West Virginia has been one of the states hit hardest by the opioid epidemic, but the addition of non-fatal overdose data to the Controlled Substance Monitoring Program, its PDMP, is one way the state is turning the tide.
At the upcoming Rx Drug Abuse & Heroin Summit, Nathan Wood, MPH, and Timothy Dotson, MS, both epidemiologists with the West Virginia Board of Pharmacy, will discuss this initiative and efforts made to reduce non-fatal and fatal overdoses. Ahead of that session, they spoke with Addiction Professional about how the integration of non-fatal overdose data came about, fostering collaboration between departments, and how the information has helped to inform prescribers working with patients.
Editor’s note: This interview has been edited for length and clarity.
When did West Virginia start integrating data on non-fatal overdoses into its PDMP? How did this come about?
Wood: It started in 2018. There was some legislation that passed in early 2018 that became law on July 1, 2018, that required medical service providers to report non-fatal overdoses to the Office of Drug Control Policy within the state. The Board of Pharmacy, we were starting to do that. We were collecting naloxone data from them, so we already had the connection. … The second part of that legislation requires the reporting of naloxone. A lot of EMS runs for overdoses that have naloxone as the response…since we’re required to collect naloxone data, the Board of Pharmacy spearheaded that. That led to a good pathway for us to integrate these non-fatal overdoses into our PDMP.
What were the keys to facilitating the collaboration between the different stakeholders working on this?
Wood: Having really strong working relationships. The way to do that is to communicate. Communicate the importance, especially of this initiative for non-fatal overdoses, which is a prevention effort. One of the goals of the state for the opioid response and substance use response plan is to reduce fatal and non-fatal overdoses. To do that, we have to have good communication and relationships with partners. … For us, the key was a CDC funding opportunity in 2016, which allowed the Board of Pharmacy to become partners with the state. Luckily, at the time, our executive director was the Controlled Substance Monitoring Program [West Virginia’s PDMP] administrator. The CSMP administrator and the director of the Office of Maternal, Child and Family Health, which was the recipient of the CDC funding, they had a working relationship with previous grants. So, the Board of Pharmacy was able to partner with the health department that way. Since then, we’ve been funded through that and had a really good relationship.
Another key element that helped us in the integration process was that Tim and I are both Board of Pharmacy employees, but we’re housed in the health department. Another key that helped us was the Office of EMS, which is the data source for non-fatal overdoses and is also housed in the same office as the Office of Maternal, Child and Family Health. We were always working together. The key to our successful collaboration was communication and having the same underlying goals, which was to prevent future non-fatal overdoses, which, in turn, prevents fatal overdoses.
How has having this data implemented into the PDMP helped providers make treatment decisions with patients?
Wood: We sent out a survey to evaluate the effectiveness of these notifications. We’ve gotten some responses back on that.
Dotson: With the survey, so far, we’ve had 819 responses. Overall, it has been pretty good. There is a notice flag in the CSMP if there has been a suspected non-fatal overdose within the past 12 months, and of those respondents who have seen it, 93% say they’ve found it beneficial for how to proceed with their patient. They also receive an email notification. Of the providers that receive that email notification, 84% said they found it beneficial in how to proceed with patients with their prescribing and treatment.
Wood: We have also asked some questions about how prescribing practices have changed or what providers have done after they found out about suspected non-fatal overdoses. Some respondents talked about how they’ve prescribed fewer opioids and have referred patients to treatment. We will present some of that data, as well as some prescriber testimonials about the effectiveness of the program.
Any other thoughts you’d like to share?
Wood: If any other jurisdiction is interested in learning more about how we started this process, reach out to us. I know it’s more difficult for some jurisdictions because their PDMP is under the authority of a different organization. Some states have it within the health department, which makes it easier. Some are separate like us, but don’t have a good working relationship. Some states have delayed data. Not every state is able to do it as easily as we did, but it’s possible with effective collaboration, data use agreements and memorandums of understanding. That can be a step forward.
We’ve worked with North Carolina and New Mexico, which are interested in doing the same integration of suspected overdoses with their PDMP. We’ve been able to help with that process.
For prescribers, it’s understanding the importance of utilizing the PDMP every time they prescribe an opioid. I know they’re really busy and it’s not possible every time. Some health systems have their EHR integrated with the PDMP so it’s one click, but a lot don’t, so they have to sign on to a separate system, which takes time they don’t have. But making sure providers know this is an option, and especially for West Virginia providers, if they don’t check their PDMP every time, they may not know the patient had an overdose. A lot of providers don’t check their PDMP every time…which is why we also implemented the email notification to prescribers who have prescribed within 60 days before the overdose.
Dotson: To add onto that, not only are we collaborating with EMS departments, collaborating with the prescribers is good to because we get a lot of feedback from them as well. We provide contact information on the CSMP and also through email. We do want to hear from them on the issues and concerns they have with suspected non-fatal overdoses. They are suspected, not confirmed cases. We have received requests on review, and we’re always quick to go through those and get back to providers. That’s a high priority for us as well.