Prescription Drug Monitoring Program Update. Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017

Transcription

1 Prescription Drug Monitoring Program Update Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017

2 Objectives Brief historical overview of opioids Review of PDMP information Discuss ideas from community meetings Discuss PDMP best practices Summarize Florida s successes 2

3 Brief History of Opioids 1920 & 1930 The Heroin Act of 1924 passed The Food, Drug and Cosmetic Act passed 1950s-1970s Oxycodone (Percodan) became available Illegal heroin smuggled into the US Controlled Substance Act was passed DEA was created 1980 Just Say No! Vicodin (hydrocodone & acetaminophen became available Opiophobia - doctor s fear to prescribe opioids 3

4 Brief History of Opioids 1990 Increased use of opioids for all pain types, including non-cancer Marketing efforts to health care providers increased Extended release technology introduced Joint Commission- Pain as the fifth vital sign Opioid prescribing increased and prescriber education implemented FDA approved formulations that contained properties to deter abuse 2010-Today Heroin and synthetic opioid use increased Proliferation of Florida s Pill Mill industry Product formulation contain abuse-deterrent properties Education on proper opioid prescribing and use increased 49 states have implemented Prescription Drug Monitoring Programs 4

5 Information Reported to the Database Patient Name, Address, Date of Birth, Prescription Information, Payment Type, Telephone Number Prescriber Name, Address, DEA Number Pharmacy Name, Address, DEA Number 5

6 How is the information used? Prescribers, pharmacies and pharmacists use the information from E-FORCSE to improve health care outcomes. Reports can supplement a patient evaluation, confirm the patient s prescription history, document compliance with a therapeutic regimen, and identify potentially hazardous or fatal interactions. 6

7 Controlled Substance Information Not Reported to the Database If administered directly to a patient If administered or dispensed to a patient less than 16 years of age; If administered or dispensed in the health care system of the Department of Corrections; If dispensed by a Department of Defense facility 5

8 Have you accessed the PDMP? Physicians, Pharmacists, PA s, ARNP s or their designees may access the PDMP to guide clinical decisions, reduce drug abuse and diversion 3.5 million prescription records are uploaded on a monthly basis 66% of the dispensers upload information on a daily basis 7.85 million unique individuals are in the database 8

9 License Type Registered Users (No.) Users who have Queried (No.) Users who have Queried (%) 2016 Queries (No.) Queries per User ARNP 2,730 1, , DN , ME 13,815 9, ,120,535 1,042 OPC OS 2,953 2, ,275,318 1,002 PA 1,877 1, , PO , PS 17,333 15, ,699, TOTAL 39,905 28, ,526,

10 Registration and Utilization Rates 10

11 PDMP Data Controlled 2013 Substance 2014 Data Number of unique individuals Number of unique patients in Florida Change (%) Change (%) Change (%) RY2013 RY2014 RY2015 RY ,590, ,664, ,666, ,847,122 6,202, ,258, ,226, ,387,884 Number of unique prescribers Number of unique in-state prescribers Mean number of unique patients per prescriber Number of prescriptions to Florida residents 217, , , ,238 59, , , , ,704, ,489, ,929, ,048,030 Prescriptions per patient Prescriptions per prescriber Number of unique pharmacies , , , ,546 11

12 The number of controlled substance prescriptions reported by dispensers in Orange County in CY2015 &

13 The number of opioid prescriptions reported by dispensers for report year July 1, 2013 through June 30, 2016 by drug name. DRUG NAME RY2013 RY2014 RY2015 RY2016 Total Opioid Prescriptions 13,090,880 12,885,546 15,200,301 15,372,742 HYDROCODONE SA 6,120,956 6,014,557 5,359,325 5,123,070 OXYCODONE SA 3,742,288 3,673,917 3,963,049 4,263,901 TRAMADOL SA ,510 2,598,803 2,763,302 CODEINE 600, , , ,405 MORPHINE LA 599, , , ,817 FENTANYL LA 357, , , ,103 HYDROMORPHONE 458, , , ,305 MORPHINE SA 305, , , ,894 OXYCODONE LA 318, , , ,492 METHADONE 371, , , ,369 OXYMORPHONE LA 58,446 61,472 64,759 69,884 TAPENTADOL 91,019 71,735 66,047 67,354 TRAMADOL LA 13 2,020 54,488 52,626 OXYMORPHONE SA 14,890 19,655 21,984 21,625 MEPERIDINE 29,748 24,404 18,235 15,388 FENTANYL SA 9,093 11,478 13,910 13,058 PENTAZOCINE 10,165 7,783 5,743 4,459 HYDROCODONE LA 707 4, DIHYDROCODEINE 1,

14 Prescription rates in Orange County, top six opioids, CY2015 and CY

15 Percentage of patients prescribed long-acting/extended release (LA/ER) opioids who were opioid-naïve and mean daily dosage per LA/ER prescription by year NOTE: The 1 st three quarters of 2011 data are incomplete, therefore none of the data in 2011 may be useful. 15

16 Prescription rates by drug class, sex and age group, Florida residents, CY

17 Prescription rates by drug class, sex and age group, Florida residents, CY

18 Prescription rates by drug class, sex and age group, Florida residents, CY

19 The mean daily dosage per patient in morphine milligram equivalents (MMEs) and the percentage of patients on opioids receiving a dosage >100 MMEs. 19

20 Prescriptions per 1,000 county residents for all controlled substance prescriptions in schedules II-IV, report year 20

21 Prescriptions per 1,000 county residents for all controlled substance prescriptions in opioids, current reporting period. 21

22 Prescriptions per 1,000 county residents for all controlled substance prescriptions in stimulants, current reporting period. 22

23 Florida Death Rate by Opioid Type 23

24 Potency Compared to Morphine 24

25 Lethal Doses of Each Drug 25

26 Florida Declares Public Health Emergency 26

27 What has Been Done to Date? Established Drug Policy Advisory Council Victoria Siegel Act- Educational Pamphlet Disposal of Unwanted Drugs Infections Disease Elimination Pilot Program Standing order for Naloxone PDMP Good Samaritan Laws Prescription Limits 27

28 Powerful Stories from Community Meetings I have no words of wisdom to offer an addict as he destroys everything he loves for 30 minutes of nirvana. - Jeff, son of an addict 28

29 Ideas from Community Meetings Expand needle exchanges to reduce the likelihood of spreading HIV/HepC Expand family planning counseling for women of childbearing years to reduce incidence of NAS Establish peer follow-up programs to assist case management Expand mental health service follow-up Expand naloxone programs 29

30 More Ideas from Community Meetings Implement a comprehensive community education strategy Continue professional and community-based trainings Expand drug take-back programs Evaluate local best practices to help identify issues before they become problems Encourage prescribers to follow CDC Guidelines when prescribing opioids Increase registration and utilization of the PDMP 30

31 Recommended PDMP Best Practices Collect positive identification of patient Collect data on method of payment Collect data in timely intervals Send unsolicited reports/alerts Allow delegate access Stable funding Mandate enrollment and utilization Enact and implement interstate data sharing Integrate PDMP reports with HIEs/EHRs 31

32 Florida s Successes Increased dispenser reporting Increased prescriber enrollment and utilization Reduced morphine milligram equivalent dosing prescribed Reduced the number of individuals having multiple provider episodes 32

33 Rebecca Poston (850)

34 Acknowledgements Grant No PM-BX-0009 awarded by the Bureau of Justice Assistance (BJA), Office of Justice Programs, U.S. Department of Justice supports the Prescription Drug Monitoring Program Annual Report. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Justice. Bruce A. Goldberger, PhD, Chief, Director and Professor, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine Chris Delcher, PhD, Assistant Professor, Department of Health Outcomes and Policy, University of Florida College of Medicine Yanning Wang, MS, Statistical Research Coordinator, Department of Health Outcomes and Policy, University of Florida College of Medicine Peter W. Kreiner, PhD, Senior Scientist, Institute for Behavioral Health and Principal Investigator, Prescription Behavior Surveillance System 34