ALERT: Use of VMPS required 11/15/13
UPDATE: Due to the high volume of registration applications to the VPMS, physicians who submitted their applications may not have received an email acknowledgment of receipt from the Department of Health yet. The Department of Health has notified VMS that “If your application was submitted on or before November 15, 2013, you are considered in compliance with the Act 75 mandate to register.” Applications are being processed by the Department of Health in the order they were received.
Alert: Notice to All Physicians, All Specialties, Who Prescribe Controlled Substances
- Friday, November 15, 2013 is the Deadline for Registration with Vermont Prescription
Monitoring System (VPMS)
- Beginning Friday, November 15, 2013, prescribers must query the VPMS when they prescribe controlled substances in certain cases.
Act 75: Prescription Drug Abuse Prevention and Monitoring:
In response to increased opioid addiction and methamphetamine abuse in Vermont, the Vermont General Assembly passed Act 75, a law that has a number of provisions that are applicable to physicians, including a requirement to register with the Vermont Prescription Monitoring System (VPMS), and in specific circumstances, query the VPMS. These requirements were based in part on the report of the Department of Health’s Unified Pain Management System Advisory Council, a group of prescribers and dispensers dedicated to improving the care of patients with chronic, non-cancer pain. Link to report: http://healthvermont.gov/adap/documents/UPM_Advisory_Council_Final_Report_022513.pdf
Links for summary and full text of Act 75: http://www.leg.state.vt.us/docs/2014/Acts/ACT075sum.htm (summary) http://www.leg.state.vt.us/DOCS/2014/ACTS/ACT075.PDF (full text)
Friday, November 15, 2013 is the Deadline for Registration with Vermont Prescription Monitoring System (VPMS)
- Prescribers must register with VPMS.
Each health care professional who prescribes any Schedule II, III, or IV controlled substances must register with the VPMS by November 15, 2013.
Steps to register with the Department of Health to use VPMS:
Mail the original forms and supporting documents to the Vermont Prescription Monitoring System at the Vermont Department of Health
A. Registration Form - Link to: Prescriber Registration Form
B. Mail registration form and copies of DEA Certificate and Vermont State License to the Department of Health:
Vermont Prescription Monitoring System
Vermont Department of Health
108 Cherry Street
PO Box 70
Burlington, VT 05402-0070
After November 15, 2013, if the VPMS shows that a patient has filled a prescription for a controlled substance written by a health care professional who is not a registered user of VPMS, the Commissioner of Health will notify the professional by mail and will notify the applicable licensing authority, the Vermont Board of Medical Practice or the Vermont Board of Osteopathic Physicians. See, discussion of licensing boards’ role below. Link to VPMS registration: http://healthvermont.gov/adap/VPMS_prescribers.aspx#register
On-line VPMS Registration
The Department of Health is working with the vendor for the VPMS to create an on-line process for registration with the VPMS. Originally planned to be up in September, the on-line registration system has been delayed. Once the online system is up, it will automatically check with licensing boards and the Drug Enforcement Agency so that it will no longer be necessary to submit a paper copy of your Vermont medical license and DEA certificate. Once the on-line registration process is ready it will be posted at: http://healthvermont.gov/adap/VPMS.aspx
Physicians’ delegates are authorized to query the Vermont Prescription Monitoring Data Base (VPMS)
Act 75 provides for the use of delegates. Delegates are defined as individuals employed by physicians or other health care professionals who are authorized by a physician or other prescriber to request information from the Vermont Prescription Monitoring System (VPMS) database relating to current patients of the health care professional. Delegates must be registered with the VPMS and must certify that the requested information is for the purpose of providing medical or pharmaceutical treatment to a current patient.
Steps to register a delegate who can check the VPMS:
Mail the original prescriber delegate registration forms and supporting documents to the Vermont Prescription Monitoring System at the Vermont Department of Health
A. Link to: Prescriber Delegate Registration Form Delegates must complete a separate registration form for each prescriber they are registering to work under, signed by the prescriber.
B. Prescriber delegates must supply a copy of the DEA Certificate and Vermont State Medical License of each prescriber(s) who they are registering to work under.
C Mail to:
Vermont Prescription Monitoring System
Vermont Department of Health
108 Cherry Street
PO Box 70
Burlington, VT 05402-0070
Link to VPMS registration: http://healthvermont.gov/adap/VPMS.aspx
Beginning Friday, November 15, 2013, prescribers must query the VPMS when they prescribe controlled substances in certain cases.
Section 11 of Act 75 requires that beginning on November 15, 2013 prescribers who prescribe controlled substances on Schedule II, III, or IV must query the VPMS in four circumstances:
- At least annually for patients who are receiving ongoing treatment with an opioid Schedule II, III, or IV controlled substance;
- When starting a patient on a Schedule II, III, or IV controlled substance for non-palliative long-term pain therapy of 90 days or more;
- The first time the provider prescribes an opioid Schedule II, III, or IV controlled substance written to treat chronic pain; and
- Prior to writing a replacement prescription for a Schedule II, III, or IV controlled substance.
- In the future, the Department of Health may promulgate rules that require health care practitioners to check the VPMS in additional circumstances.
Act 75 requires licensing boards such as the VBMP to consider the requirements of Act 75, Department of Health rules and licensing board standards “in disciplinary proceedings when determining whether a licensee has complied with the applicable standard of care.” See, discussion of licensing boards’ role below.
Link to Act 75: http://www.leg.state.vt.us/DOCS/2014/ACTS/ACT075.PDF (See, Section 11, pgs. 13 -14 for requirements to register with VPMS and query the VPMS.)
Definition and specific requirements for “replacement prescriptions” for controlled substances – in effect as of October 1, 2013
Specific requirements for “replacement prescriptions” went into effect on October 1, 2013. Act 75 defines a “replacement prescription” as “an unscheduled prescription request in the event that the document on which a patient’s prescription was written or the patient’s prescribed medication is reported to the prescriber as having been lost or stolen.“ When a patient, parent or guardian requests a “replacement prescription” for a Schedule II, III, or IV controlled substance, the patient’s physician must query the VPMS prior to writing the replacement prescription to determine whether the patient may be receiving more than a therapeutic dose of the controlled substance.
When a physician writes a replacement prescription for any controlled substance, the physician must write the word “Replacement” on the face of the prescription and document the writing of the replacement prescription in the patient’s medical record.
Requirements for “replacement prescriptions” apply to prescriptions for all controlled substances, not just opioids. The requirement to check the VPMS database is limited to Schedules II, III, and IV, however, because the VPMS database does not include Schedule V drugs. A “replacement prescription” does not include a prescription refill, or a prescription that is changed for clinical reasons, for example in response to side effects or when a trial of a particular drug is not effective.
Licensing Boards’ role - interpreting the standard of care
Licensing boards interpret the applicable standard of care when they investigate complaints of unprofessional conduct, often with the assistance of experts they retain. The standard of care, in the context of prescribing opioids, may include the use of tools that help to confirm that the medication is being safely and appropriately used, such as checking the VPMS, urine monitoring, and contracts. Once the Vermont Board of Medical Practice (VBMP) updates its policy on Prescribing Controlled Substances for the Treatment of Chronic Pain, that policy is likely to reference the use of VPMS.
The sources that the VBMP typically relies on to determine whether the standard of care is met in a case involving prescribing controlled substances may include:
- Dr. Scott Fishman’s book, Responsible Opioid Prescribing http://www.fsmb.org/book;
- The Vermont Board of Medical Practice’s existing policy on Prescribing Controlled Substances for the Treatment of Chronic Pain http://healthvermont.gov/hc/med_board/documents/pain_policy.pdf ;
- The recently revised Federation of State Medical Boards Model Policy on the Appropriate Use of Opioid Analgesics in the Treatment of Chronic Pain http://www.fsmb.org/pdf/pain_policy_july2013.pdf ;
- The experts who spoke at the Boston University CMEs sponsored by the VBMP, including Drs. Manuel and Alford http://www.opioidprescribing.com/overview ; or
- Experts who provide opinions to the licensing board.
Failure to use VPMS could become an issue for a practitioner in one of two ways. First, a failure to comply with statutes or rules governing practice of medicine, itself is grounds for a finding of unprofessional conduct. Second, failure to check the VPMS could be one fact that, along with other facts concerning the physician’s activities, supports a conclusion by the licensing board that the provider did not provide safe and acceptable care, or failed to conform to the essential standards of acceptable and prevailing practice.
The unprofessional conduct provisions for physicians include:
(a)(27) Failure to comply with provisions of federal or state statutes or rules governing the practice of medicine or surgery;
(b) The board may also find that failure to practice competently by reason of any cause on a single occasion or on multiple occasions constitutes unprofessional conduct. Failure to practice competently includes, as determined by the board:
(1) performance of unsafe or unacceptable patient care; or
(2) failure to conform to the essential standards of acceptable and prevailing practice.
Links to unprofessional conduct laws for physicians:
- http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=26&Chapter=023&Section=01354 (MD)
- http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=26&Chapter=033&Section=01842; http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=03&Chapter=005&Section=00129a (DO)
Other Requirements in Act 75
Dosage must be written in numeric and word form as of June 5, 2013
For all controlled substances – written or typewritten prescriptions must include the quantity of the drug written in both numeric and word form, similar to using numeric and word form when writing a check. This requirement does not apply to electronic prescriptions.
Prescription must include patient’s date of birth as of June 5, 2013
Prescriptions for controlled substances must include the patient’s date of birth.
VMS Education & Research Foundation White Paper:
Safe and Effective Treatment of Chronic Pain in Vermont
In November of 2012, the Vermont Medical Society Education and Research Foundation released Safe and Effective Treatment of Chronic Pain in Vermont, a whitepaper detailing the challenges health care providers face in providing safe and effective treatment to persons with chronic pain in Vermont and the role those challenges play in prescription drug abuse. Cy Jordan, M.D. is the Foundation’s director and author of the whitepaper. Developed through structured interviews with nearly 40 professionals involved in the treatment of chronic pain and addiction, the report aims to influence public policy by recommending concrete improvements to the care system in the state, including:
- Creating a single set of recommendations for treating pain in Vermont;
- Improving the Vermont Prescription Monitoring System;
- Educating the public to expect best medical practices;
- Evaluating the approach of professional oversight;
- Differentiating the role of law enforcement from the role of care giver; and,
- Discouraging payment policies that encourage pill prescribing.
Link to whitepaper on Safe and Effective Treament of Chronic Pain in Vermont: http://www.vtmd.org/sites/default/files/files/Safe_and_Effective_Treatment_of_Chronic_Pain_in_VT.pdf