NM DRUG OVERDOSE PREVENTION QUARTERLY MEASURES REPORT THIRD QUARTER OF 2018 (2018Q3)

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1 NM DRUG OVERDOSE PREVENTION QUARTERLY MEASURES REPORT THIRD QUARTER OF 218 () Substance Abuse Epidemiology Section Prescription Drug Overdose Prevention Program Injury and Behavioral Epidemiology Bureau Epidemiology and Response Division This report is produced quarterly to track indicators related to drug overdose prevention. The indicators reported here allow for the tracking of three key interventions for prescription drug overdose: improving prescribing of controlled substances, increasing the availability of treatment for opioid dependence, and the increasing availability of nalxone in the community. This report is based on calendar quarters: Q1 is January-March of the calendar year. Data for this report were drawn from several sources: 1. The Prescription Monitoring Program (PMP) operated by the NM Board of Pharmacy, which collects data on every controlled substance prescription filled in New Mexico. 2. New Mexico Medicaid in the Human Services Department, for data on methadone treatment paid by Medicaid, and for data on claims paid for naloxone prescriptions at pharmacies. 3. The State Opioid Treatment Authority in the Human Services Department for data on methadone treatment programs operating in New Mexico. 4. The NM Department of Health Syringe Services Program for data on naloxone distributed via syringe exchange sites 5. The Behavioral Health Services Division in the Human Services Department for data on naloxone distributed through Office of Substance Abuse Prevention programs.

2 Patients Patients I. New Mexico Prescription Monitoring Program (PMP) Measures Patients with Controlled Substance, Opioid and Benzodiazepine Prescriptions, , 247, ,763 Controlled substance patients 253,69 236,4 229,964 2, 163, ,71 172,187 Patients receiving opioids 154, ,364 1, 93,526 9,169 89,622 87,49 85,73 Patients receiving benzodiazepines 217Q3 217Q4 218Q1 218Q2 Patients with Overlapping Prescriptions, , 4,5 4, 4,67 4,447 4,87 3,752 3,684 3,5 3, 2,5 2,95 2,73 2,543 2,386 2,311 2, 1,5 1, 5 Overlapping prescriptions of opioids from different prescribers (>=1 days total overlap) Overlapping prescriptions of benzodiazepines from different prescribers (>=1 days total overlap) 217Q3 217Q4 218Q1 218Q2 Page 2

3 Patients Prescriptions filled Patients I. New Mexico Prescription Monitoring Program (PMP) Measures Patients with Concurrent Opioids and Benzodiazepines (>=1 days overlap), , 2, 22,913 21,91 21,115 19,767 18,655 1, 217Q3 217Q4 218Q1 218Q2 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, High Dose Prescriptions, ,25 41,732 4,554 39,331 37,558 37,51 35,47 34,888 33,658 32,738 Number of high dose (>=9 MME/day) opioid prescriptions excluding buprenorphine/naloxone Number of high-dose(>=4 DME/day) benzodiazepine prescriptions filled 217Q3 217Q4 218Q1 218Q2 5 Patients with Multiple Prescribers and Pharmacies, or more prescribers or 4 or more pharmacies in 3 months 25 3,42 3,45 2,873 2,627 2, Q3 217Q4 218Q1 218Q2 Page 3

4 I. New Mexico Prescription Monitoring Program (PMP) Measures Totals Year and Quarter 217Q3 218Q2 218Q2 vs % 217Q3 vs Total number of controlled substance patients 247, ,4 229, % -7.% Number of patients receiving opioids 163, , , % -9.3% Number of opioid prescriptions filled (excluding buprenorphine/naloxone) 353,26 33,51 275, % -22.% Number of buprenorphine/naloxone prescriptions filled 2,641 22,824 23,742 4.% 15.% Number of high dose (>=9 MME/day) opioid prescriptions excluding buprenorphine/naloxone Total MME of opioids filled - excluding buprenorphine/naloxone 43,25 39,331 37, % -13.2% 323,328,2 296,877,63 288,65,589-3.% -1.9% Total MME/prescription-day % 8.5% Number of patients receiving benzodiazepines 93,526 87,49 85,73-2.8% -9.% Number of benzodiazepine prescriptions filled 27,82 192,93 187, % -9.6% Number of high-dose(>=4 DME/day) benzodiazepine prescriptions filled 37,51 33,658 32, % -12.7% Total DME of benzodiazepines filled 115,5,327 13,53,87 99,752,73-3.6% -13.3% Total DME/patient 1,23 1,183 1, % -4.6% SOURCE OF DATA: NM Prescription Monitoring Program (PMP), NM Prescribers with at least 2 controlled substance patients MME = Morphine Milligram Equivalent; reference at htpp:// DME = Diazepam Milligram Equivalent; reference at 24 Page 4

5 I. New Mexico Prescription Monitoring Program (PMP) Measures Number of Patients with: Year and Quarter 217Q3 218Q2 218Q2 vs 217Q3 vs High dose opioids (>=9 MME/day) 15,491 14,65 13, % -14.9% High dose benzodiazepines (>=4 DME/day) 16,61 14,87 14, % -13.7% Opioids >=9 days and <9% of days in past 6 months 23,671 2,46 19, % -16.9% Opioids >=9% of days in past 6 months 31,124 31,31 3,73-1.% -1.3% Benzodiazepines >=9 days and <9% of days in past 6 months 26,181 23,123 22,29-3.6% -14.9% Benzodiazepines >=9% of days in past 6 months 25,319 24,984 24,473-2.% -3.3% Overlapping prescriptions of opioids from different prescribers (>=1 days total overlap) 4,67 3,752 3, % -21.1% Overlapping prescriptions of benzodiazepines from different prescribers (>=1 days total overlap) 2,95 2,386 2, % -2.4% Concurrent opioid and benzodiazepines (>=1 days overlap) High dose opioids (>=9 MME/day) plus benzodiazepines 22,913 19,767 18, % -18.6% 4,441 3,643 3, % -23.% Multiple prescribers and pharmacies: 4 or more prescribers or 4 or more pharmacies in 3 months 3,42 2,627 2, % -2.6% New Opioid Patients with at least 3 days of coverage in the past 3 months New Benzodiazepine Patients with at least 3 days of coverage in the past 3 months 3,79 3,43 3,12-8.3% -17.7% 4,842 4,421 4,37-2.6% -11.% SOURCE OF DATA: NM Prescription Monitoring Program (PMP), NM Prescribers with at least 2 controlled substance patients Page 5

6 Prescribers I. New Mexico Prescription Monitoring Program (PMP) Measures New Mexico Prescribers with at least 2 controlled substance patients: Year and Quarter 217Q3 218Q2 218Q2 vs 217Q3 vs Total active controlled substance prescribers 3,147 3,76 3,32-1.4% -3.7% Prescribers with at least 5% high dose of opioid prescriptions, excluding treatment prescribers Prescribers with at least 5% high dose of benzodiazepine prescriptions Prescribers with at least 25% of patients having concurrent opioids and benzodiazepines Some PMP Use: Requested reports on at least 25% of patients estimated to require them Zero PMP Use: Requested no PMP reports on patients filling Controlled Substances Number of Patients with PMP reports requested by practitioners % of Chronic opioid users with a PMP request in the past 3 months* % of Chronic benzodiazepine users with a PMP request in the past 3 months* % of New Opioid Patients with a PMP request in the past 3 months** % of New Benzodiazepine Patients with a PMP request in the past 3 months** % 11.3% % -6.8% % -32.% 1,18 1,164 1, % 12.4% % -21.5% 112, ,99 121,57-3.6% 8.% 61.6% 66.3% 66.1% -.3% 7.3% 38.8% 43.% 42.1% -2.2% 8.5% 17.3% 19.3% 2.5% 6.5% 18.4% 2.% 23.% 22.8% -1.2% 13.7% *Chronic users are those with at least 9 days of coverage in six months. **New patients are those with more than 4 days of coverage in the quarter and none in the prior quarter. SOURCE OF DATA: NM Prescription Monitoring Program (PMP), NM Prescribers with at least 2 controlled substance patients 2 Treatment (buprenorphine/naloxone) prescribers with at least 1 Treatment Patients, Q3 217Q4 218Q1 218Q2 Source: NM Prescription Monitoring Program Page 6

7 Patients II. Medication Assisted Treatment (Buprenorphine/naloxone and methadone) Measures Treatment (buprenorphine/naloxone) prescribers with at least 1 treatment patients Year and Quarter 217Q3 218Q2 218Q2 vs 217Q3 vs % 33.1% Buprenorphine/naloxone patients (>=1 days) Buprenorphine/naloxone prescriptions filled Total Practitioners with DATA Waiver Nurse Practitioners and PA's with DATA Waiver Medicaid Methadone Treatment Number of distinct individuals with methadone claims paid by NM Medicaid Number of distinct NM Medicaid providers of methadone 5,26 5,895 6,83 3.2% 15.6% 2,641 22,824 23,742 4.% 15.% % 18.3% % 74.2% 4,764 5,152 5, % 12.% %.% Methadone Treatment Programs by Survey Date 3/217 1/218 3/218 4/218 8/218 Number of Methadone Treatment Programs Number of Methadone Treatment Patients in those Programs 5,531 5,275 5,662 6,76 6,258 DATA Waivered provider data are as of the last month of the quarter Sources: Buprenorphine/naloxone data: NM Prescription Monitoring Program Methadone data: NM Human Services Department, State Opioid Treatment Authority; NM Medicaid DATA Waivered providers: US DEA Diversion Control Division Total Buprenorphine/Naloxone Treatment Patients, Buprenorphine/naloxone patients (>=1 days) 5,26 5,415 5,668 5,895 6,83 217Q3 217Q4 218Q1 218Q2 Source: NM Prescription Monitoring Program Page 7

8 Count III. Naloxone Distribution and Usage Measures Total number of NM Government Program Naloxone Enrollments Year and Quarter 217Q3 218Q2 % 218Q2 vs % 217Q3 vs 1,423 1,48 2, % 7.1% Total Number of NM Naloxone Doses distributed Total Number of NM Reported Reversals 5,238 8,334 8, % 54.9% % 56.4% Year and Quarter 217Q3 218Q2 % 218Q2 vs % 217Q3 vs Pharmacies Presenting Medicaid Naloxone Claims Number of Medicaid Naloxone Claims Processed Number of Police Agencies Carrying Naloxone % 15.5% 1,174 1,698 1, % 58.1% 73 #DIV/! -1.% Number Some naloxone of Pharmacies doses were Stocking given Naloxone to organizations and may n/anot have n/a been distributed n/a in that quarter. Reported Reversals are not necessarily individual level data, as one person could have overdosed and been reversed more than once. Data on reversals are combined across several agencies and programs, and the definition of a reversal may vary. An outpatient pharmacy could present claims in more than one quarter. The total number was obtained by counting each pharmacy once. There were 369 outpatient Pharmacies with a NM address in 217 according to the Board of Pharmacy. All law enforcement agencies have been contacted about naloxone training and use. The data reported reflect the number of agencies where at least some officers are carrying naloxone. Sources: NM DOH Programs; NM HSD/BHSD Programs; NM Medicaid 9, 8, 7, 6, 5, 4, 3, 2, 1, Total Naloxone Enrollees, Doses and Reversals, Total Number of NM Naloxone Doses distributed Total number of NM Government Program Naloxone Enrollments 8,334 8,115 Reported Reversals 8,3 5,238 6,334 2,42 1,423 1,361 1,781 1, Q3 217Q4 218Q1 218Q2 Page 8

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