prescribing•  Diversion

OPIOIDANDHEROINABUSEISNOTANURBANISSUE

•  DEAhaspin-pointedthatinaddi;ontothepoten;alforpa;entRXabuse…▫  Familymembers▫  Friends▫  Children▫  Anyonewhoentersyourhome…

•  It’stheresponsibilityoftheprescribingphysiciantocounselpa;entsonproperuseanddisposalofthedrug

THEFRIENDSANDFAMILYDISCOUNT

•  Hydrocodone(Vicodin)

•  Oxycodone(Percocet)

•  Oxycon;n

•  Fentanyl

•  Carisoprodol(Soma)

•  Alprazolam(Xanax)

THEMOSTCOMMONLYDIVERTEDDRUGS

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•  NJDOHhasbeguntheDrugDiversionCoali;on•  Annualmee;ngs•  Quarterlyphoneconferences•  Developingresources/toolkitsfordiversionpreven;on

•  DEADiversionconferencesacrosstheUS•  1dayconferenceheldDec,2015inPih.,PAahendedbyJDJConsul;ng

•  DOHSurveyorsnowaskingforproofofan;-diversiontrainingforsurgerycenterstaff.

•  StafftrainingmodulesoontobeavailablefromJDJConsul;ngforallclients

LOCALEFFORTSTOPREVENTDIVERSION

• Wherewillthedrugsbestored?

• Whowillhaveaccesstothedrugs?

• Whatwillthepa;entdowiththemedica;onwhenthey’refinishedwiththeprescrip;on?

•  Don’tkeepafew“justincase”inthehouse!

•  Dropoffloca;ons:NJnowrequiringthisno;cetobegiventoallpa;entsreceivingaprescrip;onforcontrolledsubstances!

COACHPATIENTSABOUTMEDICATIONSTORAGE

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•  Employeeinjectsthemselveswithasyringeintendedforapa;ent

•  Couldre-fillsyringewithsalineandthenusethesamesyringeonpa;ent

•  Couldrefillvialwithsaline,vialislaterusedforapa;ent

•  2009:Surgicaltechnicianwasdiver;ngnarco;csandreusingsyringes/vialsonpa;ents

•  5970pa;entseffected•  88%submihedtotes;ng•  18posi;vecasesofHepClinkedto

thesurgicaltechwereiden;fied

INFECTIONRISK

KristenParkerstoleFentanylandusedcompromisedsyringesandvialsonpa;ents.

SouthernNewJersey:2016

USOutbreaksAssociatedwithDrugDiversionbyHealthcareProfessionals,1983-2013

GraphictakenfromtheCentersforDiseaseControlandPreven;on(CDC),2015

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•  Employeesundertheinfluenceofcontrolledsubstancesareunfittocareforpa;ents

•  Ifanemployeehassubs;tutedadrugwithsalineaqerdiver;ng,thepa;entdoesn’treceivetheintendeddoseofthemedica;on

•  Par;aldose?•  Nomedica;onadministered

atall?

PATIENTSAFETY

•  Acomprehensiveandproac;vemonitoringsystem.Who,when,whatandhowtomonitor.

•  Theuseoftheknowledgeandexperienceofyourconsultantpharmacist!Educa;onforyourstaff.

•  Engageinriskanalysisprogramsdesignedtoiden;fyareasofweaknessanddevelopplansofcorrec;veac;on.

THEBESTBARRIERTODIVERSION…beginswith managementteam!

Recognizewhichmedica;onsarecontrolledsubstances•  SCHEDULEI:NocurrentacceptablemedicaluseintheUnitedStates

•  SCHEDULEII:Substancesinthisschedulehaveahighpoten;alforabusewhichmayleadtoseverephysicalandpsychologicaldependence

•  SCHEDULEIII:Substancesinthisschedulehavealowerpoten;alforabusethanschedulesI/IIandmayleadtomoderatetolowerphysicalandpsychologicaldependence

•  SCHEDULEIV:Substancesinthisschedulehavealowpoten;alforabuse

•  SCHEDULEV:Substancesinthisschedulehavethelowestpoten;alforabuseandconsistmainlyofprepara;onscontaininglimitedquan;;esofnarco;cs

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Facilityplacesorder

Wholesalerfulfillsorder

Independentshipper

sendsorder

Facilityreceivesorder

Orderisunpacked

Orderis

signedintoperpetualinventory

Medica;onisissuedtoanes.or

nursingunit

Medica;onisadministered

START

Canyouiden;fythehighestareasofrisk?

THEINVENTORYCONTINUUM

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•  Expirednarco;csmustbekeptsecureun;ltheyaredisposedofordestroyed▫  Ifyourstateallowsforon-sitedestruc;on,youmayuseeitherachemicaldiges;onagentoranincinerator▫  ReverseDistributorscanbeusedinall50states

• ORWastage,i.e.par;alsyringesandvials▫  DONOTusekihyliherorcoffeegrounds▫  DONOTflushorshootdownthesink▫  DONOTshootintotheredsharpscontainer▫  Youhavearesponsibilitytoensurethecontrolledsubstanceisnotretrievable▫  Poten;alsolu;ons:SmartSinksorchemicaldiges;onagent

PROPERDISPOSALOFCONTROLLEDSUBSTANCES

•  Bypu\ngupbarrierstodiversionyou’renotpresen;nganopportunityfordiversiontohappen

•  Hiringemployeesyoufeelconfidentinandmaintaininggoodlinesofcommunica;onhelpsensurethatthereisnoroomfordiversion

•  Staffbuy-intoan;-diversioneffortsiskey!

BETTEREMPLOYEES=BETTERSURGERYCENTERS

• Contactyourconsultantpharmacist

• No;fytheDEAaqeryourini;al(and;mely)inves;ga;on▫  CompleteDEAForm106ANDno;fyyourlocalfieldofficeinwri;ng▫  (21CFR131.74(c))

• Fileapolicereport

•  IfyourstatehasaCDSdepartment,no;fythem

• Yourconsultantpharmacistwillbeabletohelpyoudetermineifaddi;onalstepsarenecessary

INTHECASEOFDIVERSION,ORSUSPECTEDDIVERSION

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•  ThesurgerycenterhasalegalANDethicaldutytoreportdrugdiversion

•  Failuretoreportmayresultin:

•  Civilandregulatoryliability

•  Nega;vepublicity•  Jeopardizethesurgery

center’slicenseandMedicarepar;cipa;on

•  Failuretoreportputsaddi;onalpa;entsatrisk

•  Releasingadiverterfromemploymentwithoutrepor;ngisillegal!

THEDUTYTOREPORT

JOHNKARWOSKI,RPh,MBABRITTNEYLODATO,MPHPresidentandFounderAdministra;veDirector

www.JDJConsul;ng.net

• Operations/Medication Management/Controlled Substances

Available on Progressive eSupport

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