Harold Rogers Prescription Drug Monitoring Program Regional Meeting-Charleston, SC April 29, 2014 Andrew Holt, PharmD

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1 Harold Rogers Prescription Drug Monitoring Program Regional Meeting-Charleston, SC April 29, 2014 Andrew Holt, PharmD

2 National Epidemic Highlighted numerous studies/media reports State Epidemic Highlighted several state-level studies/statistics Governor forms Public Safety Subcabinet Addresses many areas of public safety, including prescription drug abuse Overdose Deaths Overdoses NAS

3 Source: Tennessee Department of Health internal files, Baumblatt, et al

4 Source: Tennessee Department of Health internal files, Baumblatt, et al

5 Source: Tennessee Department of Health internal files, Baumblatt et al

6 Source: Department of Health internal files, Baumblatt et al

7 Source: Tennessee Department of Health internal files, Baumblatt et al

8 Number of Overdose Deaths Overdose Deaths Year International Classification of Diseases (ICD) version 10 cause of death codes X40-X44, X60-X64, X85, and Y10-Y14. Source: Tennessee Department of Health, Division of Policy, Planning and Assessment, Office of Health Statistics.

9

10

11 Administration bill introduced as a work product of the Governor s Public Safety Subcabinet Amended during the legislative process Passed by unanimous vote of both chambers on May 1, 2012 Signed by Governor Haslam on May 10, 2012.

12 Required registration as of January 1, 2013 Required checking of PMP as of April 1, 2013 in most cases involving the prescribing of an opioid or benzodiazepine Enabled interstate data sharing Established delegate accounts- extenders Increased administrative staffing

13 Automated Registration Web service established between vendor and: State professional licensing database State driver s license database Check against DEA database at vendor level Any non-matches are sent to PMP administrator for manual approval Established delegate accounts-extenders

14 Added capacity at vendor Hardware: Increased number of CPUs, Virtual Servers, Ram to handle 30 million transactions per year with a response time of 10.4 seconds or less in peak time; or 1,000 concurrent transactions per second with maximum query response time of 10.4 seconds per transaction during peak hours Personnel PMIX Interface Training database Use for demonstration purposes

15 Automated username retrieval Multiple practice locations per user Enhanced linking of extenders to supervisors Extender runs report on supervisor behalf Supervisor can run report on extenders Prescribing history and request history

16 Sent via to all prescribers registered in the PDMP Over 900 responses Purpose was to seek feedback about the PDMP and the Prescription Safety Act

17 71% changed a treatment plan after viewing a PDMP report 73% are more likely to discuss substance abuse issues or concerns with a patient 57% are more likely to refer a patient for substance abuse treatment 79% feel that the PDMP is useful for decreasing doctor shopping

18 Jan 2012 Feb 2012 Mar 2012 Apr 2012 May 2012 Jun 2012 Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Requests per Month Number of Registrants Number of Requests/Month Number of Registrants at Month End Source: Tennessee Department of Health internal files

19 1,200,000 1,000, , , ,000 CSMD Searches by Delegates CSMD Searches by Prescibers 200,000 0 Q Q Q Q Q Q Q Q Source: Tennessee Department of Health internal files

20 Table 6. Number of Patient Requests from CSMD, Year Healthcare Providers Law Enforcement ,200,435 N/A ,486, ,861,485 2, ,497,866 1,938 Source: CSMD Annual Report to the 108th General Assembly, 2014

21 Table 2. Number of Controlled Substances Prescriptions (by class) Reported to CSMD, * Year Opioids % Change Benzodiazepines % Change Other % Change ,150,946-3,951,144-4,423, ,018, ,152, ,001, ,265, ,061, ,125, ,227, ,913, ,433,347 6 * Classes of controlled substances were defined based on CDC guidance document. Source: CSMD Annual Report to the 108th General Assembly, 2014

22 Table 3. Comparison of the 10 most frequently prescribed products in 2012 and 2013 in CSMD Rank Hydrocodone products Hydrocodone products 2 Alprazolam Alprazolam 3 Oxycodone products Oxycodone products 4 Zolpidem Zolpidem 5 Tramadol Tramadol 6 Clonazepam Clonazepam 7 Lorazepam Lorazepam 8 Diazepam Diazepam 9 Morphine products Buprenorphine products 10 Buprenorphine products Morphine products Source: CSMD Annual Report to the 108th General Assembly, 2014

23 Source: CSMD Annual Report to the 108th General Assembly, 2014

24 C-II Controlled Substances Year Rx s Per Capita (TN Rank lower is better) 2008 TN: 0.53/person (4) US: 0.39/person 2012 TN: 0.64/person (2) US: 0.41/person 2013 TN: 0.68/person (2) US: 0.42/person Percent Change in Filled Rx s from Previous Year (TN Rank lower is better) N/A TN: 7.4% (23) US: 7.0% TN: 0.3% (31) US: 0.7% 24 Source: IMS Health, Inc.

25 MME in Billions MME Reported by Newly Reporting Dispensers MME Reported by All Other Sources 25 Source: Tennessee Department of Health Internal Files, February 2014

26 Source: CSMD Annual Report to the 108th General Assembly, 2014

27 Patient Requests (in Millions) High Utilization Patients Number of Searches Made by Prescibers, Dispensers, and Delegates High Utilization Patients: Patients filled 5 or more prescriptions with different DEA Prescribers at 5 or more different DEA dispensers within 90 days Source: Tennessee Department of Health Internal Files, February 2014

28 Dr. David Udoko Keshia Evans James Graddey David Jones Debora Sanford (Project Manager) Dr. Zhi Chen (Epidemiologist)

29 Andrew Holt, PharmD Director Tennessee Controlled Substance Monitoring Database 665 Mainstream Dr. Nashville, TN

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