A lasting partnership between Kentucky’s Prescription Drug Monitoring Program (PDMP) and the Division of Behavioral Health provides access to vital data to prevent opioid misuse.
About the Collaboration
To track the prescribing and dispensing of controlled substances such as opioids, nearly all states in the U.S. have legislatively mandated the creation of Prescription Drug Monitoring Programs—statewide electronic data systems that collect, analyze, and make available prescription data on controlled substances dispensed by non-hospital pharmacies and practitioners. PDMP data can be used in a variety of ways to address the prescription drug and opioid crisis, making PDMPs key public health and safety tools.
For more than a decade, Kentucky’s PDMP—the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER—has represented the gold standard of these data systems. A hallmark of its success has been its close relationship with the state’s Division of Behavioral Health. Working together, the two agencies have been able to draw attention to the state’s growing opioid problem and engage the stakeholders needed to address it.
“[Early on], KASPER provided the single most convincing data about the real magnitude of the problem,” explains Phyllis Millspaugh, Branch Manager for Kentucky’s Division of Behavioral Health. “We were able to see how many opioid analgesics were actually being dispensed in each county. When local prevention coalitions looked at these data and saw that, in some cases, there were 20 pain medications written annually for every member of the county, it got folks out to town meetings. It made the problem real.”
Today, KASPER’s partnership with the Division of Behavioral Health has been instrumental in helping Kentucky reduce overprescribing, and serves as a model for how state prevention staff can work together with their PDMPs to better understand and address prescription drug misuse and its related consequences.
Elements of Success
Address Potential Privacy Concerns
KASPER began sharing its data with the Division in 2007, through Kentucky's Data Warehouse for Substance Abuse Prevention. Shortly thereafter, privacy concerns led state officials to take legal action to stop the process.
“There was concern that the data might make it possible to identify individuals from small, rural communities with a single pharmacy—and we didn’t have clear guidelines in place to allay their fears,” says Steve Cambron, former Strategic Prevention Framework Grant Coordinator.
Though the issue was eventually resolved with clear assurances from outside experts, the incident highlighted the importance of establishing clear data-sharing guidelines from the outset. “We lost a year of data access because we weren’t prepared to address privacy issues,” says Cambron. He suggests bringing in data experts to ensure that data-sharing agreements comply with HIPAA* privacy rules.
Formalize Your Relationship
After several years of sharing data informally, the Division of Behavioral Health invited KASPER to join the state’s epidemiological outcomes workgroup (SEOW)—a collaborative group of agencies and individuals focused on collecting and using data to inform and enhance prevention practice. Formalizing their relationship was a win-win for both groups, providing the SEOW with valuable data and data expertise, and KASPER with an opportunity to join the Division’s prevention planning team.
“[KASPER] has been an integral part of our SEOW for several years now,” says Millspaugh. “Their involvement has been incredibly vital to the prevention planning process—not just because of what they bring to the table, but because of their knowledge and understanding of how to work with data sources.” She encourages other states to invite their PDMPs to join their SEOWs or advisory panels “sooner than later” to clearly communicate the value of their data. “They need to know we can’t do it without them—that without the information they collect, our prevention efforts would be hugely misinformed.”
Don’t Overburden Your Partners
The Division worked closely with KASPER to develop a reasonable schedule for sharing data. Together they decided that KASPER would prepare a data report for each of the SEOW’s quarterly meetings. This timeframe was frequent enough to support the Division’s planning efforts without inconveniencing KASPER staff. “The quarterly format allows us to see trends sooner than would be the case if we had a biannual or an annual format,” explains Millspaugh. “It’s helpful for us and it doesn’t burden the KASPER system.” In addition, KASPER provides the Division with “real time” data updates when they need it. “We have a great relationship with them. They trust that we’re not going to over-reach and they know we’ll use their data well.”
Find Additional Ways to Connect
Because the only formal times the Division and KASPER get together is at quarterly SEOW meetings, Millspaugh encourages her staff to find additional opportunities to connect. “Any time you work with another state or any government agency, it forces you to get out of your ‘silos’—but that only happens with time, effort, and food.” Fortunately, the Division of Behavioral Health is located in the same building as KASPER, making water cooler conversations and lunch dates fairly easy.
The KASPER-Division partnership is further strengthened by joint participation on several cabinet-level opioid overdose workgroups. These “outside” opportunities to work together gives the prevention team a fresh perspective on the PDMP and the data it collects. “Even though we understand pretty well what KASPER’s doing, being in these groups with them, and hearing them present data that’s a little different from what they provide us, is an important learning opportunity.”
Create Memoranda of Understanding
Finally, Millspaugh underscores the value of creating memoranda of understanding (MOU) with PDMPs to protect and sustain established partnerships. “[Administration changes] can really change the tone and tenor of a division. Having an MOU in place reminds new leadership that the relationship exists, it’s fruitful, and there’s a commitment to it continuing.” MOUs can help partners articulate the purpose of their collaboration, as well as their roles and responsibilities. MOUs with PDMPs, in particular, should also clarify how frequently the PDMP will share data, what data they will share, and how often partners will meet.
KASPER data has been instrumental in the state’s battle against prescription drug misuse and overdose. The data has served as the foundation for multiple SAMHSA prevention grants, including Kentucky’s Strategic Prevention Framework State Incentive Grant and two Partnership for Success grants, and has been key to helping counties and communities understand the scope of their local problems.
“In the beginning, the data helped folks understand how the prescription numbers relate—why the number of prescriptions being filled at pharmacies are important to physicians, and why the number of prescriptions written by physicians is important to law enforcement,” says Millspaugh.
Since then, KASPER data has continued to serve as a nexus for bringing together multiple stakeholders to prevent opioid misuse. “Today, law enforcement, doctors, pharmacists, and other prevention stakeholders gather and plan collaboratively,” says Cambron. “Hard and fast data can break down barriers.” A number of communities have begun sponsoring town hall meetings focusing on their prescription drug addiction problems. KASPER and Division staff frequently attend these meetings together—with one sharing data and the other discussing their implications for prevention.
Finally, KASPER data has played a critical role in shutting down Kentucky’s “pill mills” by pinpointing where the pill mills were operating. “They mapped it out for us, so we could clearly see where the hot spots were,” says Millspaugh. “We then communicated with our partners in these areas, created plans, and ultimately, saved thousands of lives.”
For more information, contact Lourdes Vazquez, CAPT Southeast Resource Team Coordinator, at email@example.com.
*Health Insurance Portability and Accountability Act of 1996