oregon pdmp requirements

Interventions aimed at increasing PDMP utilization among healthcare providers would impact opioid-related harms and outcomes over time. Addiction. providers, patients), interventions (i.e. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Improving Drug Utilization Review Controls in Part D. Section 1860D-4(c)(5)(A) of the Social Security Act permits Part D sponsors to establish drug management programs (DMPs) for beneficiaries who are at risk for misuse or abuse of frequently abused drugs (FADs). Reviewing the , Url: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SAFELIVING/PDMP/Pages/advisory-board.aspx Go Now, Schools Details: WebAs of July 2018, Oregon law requires PDMP registration for all Oregon prescribers. Furthermore, although some studies accounted for PDMP features, this review did not focus on differences across types of PDMPs or on the effect of legislative changes to PDMP characteristics in regions with pre-existing PDMPs (e.g. information requirements for the request to: Click Learn how, An official website of the State of Oregon, An official website of the State of Oregon , Other Health System Reform Related Topics, Birth, Death, Marriage and Divorce Records, Residential and Outpatient Behavioral Health, Other License and Certificate Related Topics, PDMP Researcher Data Limitations Fact Sheet, OHA ADA Policy and Request for Modification. Law Enforcement staff will query the system for the requested information and provide a report Board if you do not have a copy of the formulary. What are the schedules that Oregon PubMed Central an authorized drug-related investigation may request information from the PDMP Oregon Prescription Drug Monitoring Program . Patients are encouraged to talk with their healthcare providers regarding their prescription medications. Review the Oregon Prescription Drug Monitoring Programs (PDMP) Requirements. Information Request Procedure. Any other questions about your DEA registration Ali MM, Dowd WN, Classen T, Mutter R, Novak SP. ER wrote the manuscript, and then MA, JH, and MW critically revised it before all authors read and approved the final version. HIT Commons, a shared public/private governance model formed between OHLC and the OHA. Your browser is out-of-date! Businesses providing architectural services in Oregon must register as a firm with OSBAE. Addictions and Mental Health Services, Addiction Technology Transfer Center Network, STOMP (Structuring Your Own Management of Pain) Pain self management brochure developed by Swedish Hospital in Seattle, Living Well with Chronic Conditions Six week workshop provides tools for living a healthy life with chronic health conditions, Find us on Facebook Learn how, An official website of the State of Oregon, An official website of the State of Oregon , Other Health System Reform Related Topics, Birth, Death, Marriage and Divorce Records, Residential and Outpatient Behavioral Health, Other License and Certificate Related Topics, http://www.deadiversion.usdoj.gov/schedules/, Authorization for Use and Disclosure of Information Form, Patient Prescription Correction Request Form, Authorization for Use and Disclosure (pdf), OHA ADA Policy and Request for Modification. A .gov website belongs to an official government organization in the UnitedStates. 2015;150:638 Available from: https://doi.org/10.1016/j.drugalcdep.2015.02.010, Elsevier Ireland Ltd. Kim M. THE IMPACT OF PRESCRIPTION DRUG MONITORING PROGRAMS ON OPIOID-RELATED POISONING DEATHS [Internet]: Johns Hopkins University; 2013. EPs can meet the specialized registry objective by complying with one of the following: To register intent, This connection allows users to pass a request to Oregons PDMP through their health IT systems connection to the Gateway. Login Assistance How do I log in? information is collected and stored securely. We considered the intervention of interest the presence of a PDMP, defined as a program that specifically monitors the outpatient prescription dispensing of opioids (or other drugs) by healthcare providers. Long-Term Opioid Use Guidelines (2014), Institute for Clinical Systems Improvement (ICSI) Guidelines: Pain Med. As such, we did not explore outcomes related to other monitored drugs such as benzodiazepines, which may also be affected by PDMP implementation. A lock icon ( ) or https:// means youve safely connected to the .gov website. Devonshire E, Nicholas MK. We included full published reports in all languages. 2023 BioMed Central Ltd unless otherwise stated. An official website of the State of Oregon . Beginning January 1, 2022, all Part D sponsors are required to have a DMP, and to include beneficiaries with a history of opioid-related overdose in their DMP pursuant to the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. Available from: https://www.datafiles.samhsa.gov/study-series/treatment-episode-data-set-admissions-teds-nid13518. Concerns with bias on PDMP/outcome measurement mainly stemmed from the timing of measurement. The Oregon Prescription Drug Monitoring Program (PDMP)is a tool tohelp healthcare providers and pharmacists provide patients better care in managing their prescriptions. Fleming M, Barner J, Bamgbade. Boards must perform is to allow at least 90 days from the date the Board actually initiates rule PubMed With EPCS legalized nationally, a majority of states have since mandated the use of EPCS for all controlled substances. Learn It contains information provided by Oregon-licensed retail pharmacies. office. See Additional file 2: Table S4 for individual study details. Oregon SBIRT, Clinical Drug Testing in Primary Care SAMHSA, SAMHSA TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorder, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction SAMHSA TIP 40, SAMHSA Health Aff. DEA Home PageDEA Drug SchedulingNational Provider Identifier (NPI) This summer you could make a lifelong friend (or several) by sharing 3 weeks of your . National Suicide Prevention Lifeline The map used on this website is published on the web by jVectorMap, and sourced under an open license. Clin J Pain. All requests for de-identified data for research purposes must be approved by the OHA. 2011;14(3):A1978 Available from: https://doi.org/10.1016/j.jval.2011.02.1089. Patients are encouraged to talk with their healthcare providers regarding their prescription medications. While there were no observed effects for the association of PDMPs with harms and consequences related to opioids, PDMPs, if properly operationalized, can be an important piece of a broader opioid strategy. respond to the law enforcement agency providing an explanation for the denial. Learn how, An official website of the State of Oregon, An official website of the State of Oregon , Other Health System Reform Related Topics, Birth, Death, Marriage and Divorce Records, Residential and Outpatient Behavioral Health, Other License and Certificate Related Topics, please visit Promoting Interoperability (Meaningful Use) in Public Health, Guideline for Safe Chronic Opioid Therapy Prescribing for Patients with Chronic Non-Cancer Pain, Guideline on Opioid Dosing for Chronic Non-Cancer Pain, Chronic Opioid Therapy Safety Guideline for patients with chronic non-cancer pain, Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain, Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain, Pharmacological Management of Persistent Pain in Older Persons, Assessment and Management of Acute Pain in Infants, Children and Adolescents, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, OHA ADA Policy and Request for Modification, Submit patient specific controlled substance dispensing information electronically to the PDMP; or. pharmacists to determine what medications are best for them. The HIT Commons, a shared public/private governance model . In order to address the opioid crisis in North America, many regions have adopted preventative strategies, such as prescription drug monitoring programs (PDMPs). Studies were published between 2006 and 2018 and include data years from 1992 to 2014. Can I use my Oregon license and DEA registration to prescribe for new patients? A lock icon ( ) or https:// means youve safely connected to the .gov website. PO Box 14450 The oregon pdmp website, Url: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SAFELIVING/PDMP/Pages/healthcare-provider-faq.aspx Go Now, Get more: Oregon pdmp websiteView Schools, Schools Details: WebThe State of Oregon has established a Prescription Drug Monitoring Program (Oregon PDMP) as directed in statute ORS 431.962. Bohnert A, Valenstein M, Bair MJ, Ganoczy D, Mccarthy JF, Ilgen MA, et al. 2018;184:2632. A recent evidence synthesis by our team found that only 57% of healthcare providers had ever used PDMP data to inform their prescribing decisions (using data from 26 studies), and fewer than 1 in 5 used a PDMP with each prescription. A study examining cohorts of Medicare beneficiaries for each year from 2006 to 2012 in 45 states found no association between PDMP status and the proportion of insurance beneficiaries experiencing non-fatal prescription opioid overdoses in adjusted models [48]. The user then views the PDMP result in their electronic workflow, and may choose to retain that result in the patients electronic record. covered the most years of data from TEDS; they found no association when examining the association between treatment admissions for heroin and PDMP status [27]. Follow us on Twitter PubMed 847-010-0120 Prescription Drug Monitoring Program. Have the Executive (how to identify a Oregon.gov website) 2016;68(4):S79 Available from: https://doi.org/10.1016/j.annemergmed.2016.08.216. 2016;112:3119 Available from: https://doi.org/10.1111/add.13620. through the same rule making process as any other rule change. As of 2018, 49 states, the District of Columbia, and two U.S. territories (Guam & Puerto Rico) had implemented a PDMP [20]. The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review. endobj for addition to the Formulary compendium must I wait before I can legally Oregon State Archives 800 Summer Street NE Salem, OR 97310 Phone . Two studies reported on illicit and problematic use but found no significant associations with PDMP status. Birk E, Waddell G. The mitigating role of Prescription drug monitoring programs in the Abuse of Prescription drugs. The authors declare that they have no competing interests. Physician attitudes and experiences with Maryland s prescription drug monitoring program ( PDMP ). Secure .gov websites use HTTPSA The QUIPS tool assesses risk of bias across six domains: study participation, study attrition, prognostic factor measurement, outcome measurement, study confounding, statistical analysis and reporting [36]. overdose, death), and opioid-related legal and criminal outcomes (i.e. A: Yes, if you are dispensing samples at Schools Details: WebStatus: No Requirement. Borwein A, Kephart G, Whelan E, Asbridge M. Prescribing Practices Amid the OxyContin Crisis: Examining the Effect of Print Media Coverage on Opioid Prescribing Among Physicians. The Cochra. IMPORTANT: EPs who receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program potentially may be subject to an audit. This variability limits TEDS in its ability to assess admissions outcomes. Oregon PDMP Gateway Service Use Agreement) and submit them to OHA. How you know 2016).Here, the Drug Enforcement Administration (DEA) sought to overturn a ruling that the DEA's use of administrative subpoenas to access records from the Prescription Drug Monitoring Program (PDMP) violates the Fourth . Available from: https://www.pdmpassist.org/content/state-profiles. Cookies policy. Table S2. CMS codified these requirements and other policy changes in the 2022 Parts C & D Final Rule, available at: https://www.govinfo.gov/content/pkg/FR-2021-01-19/pdf/2021-00538.pdf. Epidemiology. making to the permanent adoption of any substance to the formulary. Submit the signed Board Sign up to get the latest information about your choice of CMS topics. It is A: You can find information at theDepartment BMC Health Services Research This well-designed study provides support for the effectiveness of PDMPs, finding that jurisdictions with online PDMPs observed significant reductions in rates of opioid-related hospitalizations. A: Issuance of a DEA registration to prescribe We performed the search on January 22, 2018 and included all pertinent publications published prior to that date (see Additionalfile1). 2018;53(4):694701 Available from: https://doi.org/10.1080/10826084.2017.1363232, Taylor & Francis. Article The misuse of opioids has reached epidemic levels across North America [1]. Oregon Prescription Drug Monitoring Program. Additionally, the new compliance date for electronic prescriptions in Long Term Care facilities is January 1, 2025. An official website of the United States government New legislation was just passed in February 2018, along with a temporary rule enacted by the OHA in April 2018, that requires all dentists with an active Drug Enforcement Administration (DEA) registration to register with the PDMP by July 1, 2018. . %PDF-1.7 monthly or quarterly) raised less concerns about misclassification. The Effect of Prescription Drug Monitoring Programs on Opioid Prescriptions and Heroin Crime Rates. prescribe it? Outcomes extracted included any unadjusted and adjusted associations between the presence of a PDMP, or the change in PDMP states and non-PDMP states over time, and each opioid-related harm or consequence outcome, as well as all variables controlled for. In: Canadian Centre on Substance Abuse; 2015. p. 20910. lock Five studies reported on fatal prescription opioid overdoses using three unique data sources CDC WONDER, NVSS and state-specific inpatient and emergency databases [40, 45,46,47, 53]. 847-020-0200 Required School Subjects Division 23 - RULES FOR LICENSURE OF oregon pdmp rules, Url: https://secure.sos.state.or.us/oard/displayChapterRules.action?selectedChapter=14 Go Now, Get more: Oregon pdmp rulesView Schools, Schools Details: WebYes. Available from: https://doi.org/10.1002/pds.4036. None of the included studies considered PDMP utilization by healthcare providers when estimating the effect of PDMPs on outcomes. Equally important, in order for PDMPs to function optimally, healthcare providers must use the data whenever they are prescribing an opioid [56]. See Additional file 2: Table S2 for individual study details. Requests are fulfilled only for the purposes and under the provisions specified below. State legal restrictions and Prescription- opioid use among disabled adults. Learn The second study was an interrupted time series of 49 state PDMPs from 2004 to 2014 and found that at baseline (2004), prescription opioid poisoning rates were higher in PDMP states than non PDMP states; however, the rate of prescription opioid poisonings over time decreased more quickly in PDMP states than in non PDMP states (=0.005, 95% CI [0.008- -0.003]) [49]. Oregon Health Leadership Council page. Issuance of a DEA registration to prescribe controlled substances dispensed to Oregon residents. Meet statewide physical standards. Your browser is out-of-date! Reisman RM, Shenoy PJ, Atherly AJ, Flowers CR. Nine of the included studies were not published in peer-reviewed journals (i.e. When the appeal is received, the OHA will conduct a contested case hearing. 2011;305(13):131521 Available from: https://doi.org/10.1001/jama.2011.370. They may work in tandem with other arms of an opioid strategy, rather than functioning as standalone programs. Most PDMPs give healthcare providers the option to check PDMP data (patient profiles) before prescribing or dispensing opioids to a patient, allowing for more informed decision making. 2009;181(12):8812 Available from: https://doi.org/10.1503/cmaj.091791. 2014;23:31420 Available from: https://doi.org/10.1002/pds.3553. Monitoring Programs in Canada: Best Practice and Program [Internet]. Portland Office. for an individual that is the subject of the investigation. Studies with overlapping data differed in the years of data covered. Rev. Health information in the new Prescription Drug Monitoring Program (PDMP) is protected by the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other state laws. States contributing data to TEDS can collect either publically- or privately-funded admissions [57]. The objective of this systematic review was to examine the effect of PDMP implementation (initial and over time) on opioid-related harms and consequences. The second study was an interrupted time series of 49 state PDMPs from 2004 to 2014 and found that at baseline (2004), prescription opioid poisoning rates were higher in PDMP states than non PDMP states; however, the rate of prescription opioid poisonings over time decreased more quickly in PDMP states than in non PDMP states ( = 0.005 . Upon approval, the Approved Entity will work directly with Appriss to initiate full integration. Health care providers can review patient records while also seeing the PDMP data for prescription fill information on controlled substances. If the form is complete and the court order is valid, PDMP A subpoena is not sufficient for the PDMP to release information. Pain Med. Treatment Episode Data Set: Admissions (TEDS-A) [Internet]. Beginning January 1, 2022, all Part D sponsors are required to have a DMP, and to include beneficiaries with a history of opioid-related overdose in their DMP pursuant to the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. Branham DK. 2 0 obj How you know Meara E, Horwitz JR, Powell W, McClelland L, Zhou W, OMalley AJ, et al. This research was funded by the Canadian Institutes of Health Research Operating Grant: Opioid Crisis Knowledge Synthesis/Subvention (#397982). stream Subst Abuse Treat Prev Policy. Or. Drug Alcohol Depend. Bordering state licensed healthcare providers may also be authorized for access accounts. To request a report, a patient needs to sendthe Oregon Health Authority (OHA) the following documents: A patient may request that the OHA correct any information about the patient that is considered incorrect. CMAJ. Ann Emerg Med. Prescription Drug Monitoring Program - Oregon.gov. CONTROLLED SUBSTANCES: PubMed The following can legally access Oregon PDMP data once authorized: All prescribers of controlled substances (Schedule II-IV) Pharmacists Medical, dental, and Pharmacy Directors Portland Office. Drug Alcohol Depend, Available from: https://doi.org/10.1016/j.drugalcdep.2015.09.024, Elsevier Ireland Ltd. 2015;156(January):2828. Prescription Drug Monitoring Program PO Box 14450 Portland, OR 97293-0450 Phone: 971-673-0741 TTY: 971-673-0372 E-mail: pdmp.health@odhsoha.oregon.gov. controlledsubstances? Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain, The protected health Rev. Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada, Emily Rhodes,Maria Wilson,Alysia Robinson,Jill A. Hayden&Mark Asbridge, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada, You can also search for this author in ( listed on the formulary compendium. For a list of these medications and more information, go to Prescription drug monitoring programs : the role of asymmetric information on drug availability and Abuse; 2017. p. 148. Two unique studies reported on three types of opioid-related criminal outcomes: crime rates, identification of potential dealers, and opioid diversion [26, 55]. . We used Covidence software for all study screening [29]. IV, and V. (See OAR 850-060-0215) For the Contact Us Using existing health IT systems and clinician workflow will save healthcare professionals time and reduce system redundancies. Only share sensitive information on official, secure websites. EPs can meet the specialized registry objective by complying with one of the following: Submit patient specific controlled substance dispensing information electronically to the PDMP; or Castillo-Carniglia A, Ponicki WR, Gaidus A, Gruenewald PJ, Marshall BD, Fink DS, Martins SS, Rivera-Aguirre A, Wintemute GJ, Cerd M. Prescription drug monitoring programs and opioid overdoses: exploring sources of heterogeneity. statement and No, you must be conducting business in An official website of the State of Oregon , Health Care Provider Covid 19 Vaccination Regulations & Requirements, Board Jurisdiction and Scope of Practice of Naturopathic Medicine, Oregon Prescription Drug Monitoring Program, Department : The OBNM will take action against any The HIPAA privacy rule and state law protects the privacy of individuals health information. 2017;10990:142. The request must be Maryland Department of Health. One study also examined the association between past-year opioid dependence and PDMP status; no significant association was observed [24]. How do I verify my email address Account Administration How long until my PMP AWARxE Account is Approved? Google Scholar. If consensus could not be achieved after discussion, the study was carried forward to the full-text screening level. Menchine M, Georgis M, Lam C, Seabury S. Do state prescription drug monitoring programs reduce opioid consumption? Pharmacoepidemiol Drug Saf. Value Health. The schedules are II, IIN, III, IIIN, Prescription SB. A: No, only the substances that are enough. Entities who wish to participate must apply and be approved by Oregons PDMP program. Maryland Advisory Council on Prescription Drug Monitoring Legislative Report. and PDMP Utilization. Stat. Pharmacies submit prescription data to the PDMP system for all Schedules II, III and IV controlled . Pain Medicine Provider Toolkit, OHSU Available from: https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/2012/narcotic-drugs-technical-report_2012.html. Conflicting evidence was found for the association between treatment admissions and PDMP status, with some studies indicating an increase in admissions, and others finding a decrease. the signed Law Enforcement Information Request Form along with a copy of The Centers for Medicare & Medicaid Services (CMS) delayed the mandate deadline to January 1, 2023, for the SUPPORT Act which requires all controlled substance prescriptions under Medicare's Part D drug plan to be transmitted electronically. It is is to allow at least 90 days from the date the Board actually initiates rule Four studies reported on heroin-related overdose deaths, none of which found any association with PDMP status in adjusted models [39, 40, 50, 53]. Broadly, PDMPs aim to restrict drug diversion and reduce opioid misuse-related harms [18, 19]. Mark Asbridge. prescribe controlled substances that are within the scope of practice and Available from: http://search.proquest.com/docview/1923434357/. See the The rule codified many aspects of CMS earlier retrospective Part D Opioid Drug Utilization Review (DUR) policy and the Overutilization Monitoring System (OMS), with adjustments as needed to comply with the Comprehensive Addiction and Recovery Act of 2016 (CARA), by integrating them into the DMP provisions. The request must be made in writing using the Imtiaz S, Shield KD, Fischer B, Rehm J. Harms of prescription opioid use in the United States. ORS 431.966, The boards Executive Director or his/her designee must We aimed to synthesize the literature on changes in opioid-related harms and consequences, an important measure of PDMP effectiveness. A lock icon ( ) or https:// means youve safely connected to the .gov website. The bill mandates that individual prescribers, pharmacists or their delegates to have an active PDMP user account in order to receive PDMP data through the new PDMP Gateway. practitioner that prescribes outside the formulary or scope of practice. See Additionalfile2: Table S1 for individual study details. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> State trends in opioid Abuse / misuse ? Terms and Conditions, Higgins J, Green S. Cochrane handbook for systematic reviews for interventions. should be directed to the DEA at (206) 553-5443 Seattle Office or (503) 721-6600 (how to identify a Oregon.gov website) Table S4. Boards must perform the following steps to request information from the PDMP: . Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain, Have monocular vision of at least , Url: https://www.how-to-become-a-police-officer.com/states/oregon/ Go Now, International school of monterey calendar, Brevard county school calendar 2023 2024, 2020 SchoolsLearning.info. DrFirst offers two e-prescribing products that streamline workflow, inform medication reconciliation, and support medication adherence: the web-based Rcopia software and the mobile app, iPrescribe. Google Scholar. submit prescription data to the PDMP system for all Schedules II, III and IV The program was started to support the appropriate use of prescription drugs. Book The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review, https://doi.org/10.1186/s12913-019-4642-8, https://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302664, https://doi.org/10.1016/j.mayocp.2017.12.020, https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/2012/narcotic-drugs-technical-report_2012.html, https://doi.org/10.1059/0003-4819-152-2-201001190-00006, https://doi.org/10.1016/j.jpain.2013.08.012, https://doi.org/10.1097/AJP.0b013e3181ff04ca, https://doi.org/10.1016/j.drugalcdep.2015.07.565, https://www.pdmpassist.org/pdf/PDMP_admin/TAG_History_PDMPs_final_20180314.pdf, https://doi.org/10.1007/s11606-010-1377-y, https://doi.org/10.1097/PR9.0000000000000688, https://www.pdmpassist.org/content/state-profiles, https://doi.org/10.1186/s12913-017-2354-5, https://doi.org/10.1016/j.addbeh.2017.01.011, https://doi.org/10.1016/j.drugalcdep.2015.09.024, https://doi.org/10.1080/10826084.2017.1363232, http://search.proquest.com/docview/1923434357/, http://prisma-statement.org/prismastatement/Checklist.aspx, https://doi.org/10.1016/j.annemergmed.2016.08.216, https://doi.org/10.1016/j.jval.2011.02.1089, http://search.proquest.com/docview/1661461833/, http://search.proquest.com/docview/1727613694/, https://doi.org/10.1111/j.1526-4637.2012.01327.x, https://doi.org/10.1111/j.1526-4637.2011.01062.x, https://doi.org/10.1377/hlthaff.2015.1496, https://doi.org/10.1016/j.drugalcdep.2017.12.002, https://doi.org/10.1016/j.drugalcdep.2015.02.010, http://search.proquest.com/docview/1432503368/, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, Health Services Research for Opioid Use Disorders, bmchealthservicesresearch@biomedcentral.com. Other entities may obtain PDMP information as well. We need more recent and robust data as the opioid crisis has drastically evolved since then, with more recent focus on the very potent fentanyl.
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