Heller team helps fight prescription drug abuse

Peter Kreiner, head of the Prescription Monitoring Program Center of Excellence at Brandeis, and colleagues, receive 3d grant

Photo/Mike Lovett

Peter Kreiner

Prescription drug abuse is rising at alarming rates, with abusers tapping multiple sources to fill prescriptions. Overdose death rates due to the prescription drug epidemic now far outpaces those from the prior heroin and cocaine epidemics.

According to a Los Angeles Times analysis of data from the Centers for Disease Control and Prevention, prescription drug abuse is the leading cause of death from unintentional injuries in the United States, surpassing motor vehicle accidents in 2009. To combat the problem, prescription monitoring programs (PMP) are becoming more sophisticated, aiming not only to put the brakes on abusers but, in some cases, incorporating rehabilitation programs.
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On Tuesday, March 6, Peter Kreiner will give a lunchtime lecture called "Prescription Drug Abuse and Diversion: Current Research" at The Heller School for Social Policy and Management from 12:30 to 1:45 p.m. in Room G3.
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Peter Kreiner, the principal investigator of both the Prescription Monitoring Program Training and Technical Assistance Center (TTAC) and the Prescription Monitoring Center of Excellence (COE) at Brandeis, and colleagues,were recently awarded a grant of $994,960 to continue developing a multi-state database to serve as an early warning surveillance tool, called the Prescription Behavior Surveillance System (PBSS). The PBSS is funded by the Centers for Disease Control and the Food and Drug Administration, through the COE’s grant from the Bureau of Justice Assistance.

In this interview with BrandeisNOW, Kreiner explains how the programs began, how they work and what they hope to accomplish.

Kreiner is a Scientist at the Heller School's Schneider Institutes for Health Policy with an expertise in program evaluation and interagency network analysis, especially in the area of substance abuse prevention and treatment.  His research includes state and community health infrastructures, adoption of substance abuse prevention and treatment agencies, studying health related and social problems and risk and protection.

BrandeisNOW: When did the government begin formal drug monitoring programs?

Peter Kreiner: Prescription monitoring programs are state programs, which began in California in 1939. The Bureau of Justice Assistance (BJA) has been providing grants to states to enhance an existing program, implement a new program, or work toward passing legislation authorizing a program, since 2003.

The number of PMPs has more than doubled since BJA began funding them. Four years ago, in 2008, they decided they ought to fund a training and technical assistance provider to centralize a lot of the assistance states needed in implementing and improving their programs, which states were previously providing informally to each other. We partnered with the Alliance of State Prescription Monitoring Programs, which at the time brokered much of the information exchange and mentoring between the states.

Did the Bureau of Justice Assistance reach out to you and Brandeis?

Yes. We knew them because of work with the Massachusetts prescription monitoring program, which we’d been doing since 2004. We partnered with the Alliance to get the first, competitive, grant in 2008, which was for the training and technical assistance center. In the second year of that award, BJA asked us to start the Prescription Monitoring Program Center of Excellence.  That piece, which began in February 2010, was only Brandeis and it is a separate entity from the Training and Technical Assistance Center. The initial three-year award ended this past fall.  In  2011 the Bureau of Justice Assistance put out a new set of competitive solicitations, this time for the two entities separately. One for the Training and Technical Assistance Center, and the second for the Clearinghouse Provider/Center of Excellence. We were fortunate enough to receive both awards.

Did you personally write the grants?

Yes, I took the lead in writing both. Our role in the Training and Technical Assistance Center is primarily to evaluate that Center’s work. 

How many Training and Technical Assistant Centers are there?

There is one national Training and Technical Assistant Center for state prescription monitoring programs. Brandeis is the recipient of the grant, but it is a partnership between Brandeis and the Alliance of States with Prescription Monitoring Programs. The money comes to Brandeis and we contract with consultants who are the TTAC’s project director and project coordinator. They provide the technical assistance, design and conduct trainings and host national, regional and topical meetings. We collect and analyze various data to evaluate this work. Currently, all but two states have passed legislation authorizing a PMP, and 35 states have an operational PMP.

Does drug abuse vary by region?

Yes. Drugs of choice for abuse seem to be different in different parts of the country. Methamphetamine is big in the south and west, not so much in the northeast. Opioids (heroin, OxyContin, Vicadin) are a bigger problem in the northeast, the eastern U.S. and parts of the south.

Historically, crack cocaine and heroin have been problems that largely affected urban groups, especially ethnic minorities, although that has been changing somewhat recently. In contrast, prescription drug abuse seems to be more prevalent in  middle and upper middle-class, predominantly white communities. This difference means that a lot of the tools and programs developed to address and prevent drug abuse historically don't apply well to prescription drug abuse.

How do prescription monitoring programs work?

Pharmacies report information regarding the controlled substances that they have filled prescriptions for, usually on a weekly basis, to these state databases. Most of them, not all, have a web portal where authorized users such as pharmacists, nurse practitioners or physicians can access the data if they are concerned about a patient.

Law enforcement usually has more restricted access. In most states an investigator can access data for an active case. In some states the PMP is located in a law enforcement agency or a pharmacy and in other states such as Massachusetts, it is located in the Department of Public Health.  In other states, it is in the Board of Pharmacy. Where a PMP fits in state government affects a number of different aspects of how it works. For example, the Medicaid unit in Massachusetts has just recently gained access to PMP data to check on Medicaid patients that they suspect of fraud. In a few states, this relationship has been in place for years. In other states, it still isn’t in place.

How exactly does the Prescription Monitoring Program Center of Excellence work?

The Center Of Excellence (COE) complements the work of the TTAC. It works to identify best practices among the PMPs and make that information available. It also tries to develop or identify new uses for PMP data. For example, we have a series of mini case studies, called Notes from the Field, that detail novel uses of PMP data in different states, by court diversion programs, medical examiners, drug treatment programs and more. The COE also analyzes PMP data to learn more about patterns of abuse and diversion, and for new applications such as prevention. A total of seven Brandeis staff work on the three projects.

Why is the Prescription Behavior Surveillance System important?

This is the first effort to build a database of PMP data from multiple states. We’ll start with five states, then later expand to 10. Just as patterns of abuse of illegal drugs are different in different parts of the country – methamphetamine in a lot of the South and West, not so much in the Northeast; heroin more in the Northeast – patterns of abuse of prescription drugs also vary. It’s important to look at trends in different areas to get a sense of what’s emerging in the country. PMP data are valuable for surveillance because they’re much more timely – they’re available within a week or two – sooner than other health data like death or hospitalization data, which can take a year or two. The project will also look at work being done to educate prescribers about appropriate prescribing of drugs like opioids, and how to use PMP data in treating patients, both areas where a lot of work remains to be done.

When did you become involved with this?

Just about the time that I came to Brandeis, in July of 2004. I was working at a private nonprofit research company called Health and Addictions Research in Boston.  We started working with the Massachusetts Prescription Monitoring Program and have been working with them ever since.

Do you work on this program full time?

This is a major part of what I do, but I also have other projects, including four projects on HIV and substance abuse prevention in greater Boston, funded by the Substance Abuse and Mental Health Services Administration and a prisoner re-entry evaluation project based in greater Worcester. It is funded by The Health Foundation of Central Massachusetts and works to build connections among support providers to provide a more sustainable, successful array of services for people coming out of jails and prisons today.

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