Buprenorphine Initiatives and Capacity Analysis in Maryland

Transcription

1 Buprenorphine Initiatives and Capacity Analysis in Maryland B. Casey Lyons, MPH Department of Health and Mental Hygiene Presented to: PDMP East Regional Meeting October 25, 2016 Preliminary Data DO NOT CITE

2 Overview What is Buprenorphine? Maryland Buprenorphine initiatives Buprenorphine capacity Maryland specific methodology and results SAMHSA Region 3 assessment proposal

3 Buprenorphine Overview Partial opioid agonist FDA approved for use in pain management FDA approved for use in treatment of opioid use disorder Federal regulations under DATA2000 control prescribing for OUD treatment Must have special DEA DATA-waiver to prescribe for OUD Original patient panel caps at 30 and 100, for physicians only Caps changed earlier this summer now three levels: 30, 100 and 275 New rules also expand prescribing to NPs and PAs Concerns over access for OUD treatment due to greater restrictions

4 Maryland Buprenorphine Access Projects Goals: Increase number of DATA-waivered prescribers in currently underserved populations /geography Increase cap level at which prescribers waivered Support providers to prescribe up to their cap Current Initiatives: Gap buprenorphine prescribing in emergency departments Pilot program in Baltimore City PCSS-MAT

5 Buprenorphine Capacity Assessment using PDMP Data First run last year, repeating this year Initial activity: Aim to estimate the current capacity of buprenorphine prescribing in the state Known caveats OTPs and prescriber (office-based) dispensing of bupe for OUD not required to report to PDMP, so will be underestimate of true prescribing In MD, PAs and NPs may also prescribe with proper licensing Veterinarians prescribe buprenorphine and report to PDMP

6 Data Sources Buprenorphine: queries conducted in vendor portal Specific brand names and formulations of drugs designated as either for pain or for OUD treatment after review of FDA indication on drug labels Pain: Belbuca, Buprenex, Butrans, injectable generic buprenorphine OUD: Bunavail, Butrans, Probuphine, Suboxone, Subutex, Zubsolv, generic buprenorphine tablets and all generic buprenorphine/naloxone formulations ***DATA2000 prohibits prescribing formulations indicated for pain relief for OUD treatment, but does not restrict off-label prescribing of formulations indicated for OUD treatment to relieve pain*** Prescribers: DEA DATA-waiver information obtained from DEA Registrant File PDMP prescriber information obtained from vendor portal Crosslinked information using SAS and Excel

7 Results: Buprenorphine Dispensed in Maryland to Recipients at Maryland Addresses Buprenorphine Prescriptions by Type, Jan 1- Oct 15, 2016 OUD 97% PAIN 3% DRUG NAME/FORMULATION RX COUNT % TOTAL BELBUCA BUNAVAIL BUPRENEX BUPERENORPHINE-NALOXONE BUPRENORPHINE VIAL BUPRENORPHINE TABLETS BUPRENORPHINE POWDER BUTRANS PROBUPHINE SUBOXONE FILM SUBOXONE TABLET ZUBSOLV Total Highlighted rows = pain management formulations Source: MD PDMP, October 17, 2016

8 Results: Initial Prescriber Counts DEA FILE Number %total PDMP Number %total Pain OUD Both 150 Total Prescribers 2578 Prescribers are those who wrote at least one prescription that was dispensed in Maryland to someone with a Maryland address Total Practitioners DW/ DW/ Military DW/ Military DW/100 0 DOD Contractor DW/30 0 DOD Contractor DW/100 0 DW/ Military DW/275 0 DOD Contractor DW/275 0 Total DW *Preliminary data DO NOT CITE Source: MD PDMP+ DEA Registrant Database, October 17, 2016

9 Merge Process Initial match of PDMP Prescriber and DEA Registrant files on DEA Number Hand matching of X-codes based on name/address Noted additional potential matches based on name with unique DEA numbers these have not been reconciled in this analysis Hand matching of a few records missing a waiver type but with Maryland addresses (meant that DEA Number in PDMP was not in initial waiver status coding based on DEA registrant file) Matching of PDMP Pain and OUD Prescriber subsets to intermediate file on DEA Number and then on X-code Final hand matching to ensure each record had either pain or OUD designation

10 Results: Final Prescriber Counts *Preliminary data DO NOT CITE Merge %Merge %DEA File Number total total MD DW MD Not DW Other Total DEA Waiver No %total Original DEA Types Match Match Total Match File DW/ DW/ Military DW/ DW/ Total Source: Analysis of Merged File, October 20, 2016

11 Results: Prescriber Characteristics DW 275 2% Unable to Match 6% Prescribers by Waiver Status In State, Not DW 38% DW % Out Of State Address 26% DW 30 15% Waiver Type Pain SUD Both Total DW DW DW Out Of State Address Unable to Match In State, Not DW *Preliminary data DO NOT CITE Source: Analysis of Merged File, October 20, 2016

12 Takeaways Only ~3.5% of MD practitioners have a data waiver Bulk of buprenorphine dispensed to MD residents year to date were formulations for OUD Almost all of DW/275 practitioners prescribed, specifically for OUD; only 47.5% of DW/30 prescribed in past year, though most for OUD ~41% of non-dw prescribers wrote at least one script for a OUD formulation Majority of out of state prescribing for OUD as well

13 Data Challenges Prescription side: Created rule for pain vs. SUD on indication, not on known use (diagnosis) Missing anything dispensed in office/otp because not required to report to PDMP Reports prescription count, not individual recipients Unable to characterize dose escalation vs maintenance prescriptions Prescriber side: Out of state prescribers (per address linked to DEA number) higher than anticipated Matching multiple DEA numbers/practices to same individual: 74 possible in/out of state matches, 44 possible within state, 19 possible both out of state X-coded DEA numbers difficult to match Poor data quality in PDMP unmatchable DEA numbers, missing names

14 Other States in Data Set 34 states represented by at least one prescriber record Top 10 includes all our border states who are also our SAMHSA Region 3 partners! *Preliminary data DO NOT CITE State Prescriber Count PA 139 VA 126 DC 73 DE 44 FL 25 NJ 23 NY 21 WV 20 CA 8 NC 8 Source: Analysis of Merged File, October 20, 2016

15 SAMHSA Region 3 Proposal Primary Goal: most feasible, initial dive into data Describe the current volume of office-based physician buprenorphine prescribing and patient utilization within contiguous states, including: number of active buprenorphine prescribers, stratified by waiver status (100 patient, 30 patient or no waiver) number of patients currently being prescribed buprenorphine by physicians, stratified by physician waiver status Physician prescribing and patient utilization activity at the jurisdictional and sub-jurisdictional level, particularly in state border areas Draft Proposal, April 2016

16 SAMHSA Region 3 Proposal Secondary Goals: more complex to address due to resources or data limitations, but provides truly actionable results Determining rates of physician prescribing and patient utilization based on the physician density and general populations in geographic area Identifying the specialty status of active physician buprenorphine prescribers Estimating the gap between current service availability and actual need at the regional, state, jurisdictional or sub-jurisdictional level through analysis of data on deaths, hospitalizations, specialty treatment admissions and other potential indicators of opioid addiction prevalence.

17 Current Status Activities to date: Region III calls, including TA from Chris Jones who is working with PBSS states on similar analysis Regional partners filled out surveys regarding data access and state law/policies regarding data collection (i.e. reporting) and linkage Excitement around idea Partners recognize fluidity of patient movement within region and need for regional assessment SAMHSA interest in support; similar project being conducted by PBSS Next Steps Start with analyses intra-state, then consider linking across states? Obtain input from others who might be doing this kind of work?

18 Potential Barriers to Overcome Identified Barriers Lack of staffing and/or staff hours for analysis Access to applicable data files (PDMP, DEA/SAMHSA, etc) Technical capacity for cleaning and linking data Differences between states in how unique prescribers and patients identified in PDMP dataset (e.g. use of X-DEA numbers, patient matching or clustering) Legal restrictions around data sharing of identifiable data variables, even for public health use Others?? How do we overcome these barriers?

19 Acknowledgements Office of Overdose Prevention Michael Baier Brian Holler Kate Jackson Behavioral Health Administration Kathy Rebbert-Franklin Christy Trenton SAMHSA Region 3 Jean Bennett Contact Info: Michael Baier, Director, Overdose Prevention michael.baier@maryland.gov Phone: Casey Lyons, Overdose Prevention Epidemiologist brianna.lyons@maryland.gov Phone: TTAC Pat Knue Jim Giglio