Drug Overdose Prevention Program Supplement

.Kentucky had the 2nd highest age-adjusted drug overdose (DO) fatality rate in the nation, with 23.7 drug overdose fatalities per 100,000 population in 2013, more than quadruple the 2009 rate. The state has been a leader in prescription drug monitoring program (PDMP and called KASPER in Kentucky) development and implementation to support proactive reporting and data analysis. Groundbreaking prescription drug overdose (PDO) control legislation was passed in 2012, 2013, and 2015 (see KRS 218A.172, 118A.205, and 72.026). Supplemented by regulations at 201 KAR 20:207; 201 KAR 9:260; and 201 KAR 8:540, Kentucky law 1) requires a PDMP query by a controlled substance prescriber or delegate when prescribing schedule II-IV controlled substances and outlines prescribing standards by clinical profession; and 2) mandates decedent testing for controlled substances in post-mortem examinations to identify specific drugs that resulted in the fatal DO and reporting of results to Vital Statistics, Kentucky State Police, the licensure board of the prescriber, and the state Office of Drug Control Policy. The purpose of this application by the Kentucky Injury Prevention and Research Center (KIPRC), the bona fide agent of the Kentucky Department for Public Health, to the CDC National Center of Injury Prevention and Control is improve controlled substance prescribing practices by informing, advancing, and evaluating DO prevention interventions (including prescription drugs and heroin) to reduce overdose, misuse, and abuse, using three strategies: 1) enhancing and maximizing KASPER; 2) implementing targeted county interventions through PDO surveillance data analysis to identify high-risk DO populations and inappropriate controlled substance prescribing patterns; and 3) evaluating and performing cost-benefit analyses of PDO-related laws and regulations. The first strategy to enhance and maximize KASPER will be through 1) improvement of KASPER use and access by integrating KASPER with Electronic Health Record systems, expanding and enhancing KASPER training programs by clinical profession, and developing prescriber continuing education training on addiction and pain management; and 2) public health surveillance by linking KASPER data to health outcome data and establishing a DO fatality surveillance system using toxicology, medical examiner, vital statistics, coroner, crime, and KASPER data, as well as by collecting, analyzing and disseminating county-level KASPER data for local health department (LHD) use. The second strategy to implement LHD PDO prevention interventions through technical assistance provision to high-DO burden counties will be by 1) creating a multidisciplinary data-focused DO prevention group; 2) establishing a KIPRC DO Technical Assistance Center to support and enhance LHD DO data analysis, interpretation, and use; 3) informing LHD DO intervention development using DO County Profiles and PDO Dashboards; and 4) informing high-DO burden county prevention efforts to reduce problematic controlled substance prescribing through development of web-based and in-person training on best prescribing practices and use of naloxone across clinical professions, law enforcement in-person training on overdose interventions including administration of naloxone, public service announcements based on personal stories, and press releases. The third strategy will be to evaluate and perform cost-benefit analyses of Kentucky’s clinical profession-specific regulations that require a KASPER query when prescribing schedule II-V controlled substances and decedent controlled substance testing in post-mortem examinations. Anticipated outcomes of this project include enhanced safe controlled substance prescribing decision-making and patient safety, increased standard of care for pain management, improved state and local PDO prevention policies, as well as evidence of the economic value of model PDMP attributes, community interventions, and prevention policies that can be shared with other states