Letter to Controlled Dangerous Substance (CDS) Prescribers
Maryland Department of Health commends practitioners across the state for success in improving opioid prescribing practices. Maryland, as well as the rest of the country, continues to feel the complex and evolving consequences of opioid misuse. There is an important balance between reducing the very real health risks of opioids with the equally real needs of patients suffering from pain. Please read the letter to prescribers
from the Department of Health to healthcare practitioners regarding our continued commitment to improving the delivery of quality care to Marylanders.
Naloxone Co-Prescribing Regulations
Newly promulgated Maryland regulations (COMAR 10.13.03) support the co-prescribing of naloxone, the opioid overdose reversal agent, to these patients. See the Naloxone Co-Prescribing fact sheet
for additional information.
Naloxone (NARCAN®, EVZIO®) is a prescription medication that safely and effectively reverses an opioid overdose. Naloxone does NOT: “enable” someone's drug use, have “street” or resale value, or make a prescriber liable for a patient’s overdose. Medical providers can prescribe naloxone directly to patients, become an ORP to certify patients and provide naloxone through a standing order, or refer patients to a local ORP training.
New Tapering Guidance
The HHS Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use includes the following recommendation: Health care professionals should not abruptly discontinue opioids with a patient who is physically dependent. Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms, and these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for misuse. Patients may attempt to treat their pain or withdrawal symptoms with illicit opioids or other substances. When tapering, create a patient specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support to avoid serious withdrawal symptoms, worsening of patient’s pain, or psychological distress.
Morphine Milligram Equivalents (MME) Added to PDMP
On February 25, 2020, morphine milligram equivalents (MME) were added to the PDMP. MME converts prescription opioids into a standard value that is based on morphine. MME is intended to help clinicians make safe, appropriate decisions while managing pain. For more information please view the following resources:
Changes in Maryland PDMP Dispenser Reporting Requirements
Data Collection Vendor Change: Maryland PDMP has contracted with a new data collection vendor, RxGov, which has begun accepting data submissions. Dispensers, or their authorized data submitter, must begin reporting data to RxGov by June 1, 2019. Every data submitter account currently registered with the existing RxSentry platform will be migrated to the new vendor, RxGov. Here is the new
Daily Reporting Change: Maryland statute governing the PDMP was amended (HB437/Chapter 147, 2016) to change the dispenser reporting frequency in line with national PDMP best practices. All non-exempt dispensers of CDS medications are required to report applicable dispenses every 24 hours to the Maryland PDMP, including submission of zero reports if no dispensing occurs. ‘Zero reports’ will be required on any day that the dispenser does not dispense a CDS prescription, regardless of whether or not the dispensing facility is open for business that day. Monitoring for compliance with the daily reporting requirement will begin July 1, 2019.
Please link here
to view the correspondence that was faxed to pharmacies and mailed to dispensing practitioners.
The Prescription Drug Monitoring Program (PDMP) Office has worked with Maryland Public Television to produce educational PDMP videos. The Maryland Department of Health (MDH) remains committed to providing prescribers, pharmacists, and their delegates with helpful tools, including optimized use of the PDMP to drive clinical decision-making. In alignment with this goal, MDH is pleased to share the following four educational videos that assist in not only explaining how to effectively use the PDMP, but also address resources available when a healthcare professional identifies a patient in need of any next steps. These video vignettes were created to address priority topics based on feedback from the provider community:
- The role of the PDMP as an effective tool for prescribers, pharmacists, and delegates, and a description of the PDMP use mandate as explained by the Maryland PDMP Director.
- An Emergency Department physician's experience incorporating PDMP data into real-time decision-making.
- A pharmacist navigating the ‘PDMP Search’ user interface in CRISP, providing helpful search tips and tricks.
- A delegate explaining how to register with and use the PDMP on behalf of a prescriber or pharmacist:.
New PDMP Platform
Following a competitive, open procurement process to obtain Maryland Prescription Drug Monitoring Program (PDMP) vendor services, a five-year contract extending to 2025 was awarded to NIC by Chesapeake Regional Information System for our Patients (CRISP), the Maryland state-designated regional health information exchange. CRISP serves as the Maryland Department of Health’s main information technology partner to administer the PDMP: NIC’s press release
. NIC’s RxGov will serve as the secure technology platform to collect controlled dangerous substances (CDS) data from dispensers and the interface for investigative requesters to request PDMP data. The migration to the new platform is slated to begin in the Spring of 2019.
For updated information for CDS dispensers, click here