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Facing the Crisis in Tennessee and Looking Forward
Presenters and Advisors
All presenters & advisors declare that they do not have any current financial disclosures.
Katie Webb, PharmD PGY-1 Pharmacy Resident TN Department of Mental Health & Substance Abuse Services [email protected]
Wesley Geminn, PharmD, BCPP Chief Pharmacist, State Opioid Treatment Authority TN Department of Mental Health & Substance Abuse Services [email protected]
Reginald Dilliard, PharmD Executive Director TN Department of Health Board of Pharmacy [email protected]
Erica Schlesinger, PharmD Assistant Chief Pharmacist TN Department of Mental Health & Substance Abuse Services [email protected]
Learning Objectives
1. Identify key outcomes seen in Tennessee following targeted legislative efforts to address the opioid crisis.
2. Describe the shift seen in the drug epidemic in Tennessee over the last several years.
Important Legislative Efforts in Tennessee
Prescription Safety Acts of 2012 and 2016
• Dispensers must submit data each business day to CSMD
• Mandatory CSMD checks for prescribers & dispensers
TN Together (2018)
• Days supply and MME limitations
• Mandatory CSMD check every 6 months
Prescription Outcomes *Note: Updated CDC data was not available for 2019 analysis; once available, some numbers may change. Data from 2018 was used for outcomes most
likely to be affected.*
MME & Days Supply Limits
• MME reported decreased 53% (2012-2019)
• Opioids for pain decreased 38% (2012-2019)
• Patients receiving >120 MME decreased 52% (2012-2019)
• 58% of patients with an opioid prescription had 7 or fewer active prescription days in 2019
CSMD Checks/Other
• Potential doctor shoppers decreased 89% (2011-2019)
• 62% decrease in number of pain clinics (2014-2019)
• 171% increase in buprenorphine for OUD (2011-2018)
• 24% increase in stimulant prescriptions (2012-2018)
Overdose Data
• Only 40% of individuals who died of a drug overdose in 2018 had any controlled substance dispensed within the last 60 days
• Deaths involving:
o All Opioids: Increased 3% (2017-2018) o Rx Opioids: Decreased 28% (2016-2018) o Stimulants: Increased 228% (2014-2018)
o Heroin: Increased 148% (2014-2018) o Fentanyl: Increased 945% (2014-2018)
Next Steps
We have moved from an epidemic driven largely by prescription opioids to one that involves many other
substances, including illicit opioids and stimulants. While we need to continue our momentum in reducing
unnecessary opioid exposure, we also need to shift our focus to include all substances involved in this crisis.
Moving forward, the accessibility of pharmacists should be better leveraged to provide education, screening,
and early intervention at the point of care. Finally, we need greater pharmacist involvement in medication-
assisted treatment to continue promoting quality treatment for patients with substance use disorders.
2012
2013
2014
2015
2016
2017
2018
2019
10
7.5 5
2.5 0
2012
2013
2014
2015
2016
2017
2018
2019
10
7.5
5
2.5
0
28%
148%
945%
228%
AND
LOOKIN
G
FORW
ARD
2012
2002
Pres
crip
tion
Saf
ety
Act
2015
Addi
ctio
n Tr
eatm
ent A
ctD
rug
Dis
posa
l Pro
gram
s Ac
t
2017
Non
-Res
iden
tial B
upre
norp
hine
Trea
tmen
t Gui
delin
es
Cont
rolle
d Su
bsta
nce
Mon
itori
ng A
ct
2014
Nal
oxon
e Re
gula
tions
2016
Pres
crip
tion
Saf
ety
Act
Stat
ewid
e N
alox
one
CPPA
2018
TN T
oget
her
Gab
apen
tin S
ched
uled
(C-IV
)20
19TN
Tog
ethe
r Am
endm
ents
2021
Man
dato
ry E
-pre
scri
bing
NO.RXSINMILLIONS
OPIO
IDS
FOR
PAIN
BENZODIA
ZEPIN
ES
BUPRENORPHIN
E F
OR
OUD
STIM
UL
ANTS
FACIN
G T
HE
CRIS
IS I
N
TENNES
SEE
MMEREPORTEDINBILLIONS
KEY
OUTCOM
ES
OVERDOSE
D
AT
A
POTENTIAL
DOCTOR
SHOPPERS
DECREASED
FROM
2011-201989
%52
%
REDUCTION
IN
NO
.
OFPATIENTS
RECEIVING
> 120
MME
PER
DAY
FROM
2012
-2019
40%
LESSTHAN
HALF
OF
INDIVIDUALS
WHO
DIED
OF
AN
OVERDOSE
IN
2018
HAD
A C
ONTROLLED
SUBSTANCE
DISPENSED
WITHIN
60
DAYS
DECREASE
IN
OPIOID
RX
'S FOR
PAIN
FROM
2012
-2019
38%
DECREASE
IN
DRUG
OVERDOSE
DEATHS
INVOLVING
PRESCRIPTION
OPIOIDS
INCREASE
IN
DRUG
OVERDOSE
DEATHS
INVOLVING
HEROIN
INCREASE
IN
DRUG
OVERDOSE
DEATHS
INVOLVING
FENTANYL
INCREASE
IN
DRUG
OVERDOSE
DEATHS
INVOLVING
STIMULANTS
SHIFT
FROM
PRESCRIPTION
PAIN
RELIEVERS
TO
ILLICIT
OPIOIDS
AND
STIMULANTS
WH
AT
'SNEXT
?
CONTINUE
MOMENTUM
IN
REDUCING
UNNECESSARY
OPIOID
EXPOSURE
CHANGE
OUR
FOCUS
FROM
THE
"OPIOID
"
PROBLEM
TO
THE
"DRUG
" P
ROBLEM
LEVERAGE
PHARMACISTS
FOR
SCREENING
AND
EARLY
INTERVENTION
EFFORTS
INCREASE
PHARMACIST
INVOLVEMENT
IN
MEDICATION
ASSISTED
TREATMENT
PH
ARM
ACIS
T INVOLVEM
ENT
IM
PROVES
OUTCOM
ES
PRESENTERS
& A
DVISORS
:
KATIE
WEBB
, PHARM
.D.
REGINALD
DILLIARD
, PHARM
.D.
WESLEY
GEMINN
, PHARM
.D.,
BCPP
ERICA
SCHLESINGER
, PHARM
.D.
DECREASE
IN
NUMBER
OF
PAIN
CLINICS
IN
TN
FROM
2014
-2019
62%
PERCENTOF
PATIENTS
FILLING
OPIOIDS
HAD
< 7
ACTIVE
RX
DAYS
IN
2019
58%
INCREASE
IN
NUMBER
OF
BUPRENORPHINE
RX
'S FOR
OUD
FROM
2011-2018171%
3%INCREASE
IN
ALL
OPIOID
OVERDOSE
DEATHS
*Not
e: U
pdat
ed C
DC
data
was
not
ava
ilabl
e fo
r 201
9 an
alys
is; o
nce
avai
labl
e, s
ome
num
bers
may
chan
ge. D
ata
from
201
8 w
as u
sed
for o
utco
mes
mos
t lik
ely
to b
e af
fect
ed.*
Preventative Measures for HIV-Vulnerable
Patients in the LGBTQ+ Community
By: Ryan Bernhardt and Andrea Buzakovic, PharmD Candidates,
Class of 2021, North Dakota State University School of Pharmacy
This presentation is brought to you today to discuss one of the leading public health concerns
among the LGBTQ+ community. The human immunodeficiency virus, also called HIV/AIDS, is a
disease that is contracted far too often among the LGBTQ+ community based on a variety of factors.
Many of these factors can be prevented by ensuring that the public is educated on the transmission and
spreading of this disease, along with non-pharmacological and pharmacological options. During this
presentation, we would like to inform pharmacy professionals how they are able to inform the public
about these different HIV preventative measures.
The learning objectives of this poster presentation are as follows: 1. Describe the health care
challenges patients face by being part of the LGBTQ+ community and how these challenges may lead
to a higher HIV infection rate among this community; 2. Compare and contrast the non-
pharmacological and pharmacological measures available to help patients receive the best HIV
preventative care; and 3. Identify how a pharmaceutical professional can help patients within the
LGBTQ+ community receive the best preventative care possible. Our hopes are that after this
presentation has concluded, pharmacy professionals will be able to better help patients prevent HIV
infection.
Thank you,
Ryan Bernhardt, PharmD Candidate, Class of 2021,
North Dakota State University School of Pharmacy
Email: [email protected]
Andrea Buzakovic, PharmD Candidate, Class of 2021,
North Dakota State University School of Pharmacy
Email: [email protected]
Pre
ven
tati
ve M
ea
su
res
fo
r H
IV V
uln
era
ble
Pa
tie
nts
in
th
e L
GB
TQ
Co
mm
un
ity
Ryan
Bern
hard
t an
d A
nd
rea B
uzako
vic
, P
harm
D.
Can
did
ate
s C
lass o
f 2021
No
rth
Dako
ta S
tate
Un
ivers
ity,
Farg
o,
ND
Ba
ck
gro
un
d
HIV
is o
ne
of
the
la
rge
st
pu
blic
he
alth
co
nce
rns
am
on
g t
he
LG
BT
Q c
om
mu
nity.
Acco
rdin
g to
th
e C
en
ter
for
Dis
ea
se
Co
ntr
ol1
:
•1
.2 m
illio
n p
eo
ple
are
liv
ing
with
HIV
in
th
e
Un
ite
d S
tate
s
•1
in
6 g
ay a
nd
bis
exu
al m
en
will
po
ten
tia
lly
be
dia
gn
ose
d w
ith
HIV
if cu
rre
nt
tre
nd
s
co
ntin
ue
•T
ran
sg
en
de
r w
om
en
ha
ve
49
tim
es th
e
od
ds o
f liv
ing
with
HIV
in
ce
rta
in
co
mm
un
itie
svs th
e r
est o
f th
e g
en
era
l
po
pu
latio
n
Pre
ve
nta
tive
Me
as
ure
s
Wa
ys to
re
du
ce
ra
te o
f H
IV in
fectio
n3:
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no
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ou
r se
x p
art
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rs
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ositiv
e?
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nd
ete
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ble
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l lo
ad
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se
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n d
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terc
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et
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r S
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tly if p
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isky b
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rs
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ore
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se
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ran
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n
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ilk
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agin
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oS
em
en
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ecta
l F
luid
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re P
rop
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te 3
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se
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ad
ditio
n t
o s
afe
se
x p
ractice
s to
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uce
th
e r
isk o
f H
IV in
fectio
n
•Q
ua
lific
atio
ns fo
r P
rEP
:
oN
eg
ative
HB
V t
est
oN
eg
ative
HIV
te
st
oT
este
d f
or
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eve
ry 3
mo
nth
s w
hile
on
the
me
dic
atio
n to
en
su
re H
IV n
eg
ative
sta
tus
•If
qu
estio
na
ble
exp
osu
re,
co
nta
ct a
he
alth
ca
re
pro
vid
er
imm
ed
iate
ly
oIf
HIV
positiv
e, additio
nal m
edic
ation
the
rap
y is r
eq
uire
d t
o fig
ht
the
in
fectio
n
Eff
icacy:
•A
ccord
ing t
o t
he iP
rEx s
tudy:
Co
vera
ge/P
aym
en
t5:
•C
ost
for
Tru
vada d
epends o
n y
our
specific
insura
nce p
lan,
how
ever
Gile
ad
Advancin
g A
ccess h
as m
ultip
le o
ptions
for
patients
:
oT
he c
o-p
ay c
oupon c
ard
covers
up t
o
$7,2
00 in c
o-p
ays p
er
year
if y
ou
have c
om
merc
ial in
sura
nce
oIf
you d
o n
ot
have insura
nce,
there
are
Medic
ation A
ssis
tance P
rogra
ms
to h
elp
with m
edic
ation c
ost
Co
nc
lus
ion
Re
fere
nc
es
1. H
um
an R
igh
ts C
amp
aign
. HIV
an
d t
he
LGB
TQ C
om
mu
nit
y. H
um
an R
igh
ts C
amp
aign
. Acc
esse
d S
epte
mb
er 2
0, 2
019.
A
vaila
ble
fro
m: h
ttp
s://
ww
w.h
rc.o
rg/r
esou
rces
/hrc
-iss
ue
-bri
ef-h
iv-a
ids-
and
-th
e-l
gbt-
com
mu
nit
y.
2. H
IV. C
ente
rs fo
r D
isea
se C
on
tro
l an
d P
reve
nti
on
. Cen
ters
for
Dis
ease
Co
ntr
ol a
nd
Pre
ven
tio
n, S
epte
mb
er 2
6, 2
019.
A
vaila
ble
fro
m: h
ttp
s://
ww
w.c
dc.g
ov/h
iv/g
roup
/msm
/bm
sm.h
tml
3. C
arlo
Ho
jilla
, J.,
Ko
este
r, K
imb
erly
, Co
hen
, Ste
ph
anie
, Bu
chb
ind
er, S
usa
n, L
adze
kpo
, Dea
wo
di,
Mat
hes
on
, Tim
, an
d
Liu
, Alb
ert.
Sex
ual
Beh
avio
r, R
isk
Co
mp
ensa
tio
n, a
nd
HIV
Pre
ven
tio
n S
trat
egie
s A
mo
ng
Par
tici
pan
ts in
th
e Sa
n
Fran
cisc
o P
rEP
Dem
on
stra
tio
n P
roje
ct: A
Qu
alit
ativ
e A
nal
ysis
of C
ou
nse
ling
No
tes.
AID
S an
d B
ehav
ior
20, n
o. 7
.Ju
ly
2016
; 146
1–1
469.
4. G
ran
t, R
ob
ert
M.,
Javi
er R
. Lam
a, P
eter
L. A
nd
erso
n, V
anes
sa M
cmah
an, A
lber
t Y.
Liu
, Lo
ren
a V
arga
s, P
edro
G
oic
och
ea, e
t al
. Pre
exp
osu
reC
hem
op
rop
hyl
axis
for
HIV
Pre
ven
tio
n in
Men
Wh
o H
ave
Sex
wit
h M
en.N
ew E
ngl
and
Jo
urn
al o
f Med
icin
e.36
3, n
o. 2
7 (2
010)
: 258
7–9
9.
5. L
earn
ab
ou
t TR
UV
AD
A®
(Em
tric
itab
ine
200
Mg
and
Ten
ofo
vir D
iso
pro
xil F
um
arat
e 30
0 M
g) T
able
ts a
t Tr
uva
da.
com
.” T
ruva
da.
Acc
esse
d S
epte
mb
er 2
0, 2
019.
Ava
ilab
le f
rom
: htt
ps:
//w
ww
.tru
vad
a.co
m/h
ow
-to
-get
-tr
uva
da-
for-
pre
p/t
ruva
da-
cost
. 6.
FD
A A
pp
rove
s Se
con
d D
rug
to P
reve
nt H
IV In
fect
ion
as
Par
t o
f On
goin
g Ef
fort
s to
En
d t
he
HIV
Ep
idem
ic. U
.S. F
oo
d
and
Dru
g A
dm
inis
trat
ion
. FD
A. A
cces
sed
Oct
ob
er 3
1, 2
019.
Ava
ilab
le f
rom
: htt
ps:
//w
ww
.fd
a.go
v/ne
ws-
even
ts/p
ress
-an
no
un
cem
en
ts/f
da-
app
rove
s-se
con
d-d
rug-
pre
ven
t-h
iv-i
nfe
ctio
n-p
art-
on
goin
g-ef
fort
s-en
d-h
iv-e
pid
emic
.7.
Bill
Tex
t -
SB-1
59 H
IV: p
ree
xpo
sure
and
po
stex
po
sure
pro
ph
ylax
is. A
cces
sed
Oct
ob
er 3
1, 2
019.
Ava
ilab
le f
rom
: h
ttp
://l
egin
fo.le
gisl
atu
re.c
a.go
v/fa
ces/
billT
extC
lien
t.xh
tml?
bill.
Bre
ak
ing
Ne
ws
When c
onsid
eri
ng p
reventa
tive m
easure
s
for
HIV
exposure
it is
cri
tical to
inclu
de n
ot
only
pharm
acolo
gic
al options,
but
als
o n
on
-
pharm
acolo
gic
al options t
o f
urt
her
pro
tect
patients
fro
m t
his
life
-alteri
ng v
irus.
It is
cru
cia
l th
at
the p
ublic
has a
backgro
und
unders
tandin
g o
f th
is d
isease a
long w
ith
diffe
rent
ways t
o a
void
tra
nsm
issio
n.
Pharm
acis
ts c
an p
lay a
role
in h
elp
ing
LG
BT
Q p
atients
by u
sin
g c
onsultation
str
ate
gie
s t
o p
revent
infe
ction.
Figu
re 1
: Fro
m n
ew d
iagn
ose
s b
ased
on
rac
e/et
hn
icit
y in
2
01
72
Figu
re 2
: Dat
a fr
om
iPrE
x tr
ial o
n P
rEP
eff
icac
y4
PrE
P E
ffec
tive
nes
s
% Reduction in HIV Risk
Nu
mb
er o
f Ta
ble
ts T
aken
W
eekl
y
Desco
vy
6:
•F
DA
ap
pro
ve
d n
ew
PrE
P m
ed
ica
tio
n o
n
Octo
be
r 3
rd, 2
01
9
oE
mtr
icita
bin
e2
00
mg
/ te
no
fovir
ala
fen
am
ide
25
mg
•T
en
ofo
vir a
lafe
na
mid
e:
oC
on
sid
ere
d b
ett
er
for
pa
tie
nts
with
ren
al im
pa
irm
en
t
oC
onsid
ere
d b
ett
er
for
patients
with
bo
ne
dis
ea
se
s s
uch
as
oste
op
oro
sis
Cali
forn
ia S
en
ate
Bil
l N
o.
159
7:
•A
pp
rove
d b
y t
he
Go
ve
rno
r o
f C
alif
orn
ia o
n
Octo
be
r 7
th, 2
01
9
oA
uth
orize
s a
ph
arm
acis
t to
pre
scrib
e P
rEP
an
d P
EP
un
de
r
ce
rta
in c
ircu
msta
nce
s
Financial Disclosure The presenters declare that neither they nor any of their immediate family members have a current affiliation or financial arrangement with any organization that may have a direct interest in this activity.
Learning Objectives
1. Discuss the role of a pharmacy-based medical reserve corps2. Recognize vulnerable populations during emergent public health threats3. Demonstrate how pharmacy students can mitigate an emergent public health
outbreak Summary
The Medical Reserve Corps (MRC) is a national network of volunteers, organized locally to improve the health and safety of their communities. Howard University College of Pharmacy students established the first nationallyrecognized pharmacy-based MRC in 2013. Capitol City Pharmacy Medical Reserve Corps (CCPMRC) was developed to recruit and train volunteers to provide pharmacy- related functions during an emergency situation. This unique MRC has a close relationship with the Department of Health and Human Services, which allows the organization to provide services for vulnerable populations in DC.
Annual Training Symposium
PrepareDC: Monthly Community Outreach
Mass Immunization Clinics
The Outbreak Ready Initiative was established to enhance the public health infrastructure through a dual approach of targeted education and enhanced training of the pharmacy workforce.
CCPRMC hopes to achieve this by: ★ Training a minimum of 25 pharmacy students on how to prevent, mitigate, and
respond to a public health outbreak
★ Educating 100 homeless individuals on emerging public health outbreaks &infectious diseases
CCPMRC in Action CCPMRC collaborates with
various organizations to improve the health and safety of DC
residents.
Outbreak Ready Initiative:Pharmacists Ensuring Community Resilience In Washington, DCPresenters: Zulikhat Segunmaru, PharmD Candidate, Howard University College of Pharmacy Rukiya Umoja, PharmD Candidate, Howard University College of Pharmacy Fatoumata Bayo, PharmD Candidate, Howard University College of Pharmacy Tamara McCants, PharmD, Chair, DC Board of Pharmacy
Vulnerable Populations Homelessness in DC
Self-Assessment Questions
1. What is a medical reserve corps?a. A group of military personnel who respond to medical emergencies.b. An international network of volunteers, organized locally to improve
the health and safety of their communities.c. A national network of volunteers, organized locally to improve the
health and safety of their communities.d. A group of medical volunteers who respond to 911 calls.
2. T/F? One function of a pharmacy-based medical reserve corps is to staffmedical point-of-dispensing stations
Presenters' Information Zulikhat Segunmaru [email protected]
Rukiya Umoja [email protected]
Poster Thumbnail
Outbreak Ready Initiative:Pharmacists Ensuring Community Resilience In Washington, DC
Maximizing HPV Vaccination Rates Through Community Pharmacist Utilization
Amanda DeWitt, PharmD Candidate, Class of 2021, [email protected]
Sydney Mosher, PharmD Candidate, Class of 2021, [email protected]
Mark Strand, PhD, MS, CPH, [email protected]
Financial disclosures
Amanda DeWitt and Sydney Mosher declare that neither they nor any of their immediate family
members have a current affiliation or financial arrangement with any organization that may have
a direct interest in the subject matter of this CPE activity.
Learning objectives
• Identify complications of HPV infection and understand the importance of the HPV
vaccination.
• Discuss common barriers that pharmacists face regarding administering HPV
vaccinations in the community settings.
• Identify ways pharmacists can increase HPV vaccination rates.
Main points
• HPV is the most common sexually transmitted infection in the US with unfavorable
outcomes such as genital warts and cancer.
• Everyone should be vaccinated before becoming sexually active. Beginning the multi-
dose vaccine series should occur around age 11-12.
• The Healthy People 2020 goal for HPV prevention is an 80% HPV vaccination rate for
teenagers aged 13-15. No state is close to this goal.
• Pharmacists, as the most accessible health care provider, are currently being underutilized
in increasing HPV vaccination rates.
• Barriers to care for pharmacists include the vaccination being a multi-dose series, stigma
from parents, and understaffing inside the pharmacy.
• Pharmacists can increase vaccination rates by collaborating with local providers,
educating parents, and having adequate staff and vaccines on hand.
Self-assessment questions
1) What is the recommended age range to begin the HPV vaccine series?
a) 8-9 years old
b) 11-12 years old
c) 14-15 years old
d) 18-19 years old
2) Parents can be a barrier to younger patients receiving vaccinations at pharmacies.
a) True
b) False
Title: ONE Rx: Community Pharmacy-Based Screening and Interventions for Opioid Misuse and
Accidental Overdose
Presenter Information
Jayme Steig, PharmD, Quality Health Associates of North Dakota
Email: [email protected] Phone: 701/989-6224
ONE Rx Team: Mark Strand, PhD; Heidi Eukel, PharmD; Elizabeth Skoy, PharmD; Amy Werremeyer,
PharmD; and Oliver Frenzel, PharmD, MPH, North Dakota State University
Disclosure: Jayme Steig and authors declare that they have no current financial disclosures.
Objectives
1. Describe the ONE Rx program process utilizing pharmacists to screen, evaluate, and provide
appropriate interventions to patients receiving opioid prescriptions.
2. Understand the impact of ONE Rx on program outcomes, including naloxone dispensing,
medication take back, and risk education.
Summary
The ONE Rx (Opioid and Naloxone Education) project has provided pharmacists in North Dakota with
training, screening tools, and interventions to assess risk and provide appropriate patient education and
interventions to reduce opioid misuse and overdose. ONE Rx includes a patient-completed screening for
opioid misuse risk (Opioid Risk Tool) and/or overdose risk (comorbidities and concomitant medications),
a triage tool to aid pharmacists in assessing results, and suggested interventions, including prescribing
naloxone, referral to treatment, partial fill, and screening for opioid risks. From October 2018 to October
2019, over 4,600 North Dakotans with an opioid prescription were screened for opioid misuse and
overdose risk at 37 pharmacies. Outcomes include 7% of those at risk for overdose receiving naloxone,
88% being introduced to medication take back, and opioid use disorder being discussed with 49% of
those at risk. ONE Rx screening and interventions take less than six minutes on average. Collaboration
has occurred between ONE Rx pharmacies and local public health. The training, screening, and
interventions can be applied in any state and other practice settings.
Self-Assessment Questions
1. Which screening device is used in ONE Rx to identify risk for opioid use disorder?
a. Comorbidities
b. Concomitant medications
c. Opioid Risk Tool (ORT)
d. CDC opioid prescribing guidelines
2. ONE Rx interventions include:
a. Recommending naloxone
b. Referral to substance use disorder treatment
c. Education on medication disposal/take back
d. All of the above
Website: www.onerxproject.org
