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PA Prescribing of Schedule II and III Controlled Substanced

Posted By Jen Feirstein, ASAPA Legislative Committee Chair, Tuesday, January 22, 2019
Updated: Tuesday, January 22, 2019

On January 17, 2019, ASAPA was made aware of many practicing PAs in Arizona being told by pharmacies that PAs can only prescribe a 72-hour supply of schedule II and III controlled substances.  The Association has been actively pursuing additional information and working to resolve the problem.

 

Here is what we know as of this writing:

 

During the 2018 legislative session, HB 2250 passed, which was intended to certify PAs for 90-day prescription privileges for non-opioid schedule II and III controlled substances.  Unfortunately, the final language that was passed in HB 2250 (attached) is being interpreted to restrict the prescribing of schedule II and III controlled substances to 72-hours.


HB 2250 was intended ONLY to increase the prescribing limits of non-opioid schedule II and III controlled substances to 90 days, and to otherwise leave prescribing privileges unchanged.  Unfortunately, explicit language was not included that indicated the ability to prescribe for up to 30 days was remaining unchanged. 


After HB 2250 passed, ASAPA testified at both the rule-making hearing and at the Arizona Regulatory Board of Physician Assistants (ARBOPA) board meeting expressing concerns about possible misinterpretation. 


ARBOPA now understands our concerns and we are working very closely with ARBOPA and our association lobbyist to identify the most expeditious solution to this problem.  Currently, it appears this will likely occur in the form of amending a fast-track bill moving through the Legislature to address e-prescribing issues associated with the enactment of the Opioid Act during the 2018 legislative session.  There is consensus among physicians and hospitals over the need to correct the interpretation that has created the prescribing limitation.


ASAPA will communicate updates with you as they are received.  Please be ready to reach out to your legislators, if needed.  We are aware of the significant burden this is placing on PAs, especially PAs practicing in pain management and other disciplines that regularly prescribe these medications.  Please know that we are doing everything in our power to resolve this barrier to PA practice and to the health care needs of our patients.


Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants

Tags:  Legislative 

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Happy PA Week! 2018 Proclamation

Posted By Administration, Monday, October 8, 2018

Happy PA Week to you! 
Thank you for all you do for the profession and your patients!

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Voting Guide to the Arizona Ballot Propositions

Posted By Administration, Wednesday, October 3, 2018
Preparing for elections in November?  A Voting Guide to the Arizona Ballot Propositions has been prepared by the ASAPA lobbyist team at Goodman Schwartz Public Affairs.  ASAPA members can access this guide under the Members Only tab.  You must be logged in.

Tags:  Legislative 

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Impending Opioid E-Prescribing Mandate Guidance

Posted By Administration, Tuesday, September 11, 2018

Action Alert – Impending Opioid E-Prescribing Mandate Guidance

One of the most significant provisions of the Arizona Opioid Epidemic Act, SB 1001, is the prescriber electronic transmission requirements for prescribing opioids. Electronic prescribing of controlled substances (EPCS) mitigates prescription fraud to prevent the occurrence of fake prescriptions, as well as reduces prescribing errors and improves the accuracy of medication dispensing. These new requirements go into effect in 2019.

Opioid E-Prescribing Requirements
Beginning January 1, 2019, each prescription order for a Schedule II opioid in
Maricopa, Mohave, Pima, Pinal, Yavapai, and Yuma counties must be transmitted electronically to the dispensing pharmacy. The only exception is for Medication Assisted Treatment (MAT) for substance use disorder, or if a waiver is granted to a prescriber (see below).

Beginning July 1, 2019, these same requirements go into effect in Greenlee, La Paz, Graham, Santa Cruz, Gila, Apache, Navajo, Cochise and Coconino counties.

Link to E-Prescribing Requirements in SB 1001 Bill Language

Take Action for Compliance
We urge you to assess your clinical practice capacities and determine if you are compliant with these impending opioid e-prescribing requirements to avoid and/or
minimize any disruption to your practice and patients.

It is important to note that e-prescribing controlled substances must satisfy the Drug Enforcement Administration’s Electronic Prescriptions for Controlled Substances (EPCS) system requirements and may cost more than basic e-prescribing. Many of the most common electronic health record vendors have both e-prescribing and EPCS capabilities so contact them for more information. To find out if your EHR vendor is EPCS-certified, you can also check the Surescripts website.

Request a Waiver, if Necessary
Pursuant to
Arizona Revised Statutes 36-2525 Q., the Arizona State Board of Pharmacy is required to grant waivers to medical practitioners who lack adequate access to broadband or face other hardships that prevent implementation of EPCS. The maximum duration for a waiver is up to one year.

If you determine you will be unable to meet the EPCS e-prescribing requirements, please submit a waiver using this link to the Arizona Board of Pharmacy as soon as possible: Waiver Form Link

DO NOT DELAY! The deadline to get a waiver to the Arizona Board of Pharmacy for consideration before 2019 is November 15, 2018. Once the waiver form is completely filled out, email the form to pmp@azpharmacy.gov.

Questions & Feedback?
If you have questions about EPCS, additional information is available on the Health Current website or you may contact them for phone-based support at 602-688-7200.

Tags:  Legislative  Opioid 

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AZ first probable WNV/SLE case

Posted By Administration, Friday, August 24, 2018

Society PA,

With monsoon season, mosquito activity is increased in Arizona. The year’s first probable West Nile virus (WNV)/St. Louis encephalitis virus (SLE) case in Arizona is under investigation.  Both of these flaviviruses are endemic in Arizona and have been detected in collected Culex mosquitos.

WNV and SLE are most commonly spread to people by the bite of an infected mosquito. In 2017, Arizona had 110 reported cases and 8 fatalities of WNV and 6 cases of SLE.

Healthcare providers are encouraged to consider WNV and SLE in patients presenting with:
  • Nonspecific signs of fever, headache, myalgia, arthralgia, rash, and weakness.
  • Meningitis, encephalitis, paralysis, or other acute signs of central or peripheral neurologic dysfunction.

The majority of WNV and SLE infections are asymptomatic; however, infections in the elderly and among immunocompromised individuals can result in neuroinvasive diseases that can be fatal.

Arizona clinicians should test serologically for both WNV and SLE if there is clinical suspicion for these mosquito-borne illnesses, with serum or cerebrospinal fluid collected after the first week from symptom onset. Providers should advise patients to prevent mosquito bites and they should contact local public health (https://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#resources-county ) regarding suspected WNV or SLE illnesses or questions on diagnostic testing.

 

For more information, visit:

https://www.azdhs.gov/preparedness/epidemiology-disease-control/mosquito-borne/index.php

https://www.azdhs.gov/preparedness/epidemiology-disease-control/index.php#idaz https://www.cdc.gov/westnile/healthcareproviders/index.html

https://www.cdc.gov/sle/technical/symptoms.html

Thank you,
Arizona Health Alert Network

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ASAPA 2018 Election Results

Posted By Administration, Friday, June 15, 2018
Updated: Thursday, June 14, 2018
The ASAPA 2018 election results are in!

The results are as follows:
President Elect: Kirsten Bonnin, PA-C
Secretary: Lynzi Warner, PA-C
Directors at Large: Carla Shamblen, PA-C and Elias Villarreal, PA-C
AAPA House of Delegates: Jamie Black, PA-C; Sarah Bolander, PA-C; Jacqueline Spiegel, PA-C

 

Returning Board Members:
President: Jennifer Feirstein, PA-C
Treasurer: Chris Davis, PA-C
Directors at Large: Sarah Bolander, PA-C and Amy Rust, PA-C
AAPA House of Delegates: Jennifer Feirstein, PA-C and Melinda Rawcliffe, PA-C

 

A big thank you to the candidates for their time and commitment to serve in their new roles starting in July!

 

Sincerely,

Amber Herrick, PA-C
ASAPA Elections Chair

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Arizona Vaccine News from the AZ Dept. of Health Services

Posted By Administration, Tuesday, May 29, 2018

Society PA,

Please see the attached “Arizona Vaccine News.”

The intent of “Arizona Vaccine News” is to summarize local, national, and international vaccine information that affects Arizona. 

 

Thank you,
Arizona Department of Health Services

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Primary Care: PAs Need Vigilance with Herbals

Posted By Barbara Cortright, PA-C, Wednesday, April 4, 2018

With complementary and alternative medicine grabbing larger market share each year, physician assistants often increasingly find themselves learning more about herbal remedies from their patients before they hear about it in continuing-education courses.

But if a clinic’s patient panel includes a large number of Hispanic and Latino populations, the list of supplements can be substantial thanks to the increasing popularity of neighborhood herbal shops called yerberías that cater to this clientele.

Also known as botanicas, these retail stores sell herbs, creams, tinctures and teas. They may also carry talismans to ward off evil spirits and votive candles for events or ceremonies. Patients whose ancestral roots come from rural parts of Latin America may lean more heavily on the yerberías for help than the local pharmacy.

Many of these substances pose little threat to the patient’s overall health. Manzanilla, for example, is the Spanish word for “chamomile” and is often formulated into a soothing tea for bedtime. Other substances often focus on treating the common cold or aching joints. They may include extracts from creosote, arnica, and chiles (think modern medicine’s capsaicin cream), and anti-inflammatory extracts like turmeric, ginger, black pepper and nettle leaves.

However, products from yerberías lack FDA studies and approval. A 2013 study found that many of the substances patients receive from yerberías for the common cold may contain excessive amounts of lead, arsenic or mercury. 

And then there is the occasional rogue yerbería, like the one Mesa Police raided five years ago and found Viagra, Valium, amoxicillin and Pentrexyl, which are prescription-grade pharmaceuticals. (Pentrexyl contains ampicillin.)

PAs practicing in Arizona often ask for a list of all medications and supplements. But in the right patient, it’s also worth asking, “¿Cuál botanicas usa Usted?” or “Which botanicals do you use?”

– Barbara Cortright, PA-C

Tags:  botanicals  complimentary  herbal  supplements  yerberia 

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Call the New AZ Provider Opioid Assistance + Referral Line: 888-688-4222

Posted By Administration, Monday, April 2, 2018

Society PA,

OAR Line: Opioid Assistance + Referral Line for Arizona Providers: 1-888-688-4222

More than two Arizonans die every day from an opioid overdose.  The Arizona Department of Health Services recognizes that there are many patients at risk for an overdose – and those with complex high-impact chronic pain, on multiple medications, or struggling with opioid use disorder can be challenging for providers to manage. 

As a result, Arizona has now launched one of the nation’s first 24/7 hotlines providing free, real-time consultations for clinicians with complex patients with pain and opioid use disorders, staffed by experts at the Poison and Drug Information Centers in Arizona.

 This clinical service can assist providers with the management of:

  •   Patients taking high numbers of morphine milligram equivalents (MME)
  •   Patients that require an exit strategy from their current opioid regimen (including tapering)
  •   New patients on multiple controlled substances
  •   Challenging patients with pain and mental health/substance use comorbidities
  •   Patients with acute opioid overdose or toxicity
  •   Patients with acute opioid or benzodiazepine withdrawal
  •   Patients that require MAT (medication assisted treatment)
  •  Patients that require local referrals to behavioral health or substance use disorder treatment

 

Consistent with Poison Control protocols, these consultations will provide tailored, evidence-based (see Arizona Prescribing Guidelines 2018) real-time and follow-up services. 

 Call them today, overnight or tomorrow: 1-888-688-4222.

Additional Resources:

Arizona Opioid Prescribing Guidelines (2018)

Arizona Department of Health Services – Opioid Epidemic

Poison Control – Tucson

Poison Control – Phoenix

AHCCCS Treatment Resources Attached

Thank you,
Arizona Health Alert Network

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Mental Health: Vaping found to be safer than smoking

Posted By Adam Klawonn, PA-C, Tuesday, February 20, 2018

Electronic cigarette smokers had fewer chemicals and carcinogens in their systems than their traditional cigarette-smoking counterparts, according to a recent multinational study.

Researchers from several institutions, including University College London and US Centers for Disease Control, found that saliva, urine and breath samples from 181 current and former smokers had fewer traces of nitrosamines – a deadly component of inhaled nicotine – and volatile organic compounds if they were using e-cigarettes only versus their counterparts who used both cigarettes and vape products.

The limited study, which was published in Annals of Internal Medicine, is being hailed as a "landmark" study. A brief summary can be found on the US National Library of Medicine's website.

However, the study did not look at whether vaping can help traditional cigarette smokers quit smoking altogether. Researchers found that serum nicotine levels were roughly the same whether participants smoked or vaped.

That question is further complicated by recent news on the vaping products themselves. First, new research shows vaping can increasingly lure teenagers 

to take up smoking traditional cigarettes, and in fact, vaping among children in grades 8 through 12 is on the rise.

Secondly, there is no consistency in the amount of nicotine present in various vaping products, according to a recent study in Journal of Addiction Medicine. E-cigarette users often look at the doses of nicotine marketed on vape packaging to develop a weaning process to kick the habit completely. But researchers found that samples of e-cigarette products contained as much as 35 percent less or 52 percent more nicotine than marketed.

 

--Adam Klawonn, PA-C

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