PRESCRIPTION DRUG MONITORING PROGRAM ST. CHARLES COUNTY Q1 2018

PRESCRIPTION DRUG MONITORING PROGRAM ST. CHARLES COUNTY Q1 2018

Contents Executive Summary... 2 User Registration & System Utilization... 4 Dispensation Rates... 6 Dispensation Rates by Geography... 6 Dispensation Rates by Gender... 8 Dispensation Rates by Age... 9 Dispensation Rates by Age and Gender... 10 Dispensation Rates by Age, Gender, and Drug Type... 11 All Ages... 11 Opioid Dispensations... 12 Opioid Dispensation Rates by Geography... 12 Opioid Dispensation Rates by Age and Gender... 14 Appendix A: Data Tables... 17 Table 1. PDMP approved users and utilization (average number of patient searches per day) by month.... 17 Table 2. Schedule II-IV controlled substance dispensation rates per 1,000 population by jurisdiction.... 18 Table 3. Dispensation rates per 1,000 population for St. Charles County by age, gender, and drug type.... 19 Table 4. Dispensation rates per 1,000 population for total PDMP by age, gender, and drug type.... 19 Table 5. Opioid dispensation rates per 1,000 population by jurisdiction.... 20 Table 6. Opioid dispensation rates per 1,000 population for St. Charles County by MME category.... 21 Table 7. Opioid dispensation rates per 1,000 population for total PDMP by MME category.... 21 Table 8. Opioid dispensation counts for total PDMP by primary drug ingredient.... 22 Appendix B: Sources & Calculations... 23 Appendix C: Suggested Citation... 23 PDMP Report Q1 2018 1

Executive Summary St. Louis County enacted legislation on March 1, 2016, to establish and authorize the operation of a Prescription Drug Monitoring Program (PDMP) by Saint Louis County Department of Public Health (DPH). The St. Louis County PDMP is the first locally based PDMP in the country. DPH serves as the program administrator, and any Missouri jurisdiction may subscribe to the St. Louis County PDMP upon enacting authorizing legislation and signing a User Agreement with St. Louis County. Chapter 602 of the St. Louis County Revised Ordinances (SLCRO) is known as the St. Louis County Narcotics Control Act or more commonly known as the PDMP ordinance. The St. Louis County PDMP monitors the prescribing and dispensing of schedule II-IV controlled substances to assist in the identification and prevention of prescription drug misuse and abuse. The program s goals are to 1) improve controlled substance prescribing by providing critical information regarding a patient s controlled substance prescription history, 2) inform clinical practice by identifying patients at high-risk who would benefit from early interventions, and 3) reduce the number of people who misuse, abuse, or overdose while making sure patients have access to safe, effective treatment. The St. Louis County PDMP launched on April 25, 2017, with 14 jurisdictions participating in the initial implementation. As of May 31, 2018, 61 jurisdictions have enacted legislation to participate in the St. Louis County PDMP. Additional jurisdictions will continue to be added to the PDMP on a monthly basis. A list of all participating jurisdictions and links to enacted legislation can be found on the DPH PDMP website, www.stlouisco.com/pdmp. Additional information on the PDMP can be found at www.stlouisco.com/pdmp or by contacting DPH at PDMP.DPH@stlouisco.com or 314-615-0522. This report contains dispensation information for patients residing in St. Louis County submitted by dispensers (pharmacies) in any of the 48 jurisdictions participating in PDMP implementation cycles 1-8. Quarter 1 (Q1) 2018 (January-March) is the fourth complete quarter the PDMP was operational, and this report contains only prescriptions dispensed in Q1 2018. As this report only contains one quarter of information, the findings are not necessarily indicative of average prescribing practices in St. Louis County. Rates in this report represent projected annual rates based on one quarter of data. Pharmacy compliance is an ongoing focus of DPH, and while over 90% of pharmacies are appropriately submitting data, not all pharmacies were submitting data at the time of this report. DPH continues to work with pharmacies on data submission and increasing pharmacy compliance. Appendix A contains data tables used to create all figures. Figure 1 represents the PDMP participation status for Q1 2018; these jurisdictions were part of the first 8 PDMP implementation cycles. Prescriptions dispensed from these jurisdictions to St. Louis County residents are reflected in this report. Figure 2 represents the PDMP participation status as of May 31, 2018. 61 jurisdictions are currently participating in the PDMP and cover 79% of the Missouri population and 92% of healthcare providers. PDMP Report Q1 2018 2

Figure 1. PDMP participation map for implementation cycles 1-3 (as of 07/01/2017). Figure 2. PDMP current participation map (as of 12/31/2017). PDMP Report Q1 2018 3

User Registration & System Utilization Section 602.806 SLCRO details persons authorized to be provided dispensation information or authorized users. Authorized users are divided into three categories with varying levels of access to the PDMP and to PDMP data. 1) Authorized users with direct, full access to the PDMP. a. Healthcare providers accessing the PDMP for the purpose of providing medical or pharmaceutical care have direct, full access to the PDMP. Doctors, dentists, and pharmacists have the ability to supervise and delegate access to the PDMP but maintain all liability. Examples of delegate users include nurses, pharmacy technicians, and medical residents. 2) Authorized users with restricted or limited access to the PDMP. a. These authorized users register in the PDMP and can submit search requests, but these requests require DPH approval and verification of additional ordinance requirements before authorized users are provided with any PDMP data. Authorized users with restricted PDMP access include state regulatory boards, law enforcement or prosecutorial officials, MO HealthNet, and judges or judicial officers. 3) Authorized users with ability to request PDMP data but do not directly access the PDMP. a. Persons may request their own dispensation information in accordance with law. These requests are submitted directly to DPH and returned to the requestor. Each user must register individually in the PDMP. Registration requires users provide personal and employer information along with validation documentation. Validation documentation is required for all users and varies by user type. Healthcare providers must provide a copy of their current professional license. DPH validates registration information prior to approving access to the PDMP. User registration for the PDMP opened on April 4, 2017. As of May 31, 2018, there are over 6,990 approved users within the system. Figure 3 represents approved user counts for the total PDMP by month as well as the average number of patient searches performed per day by PDMP users. Figure 4 represents approved user counts by user role; Table 1 in Appendix A contains registration and utilization data. User registration has steadily increased since registration started in early April 2017. Approximately 50 new users are registering per day. Prescribers (physicians, dentists, optometrists, and podiatrists) represent 43% of users, and pharmacists represent approximately 42%. Delegates comprise 15% of users and include medical residents, pharmacy technicians, nurses, etc. System utilization has increased as both the number of approved users and participating jurisdictions have increased. In May 2017, PDMP users were performing an average of 690 patient searches per day. In May 2018, over 3,500 patient searches were performed by approved users each day. Increasing utilization of the PDMP will be of primary focus for DPH in 2018. PDMP Report Q1 2018 4

Figure 3. PDMP Approved User Counts by Month. Figure 4. PDMP Approved User Counts by User Type. Dentist 148 Optometrist 18 Podiatrist (DPM) 17 Delegate 1,020 Other 26 Pharmacist 2,935 Physician (MD, DO) 2,829 PDMP Report Q1 2018 5

Dispensation Rates Throughout this report, rates will be represented per 1,000 population. Significance noted in the report is statistical significance at a 95% confidence level (α=0.05). Rates in this report represent projected annual rates based on one quarter of data. Population counts were identified from the 2010 census. Appendix A contains data tables. Suppressed rates indicate too few dispensations to report; counts less than or equal to 5 were suppressed per DPH policy. Dispensation rates by geography, age, gender, and drug type will be discussed in this report with statistically significant differences highlighted. The total or overall rate means the rate of all jurisdictions participating in PDMP implementation cycles 1-8. When examining rates by gender, total rates include dispensations to those with a gender of male, female, and unknown. Rates for those with an unknown gender are not separately displayed but are included in the total rates. While 48 jurisdictions enacted legislation to participate in PDMP implementation cycles 1-8, for the purpose of this report, some jurisdictions are combined. Boone County represents both City of Columbia and Boone County; Cole County represents Jefferson City and Cole County; Greene County represents City of Springfield and Greene County (excluding City of Republic); Osage County represents both City of Linn and Osage County; and Vernon County represents City of Nevada and Vernon County. Jasper County represents the entire county, including Joplin City in Jasper County; Joplin City includes both Jasper and Newton Counties. Dispensations to Joplin City residents in Jasper County are represented in both Jasper County and Joplin City. Mississippi County enacted PDMP legislation, but the enacted legislation does not apply to incorporated areas of the County. All Mississippi County pharmacies are located in incorporated areas and therefore not covered by legislation. Dispensations from Mississippi Counties were not included in the Q1 reports. Again, pharmacy compliance is a continued focus of DPH, and not all pharmacies were appropriately reporting data at the time of this report. Dispensation Rates by Geography Dispensation rates vary by patient residence. The schedule II-IV controlled substance dispensation rate of the total system is 1,625.5 prescriptions per 1,000 population. St. Francois County residents receive the highest rates of controlled substance dispensations (2,338.3 prescriptions per 1,000 population). Howard County residents receive the lowest rates of controlled substances (753.5 prescriptions per 1,000 population). St. Louis County s dispensation rate is significantly lower than the overall system (1,562.9 prescriptions per 1,000 population). When compared to the total system (all jurisdictions combined), 18 jurisdictions have significantly higher dispensation rates. In descending order of dispensation rates, these 12 jurisdictions are: St. Francois County, Madison County, Joplin City, Scott County, Jefferson County, Butler County, Lincoln County, St. Charles County, Wayne County, Bollinger County, Pemiscot County, Stoddard County, City of Independence, Cape Girardeau County, Greene County (excluding Republic), Ste. Genevieve County, Livingston County, and Jackson County (excluding Kansas City & Independence). 22 jurisdictions have significantly lower rates (again in descending order): Jasper County, St. Louis County, Saline County, Bates County, Grundy County, Cole County, New Madrid County, Clay County (excluding Kansas City), Montgomery County, Kansas City, Audrain County, Boone County, Pettis County, Gasconade County, Vernon County, St. Louis City, Osage County, Johnson County, Miller County, Cooper County, McDonald County, and Howard County. Benton County and Perry County s dispensation rates are not significantly different than the overall system. PDMP Report Q1 2018 6

Figure 5 represents the dispensation rates per 1,000 population for each jurisdiction. Jurisdictions were categorized as either higher, lower, or not different than the overall dispensation rate based on statistical significance at α=0.05. In Figure 5, the darker the color, the higher the dispensation rate. Further figures compare St. Louis County to the entire system. Note that not all figures are on the same scale. Figure 5. Schedule II-IV controlled substance dispensation rates per 1,000 by patient residence. PDMP Report Q1 2018 7

Dispensation Rate per 1,000 population Dispensation Rates by Gender Females receive controlled substance prescriptions at significantly higher rates than males in both St. Charles County and the entire system (Figure 6). The dispensation rate for St. Charles County females is 1,935.9 prescriptions per 1,000 population compared to 1,457.1 per 1,000 population for males. Both females and males in St. Charles County receive higher rates of controlled substance prescriptions compared to the overall system. Figure 6. Controlled substance dispensation rates per 1,000 population by gender. 2,500 Schedule II-IV Controlled Substance Dispensation Rates per 1,000 population by Gender, All Ages, Q1 2018 2,000 1,500 1,000 500 0 Females - St. Charles County Females - Total Gender Males - St. Charles County Males - Total PDMP Report Q1 2018 8

Dispensation Rate per 1,000 population Dispensation Rates by Age Dispensation rates generally increase with age (Figure 7). St. Charles County and the overall system experience a significant increase in prescription rates from ages 45-54 to ages 55-64. St. Charles County residents aged 55-64 years old receive the highest rates of controlled substances at 3,533.6 prescriptions per 1,000 population. Figure 7. Controlled substance dispensation rates per 1,000 population by age. 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 Schedule II-IV Controlled Substance Dispensation Rates per 1,000 population by Age, All Genders, Q1 2018 0 <18 18-24 25-34 35-44 45-54 55-64 65+ Total Age Group St. Charles County Total PDMP Report Q1 2018 9

Dispensation Rate per 1,000 population Dispensation Rates by Age and Gender Across all schedule II-IV controlled substances, females receive higher rates of controlled substances for all ages, except for minors. Figure 8 demonstrates that dispensation rates generally increase with age. In St. Charles County, females aged 65+ receive the highest rates of controlled substances at 3,554.9 prescriptions per 1,000 population. Among St. Charles County males, those aged 55-64 received the highest rates of controlled substances at 2,575.8 prescriptions per 1,000 population. Figure 8. Controlled substance dispensation rates per 1,000 population by age and gender. 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 Schedule II-IV Controlled Substance Dispensation Rates per 1,000 population by Age and Gender, Q1 2018 0 <18 18-24 25-34 35-44 45-54 55-64 65+ Total Age Group Females - St. Charles County Females - Total Males - St. Charles County Males - Total PDMP Report Q1 2018 10

Dispensation Rate per 1,000 population Dispensation Rates by Age, Gender, and Drug Type The group Unclassified contains schedule II-IV controlled substances not classified as opioids, benzodiazepines, muscle relaxants, stimulants, or zolpidem. Steroids and hormones are two examples of unclassified controlled substances. All Ages Across all age groups, opioids are the most frequently prescribed schedule II-IV controlled substance drug type (Figure 9). Benzodiazepines are the second most frequently prescribed drug type, followed by stimulants, zolpidem, and muscle relaxants. Females receive higher rates of all drug types, except stimulants. Opioids comprise approximately 40% of all controlled substances dispensed. Figure 9. Dispensation rates per 1,000 by gender and drug type, all ages. 800 Schedule II-IV Controlled Substance Dispensation Rates per 1,000 population by Drug Type and Gender, Q1 2018 700 600 500 400 300 200 100 0 Benzodiazepine Muscle Relaxant Opioid Stimulant Unclassified Zolpidem Drug Type Females - St. Charles County Females - Total PDMP Report Q1 2018 11

Opioid Dispensations Opioid Dispensation Rates by Geography Opioid dispensation rates per 1,000 population are represented in Figure 10. Jurisdictions were categorized as either higher, lower, or not different than the overall opioid dispensation rate based on statistical significance at α=0.05. In Figure 10, the darker the color, the higher the dispensation rate. The opioid dispensation rate for the total system is 703.4 prescriptions per 1,000 population. Like all schedule II-IV controlled substances, St. Francois County residents receive the highest rates of opioid prescriptions (1,175.5 opioid prescriptions per 1,000 population). Howard County residents receive the lowest rates of opioid prescriptions (373.0 opioid prescriptions per 1,000 population). St. Louis County residents receive significantly lower rates of opioid prescriptions than the total system (622.3 opioid prescriptions per 1,000 population). When compared to the total system (all jurisdictions combined), 22 jurisdictions have significantly higher opioid dispensation rates. In descending order of dispensation rates, these 12 jurisdictions are: St. Francois County, Madison County, Joplin City, Butler County, Wayne County, Scott County, Lincoln County, Bollinger County, Jefferson County, Benton County, City of Independence, Stoddard County, Greene County (excluding Republic), Grundy County, Pemiscot County, Bates County, Livingston County, Jasper County, Cape Girardeau County, Ste. Genevieve County, Saline County, and St. Charles County. 20 jurisdictions have significantly lower rates (again in descending order): Jackson County (excluding Kansas City & Independence), Gasconade County, Vernon County, Montgomery County, Clay County (excluding Kansas City), New Madrid County, Pettis County, Perry County, St. Louis County, Kansas City, Cole County, St. Louis City, Audrain County, Johnson County, Boone County, Osage County, Miller County, McDonald County, Cooper County, and Howard County. PDMP Report Q1 2018 12

Figure 10. Opioid dispensation rates per 1,000 by patient location. PDMP Report Q1 2018 13

Dispensation Rate per 1,000 population Opioid Dispensation Rates by Age and Gender When examining opioid dispensation rates, females receive higher rates than males across all age groups, except for minors, as displayed in Figure 11. Across both genders, St. Charles County residents aged 65+ years old receive the highest rates of opioids compared to all other age groups (1,848.6 prescriptions per 1,000 population). St. Charles County females aged 65+ receive the highest rates of opioids compared to all other age and gender groups (1,894.7 prescriptions per 1,000 population). Among St. Charles County males, those aged 65+ receive the highest rates of opioids at 1,410.7 prescriptions per 1,000 population. For St. Charles County residents, opioid dispensation rates generally increase as patient age increases with drastic jumps in dispensation rates from minors to 18-24 year olds and from 18-24 year olds to 25-34 year olds, increases of 334% and 99%, respectively. Figure 11. Opioid dispensation rates per 1,000 by age and gender. Age-Adjusted Opioid Dispensation Rates per 1,000 population by Age and Gender, Q1 2018 2,000 1,500 1,000 500 0 <18 18-24 25-34 35-44 45-54 55-64 65+ Total Age Group Females - St. Charles County Males - St. Charles County Total - St. Charles County (including unknown gender) Females - Total Males - Total Total - Total (including unknown gender) PDMP Report Q1 2018 14

Dispensation Rate per 1,000 population Morphine Milligram Equivalents (MME) Opioid dispensations were categorized into one of three morphine milligram equivalent (MME) groupings using CDC s prescribing guidelines. Per CDC s guidelines, prescribers are to prescribe the lowest dosage possible, use caution when writing prescriptions for 50-90 MME, and use extreme caution when exceeding 90 MME. From these guidelines, opioid dispensations were categorized into <50 MME (low dose), 50-90 MME (medium dose), and >90 MME (high dose). Of note, this data represents individual opioid prescriptions, not a cumulative patient total. It is possible for patients to receive multiple opioid prescriptions that combine to a daily MME greater than 90. As displayed in Figure 12, the low dose opioids (MME<50) are the most commonly prescribed MME dosage category. In St. Charles County, low dose opioids (<50 MME) have the highest dispensation rates (451.2 prescriptions per 1,000 population) compared to all other dosage categories. Dispensation rates decrease as dosage increases. Opioid dispensations 50-90 MME have higher dispensation rates than opioid dispensations >90 MME for St. Charles County residents, 109.7 and 67.0 prescriptions per 1,000 population, respectively. As shown in Figure 13, buprenorphine and methadone are in the top ten opioids dispensed. These drugs are typically used in medication assisted treatment (MAT) and have high MME conversions. Overall, low dose opioid prescriptions (<50 MME) comprise approximately 62% of all opioid dispensations. Figure 12. Opioid dispensations by MME category. Opioid Dispensation Rates per 1,000 population by Morphine Milligram Equivalent (MME) Category and Gender, All Ages, Q1 2018 800 700 600 500 400 300 200 100 0 <50 50-90 >90 Morphine Milligram Equivalent (MME) Category Females - St. Charles County Males - St. Charles County Total - St. Charles County (including unknown gender) Females - Total Males - Total Total - Total (including unknown gender) PDMP Report Q1 2018 15

Percent of Opioid Dispensations (%) Primary Drug Ingredient Figure 13 displays the top ten opioids dispensed by primary drug ingredient for the overall system. In descending order, hydrocodone, oxycodone, and tramadol are the three most frequently prescribed opioids. These three drugs comprise 82% of all opioids dispensed. Buprenorphine and methadone are in the top 10 dispensed opioids; these opioids are typically used in medication assisted treatment (MAT) for opioid use disorder. Figure 13. Percent of opioid dispensations by top 10 primary drug ingredients. 45% Opioid Dispensations by Primary Drug Ingredient, All Ages and Genders, Q1 2018 40% 35% 30% 25% 20% 15% 10% 5% 0% Primary Drug Ingredient PDMP Report Q1 2018 16

Appendix A: Data Tables Table 1. PDMP approved users and utilization (average number of patient searches per day) by month. Month April 2017 # of Approved Users Average # of Patient Searches per Day 427 1,003 May 2017 2,731 684 June 2017 3,193 1,013 July 2017 3,613 1,088 August 2017 3,967 1,301 September 2017 4,317 1,222 October 2017 4,691 1,245 November 2017 5,065 1,399 December 2017 5,580 1,425 January 2018 5,945 1,610 February 2018 6,239 1,957 March 2018 6,576 2,548 April 2018 6,855 3,305 May 2018 6,993 3,586 PDMP Report Q3 2017 17

Table 2. Schedule II-IV controlled substance dispensation rates per 1,000 population by jurisdiction. Schedule II-IV <18 18-24 25-34 35-44 45-54 55-64 65+ Total Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Audrain County 540.1 (504.0, 576.2) 597.0 (530.6, 663.5) 992.3 (923.8, 1060.8) 1400.9 (1317.8, 1484.0) 1571.5 (1489.4, 1653.5) 2669.3 (2553.1, 2785.5) 2114.6 (2025.4, 2203.8) 1357.8 (1329.2, 1386.4) Bates County 259.5 (228.9, 290.1) 598.4 (511.9, 684.8) 1121.0 (1024.8, 1217.3) 1860.0 (1739.1, 1980.8) 1680.8 (1581.4, 1780.2) 2962.7 (2816.0, 3109.3) 2611.5 (2496.2, 2726.8) 1531.6 (1494.4, 1568.7) Benton County 291.0 (254.9, 327.0) 512.1 (426.6, 597.5) 1077.4 (967.4, 1187.3) 1815.1 (1693.4, 1936.8) 1984.1 (1881.4, 2086.8) 2583.5 (2476.4, 2690.6) 2112.6 (2031.5, 2193.7) 1655.8 (1619.2, 1692.3) Bollinger County 486.8 (436.2, 537.4) 581.0 (484.4, 677.6) 1321.8 (1195.6, 1448.1) 1767.8 (1633.9, 1901.7) 2540.2 (2398.8, 2681.7) 3791.6 (3605.9, 3977.3) 3137.4 (2984.4, 3290.5) 1954.2 (1904.9, 2003.5) Boone County 455.9 (441.6, 470.2) 399.2 (385.8, 412.6) 1186.5 (1159.3, 1213.6) 1711.9 (1674.3, 1749.5) 1915.7 (1877.1, 1954.2) 2815.4 (2763.6, 2867.2) 3096.9 (3040.7, 3153.1) 1355.2 (1343.9, 1366.5) Butler County 464.9 (438.2, 491.7) 592.1 (541.4, 642.8) 1732.6 (1659.8, 1805.5) 2634.6 (2546.0, 2723.2) 2803.4 (2720.3, 2886.5) 3892.3 (3789.0, 3995.5) 3153.2 (3071.5, 3234.9) 2131.9 (2104.2, 2159.6) Cape Girardeau County 449.4 (429.0, 469.8) 453.4 (427.7, 479.0) 1317.2 (1271.0, 1363.4) 2127.7 (2066.9, 2188.6) 2285.2 (2227.1, 2343.3) 3460.2 (3383.1, 3537.2) 3568.8 (3497.6, 3639.9) 1809.8 (1790.6, 1828.9) Clay County (exc. KC) 403.1 (388.2, 418.0) 779.1 (742.2, 816.0) 987.9 (956.6, 1019.1) 1612.0 (1572.1, 1651.8) 1994.8 (1951.0, 2038.5) 2853.1 (2793.4, 2912.7) 2831.5 (2771.8, 2891.2) 1477.4 (1462.9, 1491.9) Cole County 603.4 (580.7, 626.2) 599.5 (563.0, 635.9) 1021.5 (982.8, 1060.2) 1457.0 (1410.3, 1503.8) 1788.6 (1739.7, 1837.4) 2564.6 (2500.5, 2628.8) 3061.4 (2990.4, 3132.5) 1503.8 (1486.3, 1521.2) Cooper County 258.4 (226.8, 289.9) 311.1 (258.1, 364.2) 578.3 (517.6, 639.1) 1219.2 (1124.0, 1314.4) 1068.7 (989.3, 1148.1) 1628.7 (1520.7, 1736.8) 1160.6 (1079.4, 1241.9) 845.4 (818.2, 872.6) Gasconade County 442.3 (397.4, 487.3) 307.7 (240.3, 375.1) 995.9 (894.2, 1097.7) 1468.2 (1354.0, 1582.4) 1311.1 (1220.5, 1401.6) 2369.0 (2237.1, 2500.9) 2040.5 (1939.3, 2141.7) 1329.9 (1293.3, 1366.6) Greene County (exc. Republic) 475.0 (463.4, 486.7) 415.9 (402.6, 429.1) 1292.8 (1269.5, 1316.1) 2086.8 (2054.4, 2119.2) 2362.6 (2330.4, 2394.7) 3412.9 (3371.5, 3454.3) 2903.4 (2868.6, 2938.1) 1715.7 (1705.6, 1725.7) Grundy County 325.9 (280.8, 371.0) 164.0 (112.6, 215.5) 1015.7 (891.8, 1139.7) 1621.0 (1468.2, 1773.9) 1891.2 (1747.9, 2034.5) 3020.9 (2827.9, 3213.9) 2628.6 (2489.9, 2767.3) 1528.1 (1480.3, 1576.0) Howard County 264.5 (221.3, 307.7) 146.6 (106.0, 187.3) 627.2 (533.4, 720.9) 900.5 (787.0, 1013.9) 790.6 (701.6, 879.6) 1462.7 (1330.6, 1594.8) 1315.1 (1203.0, 1427.2) 753.5 (719.8, 787.3) City of Independence 536.0 (518.4, 553.5) 661.8 (630.2, 693.4) 1387.0 (1349.8, 1424.1) 2241.4 (2191.1, 2291.6) 2239.3 (2195.1, 2283.6) 3596.7 (3534.8, 3658.7) 2648.8 (2602.3, 2695.4) 1831.7 (1816.1, 1847.2) Jackson County (exc. Indep & KC) 537.5 (526.1, 548.8) 706.1 (685.1, 727.1) 1111.6 (1090.5, 1132.6) 2117.6 (2086.8, 2148.5) 2237.0 (2206.5, 2267.5) 3120.0 (3078.9, 3161.1) 3123.9 (3082.1, 3165.6) 1665.8 (1655.7, 1675.8) Jasper County 471.2 (455.8, 486.7) 466.0 (441.7, 490.2) 1083.6 (1051.4, 1115.7) 1853.6 (1809.2, 1898.0) 2200.4 (2154.1, 2246.8) 3448.5 (3384.4, 3512.6) 2792.2 (2739.9, 2844.4) 1594.4 (1580.0, 1608.9) Jefferson County 766.9 (752.3, 781.6) 919.0 (891.1, 946.9) 1674.0 (1643.9, 1704.1) 2458.4 (2423.0, 2493.8) 2640.7 (2607.1, 2674.2) 4372.5 (4322.2, 4422.7) 3746.2 (3697.6, 3794.7) 2209.9 (2197.4, 2222.3) Johnson County 322.8 (302.5, 343.1) 271.4 (251.1, 291.8) 870.6 (826.5, 914.7) 1513.8 (1452.2, 1575.3) 1625.6 (1564.6, 1686.5) 2744.9 (2653.9, 2835.9) 2296.2 (2217.2, 2375.3) 1136.7 (1118.5, 1154.9) Joplin City 699.0 (668.2, 729.8) 539.8 (503.9, 575.6) 1497.2 (1440.9, 1553.4) 2578.7 (2496.5, 2660.9) 3151.9 (3064.7, 3239.0) 5270.6 (5148.6, 5392.6) 3733.5 (3645.6, 3821.5) 2271.1 (2244.7, 2297.5) Kansas City 416.3 (408.7, 423.8) 572.3 (558.5, 586.1) 1108.4 (1093.4, 1123.5) 1688.6 (1667.9, 1709.2) 1822.6 (1801.8, 1843.4) 2830.5 (2801.2, 2859.8) 2496.2 (2468.7, 2523.7) 1408.5 (1401.6, 1415.4) Lincoln County 657.6 (631.4, 683.8) 941.8 (883.7, 1000.0) 1615.6 (1555.7, 1675.5) 2376.5 (2304.1, 2448.9) 2641.8 (2571.9, 2711.7) 4373.2 (4264.1, 4482.2) 3596.9 (3498.5, 3695.2) 2067.1 (2042.5, 2091.7) Livingston County 364.1 (323.1, 405.1) 466.4 (388.3, 544.5) 1111.9 (1017.6, 1206.2) 1587.6 (1475.1, 1700.0) 1999.1 (1879.3, 2118.8) 3116.4 (2959.0, 3273.8) 2963.1 (2834.8, 3091.4) 1675.6 (1634.4, 1716.7) Madison County 645.5 (587.3, 703.7) 494.4 (418.9, 569.8) 2139.2 (1962.2, 2316.2) 2515.8 (2349.3, 2682.2) 3182.6 (3019.3, 3345.8) 4341.0 (4131.1, 4551.0) 3298.6 (3145.6, 3451.5) 2279.1 (2225.6, 2332.6) McDonald County 171.7 (151.5, 191.9) 173.0 (136.0, 210.0) 434.6 (385.2, 483.9) 786.8 (723.5, 850.0) 1186.3 (1113.0, 1259.6) 1661.6 (1562.9, 1760.2) 1508.8 (1419.2, 1598.4) 769.2 (746.6, 791.9) Miller County 188.8 (167.1, 210.5) 361.2 (307.2, 415.1) 557.3 (501.9, 612.7) 860.1 (794.4, 925.9) 1239.0 (1167.7, 1310.3) 1758.5 (1666.7, 1850.3) 1599.2 (1519.8, 1678.6) 910.9 (887.2, 934.7) Montgomery County 436.0 (387.6, 484.5) 450.7 (360.5, 540.9) 905.0 (801.4, 1008.6) 1409.9 (1284.4, 1535.4) 1611.5 (1498.8, 1724.1) 2908.2 (2742.3, 3074.1) 2029.7 (1912.9, 2146.6) 1409.3 (1367.2, 1451.4) New Madrid County 343.8 (309.6, 378.0) 396.6 (333.3, 459.8) 1147.6 (1057.4, 1237.8) 1723.1 (1616.8, 1829.3) 1958.5 (1855.5, 2061.4) 2578.2 (2452.8, 2703.7) 2505.1 (2392.7, 2617.5) 1496.7 (1461.9, 1531.6) Osage County 518.5 (470.3, 566.7) 373.7 (307.2, 440.3) 773.5 (684.8, 862.2) 858.1 (772.6, 943.6) 1366.7 (1267.1, 1466.4) 2198.4 (2055.0, 2341.8) 2228.2 (2099.8, 2356.6) 1161.0 (1125.1, 1196.8) Pemiscot County 332.1 (300.3, 364.0) 578.9 (504.6, 653.2) 1473.2 (1369.1, 1577.3) 2238.8 (2112.1, 2365.5) 2759.7 (2630.8, 2888.6) 4110.3 (3939.9, 4280.7) 3010.8 (2879.7, 3141.8) 1889.6 (1849.8, 1929.4) Perry County 833.3 (781.4, 885.1) 767.4 (675.5, 859.2) 1210.2 (1119.8, 1300.6) 1704.3 (1601.0, 1807.6) 1904.1 (1801.5, 2006.8) 2805.8 (2670.3, 2941.3) 2505.4 (2391.4, 2619.5) 1648.0 (1611.5, 1684.5) Pettis County 372.8 (349.7, 395.8) 502.9 (458.8, 547.0) 1057.9 (1002.7, 1113.1) 1485.3 (1417.4, 1553.2) 1680.8 (1615.9, 1745.7) 2716.2 (2623.1, 2809.2) 2323.4 (2247.5, 2399.3) 1346.5 (1324.4, 1368.7) Saline County 576.7 (536.2, 617.2) 411.9 (363.7, 460.2) 1160.6 (1079.9, 1241.3) 1913.0 (1806.6, 2019.4) 1758.2 (1667.8, 1848.5) 3104.1 (2976.1, 3232.1) 2446.1 (2345.3, 2546.9) 1552.4 (1520.5, 1584.4) Scott County 579.9 (549.8, 610.0) 822.7 (760.3, 885.0) 1677.6 (1603.4, 1751.8) 2530.5 (2441.3, 2619.7) 3006.0 (2916.0, 3095.9) 4230.1 (4115.3, 4344.8) 3553.8 (3457.4, 3650.3) 2233.6 (2204.0, 2263.2) St. Charles County 825.6 (813.9, 837.3) 1094.6 (1071.3, 1117.8) 1705.5 (1682.0, 1729.0) 2247.3 (2221.1, 2273.4) 2193.7 (2169.4, 2218.0) 3533.6 (3497.2, 3570.1) 3434.3 (3398.2, 3470.5) 1980.7 (1971.6, 1989.9) St. Francois County 680.2 (653.2, 707.1) 547.0 (510.0, 584.0) 1396.3 (1348.4, 1444.2) 2716.3 (2646.8, 2785.8) 3160.3 (3090.5, 3230.2) 5336.0 (5231.4, 5440.6) 3385.9 (3311.4, 3460.5) 2338.3 (2314.9, 2361.8) Ste. Genevieve County 628.3 (580.5, 676.1) 728.9 (637.8, 820.0) 1276.0 (1174.5, 1377.4) 1869.4 (1754.0, 1984.7) 1822.8 (1727.6, 1917.9) 3331.2 (3188.3, 3474.1) 2197.2 (2089.5, 2304.9) 1680.0 (1642.3, 1717.7) St. Louis City 395.5 (386.0, 405.0) 349.0 (337.3, 360.7) 1052.1 (1035.4, 1068.9) 1495.3 (1471.4, 1519.2) 1574.3 (1551.1, 1597.6) 2644.7 (2610.4, 2678.9) 2211.2 (2180.1, 2242.3) 1256.5 (1248.7, 1264.2) St. Louis County 590.3 (584.1, 596.5) 890.4 (877.8, 902.9) 1339.0 (1326.0, 1352.0) 1596.7 (1582.6, 1610.8) 1645.9 (1633.1, 1658.6) 2581.9 (2564.3, 2599.5) 2667.1 (2650.6, 2683.7) 1562.9 (1558.0, 1567.8) Stoddard County 561.6 (526.0, 597.1) 645.3 (581.9, 708.7) 1381.6 (1302.9, 1460.4) 2246.5 (2149.4, 2343.5) 2712.6 (2615.1, 2810.2) 3238.0 (3124.4, 3351.6) 2324.7 (2243.0, 2406.5) 1841.4 (1810.7, 1872.2) Vernon County 397.5 (363.4, 431.6) 415.1 (356.4, 473.9) 923.7 (845.5, 1001.9) 1442.1 (1346.3, 1537.8) 1977.0 (1877.0, 2076.9) 2297.8 (2185.4, 2410.2) 1748.0 (1660.1, 1835.9) 1275.7 (1245.2, 1306.1) Wayne County 397.7 (351.0, 444.4) 505.0 (416.8, 593.2) 1530.5 (1392.2, 1668.7) 1817.9 (1684.1, 1951.8) 2822.8 (2677.3, 2968.3) 3695.3 (3526.0, 3864.5) 2485.7 (2370.8, 2600.5) 1970.6 (1923.2, 2017.9) Total 543.6 (540.8, 546.5) 637.2 (632.4, 642.0) 1261.5 (1255.7, 1267.3) 1852.2 (1844.9, 1859.5) 1990.6 (1983.6, 1997.6) 3070.4 (3060.6, 3080.1) 2789.8 (2781.1, 2798.6) 1625.5 (1623.1, 1628.0) PDMP Report Q1 2018 18

Table 3. Dispensation rates per 1,000 population for St. Charles County by age, gender, and drug type. St. Charles County <18 18-24 25-34 35-44 45-54 55-64 65+ Total Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Benzodiazepine 33.8 (31.4, 36.2) 145.7 (137.2, 154.2) 360.4 (349.6, 371.2) 553.4 (540.5, 566.4) 585.8 (573.3, 598.4) 1000.3 (980.9, 1019.7) 1090.6 (1070.2, 1111.0) 475.0 (470.5, 479.5) Female 32.0 (28.7, 35.2) 150.1 (137.7, 162.4) 378.9 (363.3, 394.5) 610.2 (591.1, 629.3) 688.2 (669.1, 707.3) 1066.1 (1038.3, 1093.8) 1215.9 (1187.3, 1244.5) 539.2 (532.5, 545.9) Male 26.1 (23.2, 29.0) 109.1 (98.8, 119.3) 239.5 (227.0, 252.1) 332.3 (318.0, 346.6) 309.8 (296.8, 322.8) 614.1 (592.1, 636.1) 691.9 (667.3, 716.5) 281.3 (276.4, 286.2) Muscle Relaxant * * 1.0 (0.3, 1.7) 5.2 (3.9, 6.5) 16.2 (14.0, 18.4) 18.2 (16.0, 20.4) 32.4 (28.9, 35.9) 18.3 (15.7, 21.0) 11.7 (11.0, 12.4) Female * * * * 5.0 (3.2, 6.8) 16.8 (13.6, 20.0) 22.3 (18.9, 25.7) 39.0 (33.7, 44.3) 19.1 (15.5, 22.7) 13.5 (12.5, 14.6) Male * * * * 4.1 (2.5, 5.7) 9.0 (6.6, 11.3) 10.1 (7.7, 12.4) 19.4 (15.5, 23.3) 11.4 (8.2, 14.5) 6.8 (6.0, 7.5) Opioid 59.2 (56.1, 62.4) 256.8 (245.5, 268.1) 510.4 (497.5, 523.2) 759.0 (743.9, 774.2) 836.0 (821.1, 851.0) 1596.2 (1571.7, 1620.7) 1848.6 (1822.1, 1875.2) 732.0 (726.4, 737.5) Female 53.8 (49.6, 58.1) 255.3 (239.2, 271.5) 534.3 (515.9, 552.8) 735.3 (714.3, 756.3) 801.4 (780.8, 822.0) 1435.8 (1403.7, 1468.0) 1894.7 (1859.0, 1930.5) 736.3 (728.5, 744.2) Male 50.2 (46.2, 54.3) 184.4 (171.1, 197.7) 363.1 (347.6, 378.5) 555.4 (536.9, 573.9) 607.4 (589.2, 625.6) 1301.0 (1269.0, 1333.0) 1410.7 (1375.6, 1445.8) 537.0 (530.2, 543.8) Stimulant 686.7 (676.1, 697.4) 631.9 (614.3, 649.6) 654.3 (639.7, 668.8) 544.6 (531.7, 557.5) 329.8 (320.4, 339.3) 263.8 (253.8, 273.7) 68.9 (63.8, 74.1) 484.0 (479.4, 488.5) Female 323.3 (312.8, 333.7) 499.0 (476.5, 521.6) 605.3 (585.6, 625.0) 516.8 (499.2, 534.4) 353.1 (339.4, 366.8) 271.7 (257.7, 285.7) 58.4 (52.2, 64.7) 367.5 (362.0, 373.1) Male 776.1 (760.2, 792.0) 528.7 (506.1, 551.2) 500.2 (482.1, 518.3) 397.9 (382.3, 413.6) 200.8 (190.3, 211.2) 162.2 (150.9, 173.5) 58.7 (51.5, 65.9) 433.3 (427.1, 439.4) Unclassified 45.5 (42.8, 48.3) 44.8 (40.1, 49.5) 124.2 (117.9, 130.6) 243.9 (235.3, 252.5) 258.8 (250.5, 267.1) 332.3 (321.2, 343.5) 164.4 (156.5, 172.4) 163.4 (160.8, 166.0) Female 35.2 (31.8, 38.7) 57.0 (49.4, 64.6) 152.1 (142.3, 162.0) 259.9 (247.4, 272.3) 245.4 (234.0, 256.8) 315.4 (300.3, 330.5) 129.7 (120.3, 139.0) 161.3 (157.7, 165.0) Male 39.5 (35.9, 43.1) 25.3 (20.3, 30.2) 64.4 (57.9, 70.9) 168.3 (158.1, 178.4) 201.3 (190.9, 211.8) 262.5 (248.1, 276.8) 176.3 (163.9, 188.8) 123.6 (120.4, 126.9) Zolpidem 0.3 (0.1, 0.6) 14.3 (11.6, 16.9) 51.0 (46.9, 55.0) 130.1 (123.8, 136.4) 165.0 (158.4, 171.7) 308.7 (297.9, 319.4) 243.4 (233.8, 253.0) 114.8 (112.5, 117.0) Female 0.6 (0.2, 1.1) 12.2 (8.7, 15.7) 56.8 (50.8, 62.8) 136.5 (127.4, 145.5) 167.4 (158.0, 176.8) 295.2 (280.6, 309.7) 237.0 (224.4, 249.7) 118.0 (114.8, 121.1) Male * * 11.8 (8.4, 15.1) 32.5 (27.9, 37.2) 78.0 (71.0, 84.9) 102.7 (95.2, 110.1) 216.6 (203.6, 229.7) 186.8 (174.0, 199.6) 75.2 (72.6, 77.7) Total 825.6 (813.9, 837.3) 1094.6 (1071.3, 1117.8) 1705.5 (1682.0, 1729.0) 2247.3 (2221.1, 2273.4) 2193.7 (2169.4, 2218.0) 3533.6 (3497.2, 3570.1) 3434.3 (3398.2, 3470.5) 1980.7 (1971.6, 1989.9) Female 444.9 (432.6, 457.1) 974.7 (943.2, 1006.2) 1732.5 (1699.2, 1765.8) 2275.4 (2238.6, 2312.3) 2277.8 (2243.1, 2312.5) 3423.2 (3373.5, 3472.8) 3554.9 (3505.9, 3603.8) 1935.9 (1923.1, 1948.6) Male 892.0 (874.9, 909.0) 859.9 (831.2, 888.7) 1203.9 (1175.8, 1231.9) 1540.9 (1510.1, 1571.7) 1432.1 (1404.1, 1460.0) 2575.8 (2530.9, 2620.8) 2535.8 (2488.8, 2582.9) 1457.1 (1445.9, 1468.3) * indicates the rate has been suppressed. Table 4. Dispensation rates per 1,000 population for total PDMP by age, gender, and drug type. Total <18 18-24 25-34 35-44 45-54 55-64 65+ Total Rate 95% CI 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Benzodiazepine 23.8 (23.2, 24.5) 98.3 (96.4, 100.2) 291.7 (288.9, 294.4) 498.0 (494.2, 501.8) 553.3 (549.6, 557.0) 871.8 (866.6, 877.0) 876.3 (871.3, 881.2) 418.9 (417.7, 420.1) Female 20.7 (19.9, 21.5) 94.2 (91.7, 96.8) 298.8 (294.9, 302.8) 526.8 (521.3, 532.3) 602.2 (596.8, 607.6) 915.4 (908.1, 922.7) 940.8 (934.1, 947.5) 458.0 (456.2, 459.8) Male 19.5 (18.7, 20.3) 69.2 (66.9, 71.4) 187.5 (184.4, 190.7) 297.6 (293.4, 301.7) 332.0 (327.9, 336.1) 559.9 (553.9, 565.9) 568.1 (561.9, 574.2) 255.7 (254.3, 257.1) Muscle Relaxant 0.0 (0.0, 0.0) 0.6 (0.4, 0.7) 4.8 (4.5, 5.2) 15.1 (14.5, 15.8) 21.6 (20.9, 22.4) 34.5 (33.4, 35.5) 14.8 (14.1, 15.4) 11.9 (11.7, 12.1) Female 0.0 (0.0, 0.0) 0.7 (0.4, 0.9) 5.5 (4.9, 6.0) 16.4 (15.4, 17.3) 24.6 (23.5, 25.7) 39.1 (37.6, 40.6) 15.1 (14.3, 16.0) 13.4 (13.1, 13.7) Male 0.0 (0.0, 0.0) 0.2 (0.1, 0.4) 2.9 (2.5, 3.3) 8.8 (8.1, 9.5) 12.1 (11.3, 12.9) 19.9 (18.7, 21.0) 10.3 (9.5, 11.2) 6.8 (6.6, 7.1) Opioid 46.7 (45.9, 47.6) 201.7 (199.0, 204.3) 474.4 (470.8, 477.9) 737.7 (733.1, 742.3) 880.6 (875.9, 885.2) 1530.4 (1523.6, 1537.3) 1536.5 (1529.9, 1543.0) 703.4 (701.8, 705.0) Female 41.6 (40.5, 42.8) 206.6 (202.8, 210.5) 494.3 (489.2, 499.4) 733.4 (726.9, 739.8) 855.6 (849.1, 862.0) 1415.8 (1406.7, 1424.9) 1513.4 (1504.9, 1521.9) 708.3 (706.0, 710.5) Male 39.3 (38.2, 40.4) 132.9 (129.8, 136.0) 326.9 (322.7, 331.0) 525.1 (519.6, 530.6) 657.4 (651.7, 663.2) 1236.0 (1227.1, 1244.9) 1189.1 (1180.2, 1197.9) 513.7 (511.7, 515.7) Stimulant 451.0 (448.4, 453.7) 296.2 (292.9, 299.4) 363.0 (359.9, 366.1) 314.8 (311.8, 317.8) 187.4 (185.3, 189.6) 151.6 (149.5, 153.8) 51.6 (50.5, 52.8) 279.0 (278.0, 280.0) Female 218.8 (216.1, 221.4) 215.5 (211.6, 219.4) 307.0 (303.0, 311.0) 286.2 (282.1, 290.2) 189.2 (186.2, 192.3) 156.2 (153.2, 159.2) 46.4 (44.9, 47.9) 201.5 (200.3, 202.7) Male 524.4 (520.4, 528.4) 263.2 (258.8, 267.6) 280.0 (276.2, 283.9) 218.9 (215.3, 222.4) 113.0 (110.6, 115.4) 91.4 (88.9, 93.8) 41.3 (39.6, 42.9) 257.2 (255.8, 258.6) Unclassified 21.7 (21.1, 22.2) 31.3 (30.3, 32.4) 86.7 (85.2, 88.2) 181.4 (179.1, 183.7) 201.1 (198.9, 203.3) 234.9 (232.2, 237.6) 118.1 (116.3, 120.0) 116.2 (115.6, 116.9) Female 16.1 (15.4, 16.8) 39.2 (37.5, 40.8) 105.3 (103.0, 107.6) 189.4 (186.1, 192.7) 192.7 (189.6, 195.7) 208.2 (204.7, 211.7) 95.7 (93.6, 97.8) 112.9 (112.0, 113.8) Male 18.5 (17.8, 19.3) 15.2 (14.1, 16.2) 43.4 (41.9, 44.9) 119.3 (116.7, 121.9) 150.7 (147.9, 153.4) 194.3 (190.8, 197.9) 119.7 (116.9, 122.5) 86.2 (85.4, 87.0) Zolpidem 0.4 (0.3, 0.5) 9.2 (8.6, 9.7) 41.0 (39.9, 42.0) 105.1 (103.4, 106.8) 146.6 (144.7, 148.5) 247.1 (244.3, 249.8) 192.5 (190.2, 194.8) 96.2 (95.6, 96.7) Female 0.3 (0.2, 0.4) 8.8 (8.0, 9.5) 42.6 (41.1, 44.1) 113.2 (110.7, 115.7) 151.3 (148.6, 154.0) 245.6 (241.8, 249.4) 184.0 (181.0, 186.9) 99.8 (99.0, 100.6) Male 0.3 (0.2, 0.4) 6.3 (5.7, 7.0) 25.4 (24.2, 26.6) 59.7 (57.8, 61.5) 89.2 (87.1, 91.4) 165.0 (161.7, 168.2) 144.6 (141.5, 147.6) 60.9 (60.2, 61.5) Total 543.6 (540.8, 546.5) 637.2 (632.4, 642.0) 1261.5 (1255.7, 1267.3) 1852.2 (1844.9, 1859.5) 1990.6 (1983.6, 1997.6) 3070.4 (3060.6, 3080.1) 2789.8 (2781.1, 2798.6) 1625.5 (1623.1, 1628.0) Female 297.5 (294.5, 300.6) 565.0 (558.6, 571.3) 1253.5 (1245.4, 1261.6) 1865.3 (1855.0, 1875.6) 2015.6 (2005.7, 2025.5) 2980.3 (2967.1, 2993.5) 2795.4 (2783.9, 2807.0) 1593.8 (1590.4, 1597.2) Male 602.0 (597.8, 606.3) 487.0 (481.1, 493.0) 866.1 (859.3, 873.0) 1229.3 (1220.8, 1237.8) 1354.3 (1346.1, 1362.6) 2266.4 (2254.3, 2278.5) 2072.9 (2061.3, 2084.6) 1180.5 (1177.6, 1183.5) PDMP Report Q1 2018 19

Table 5. Opioid dispensation rates per 1,000 population by jurisdiction. PDMP Report Q1 2018 20

Table 6. Opioid dispensation rates per 1,000 population for St. Charles County by MME category. St. Charles County <18 18-24 25-34 35-44 45-54 55-64 65+ Total Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI <50 40.4 (37.8, 43.0) 143.3 (134.9, 151.7) 293.7 (284.0, 303.5) 440.0 (428.5, 451.6) 496.7 (485.1, 508.2) 937.1 (918.3, 955.8) 1275.9 (1253.9, 1298.0) 451.2 (446.8, 455.6) Female 36.8 (33.3, 40.3) 149.5 (137.2, 161.9) 324.6 (310.2, 339.0) 445.8 (429.5, 462.2) 497.3 (481.1, 513.5) 884.0 (858.7, 909.2) 1355.7 (1325.5, 1386.0) 476.2 (469.9, 482.5) Male 35.7 (32.3, 39.1) 96.8 (87.2, 106.5) 190.3 (179.1, 201.5) 306.7 (292.9, 320.4) 360.2 (346.2, 374.2) 731.7 (707.7, 755.7) 946.5 (917.8, 975.3) 318.9 (313.6, 324.2) 50-90 7.9 (6.8, 9.1) 46.6 (41.8, 51.4) 70.0 (65.2, 74.8) 112.9 (107.0, 118.7) 128.1 (122.3, 134.0) 272.0 (261.9, 282.1) 244.9 (235.2, 254.5) 109.7 (107.6, 111.9) Female 8.0 (6.3, 9.6) 42.7 (36.1, 49.3) 76.6 (69.6, 83.6) 107.1 (99.1, 115.1) 116.8 (108.9, 124.6) 244.2 (230.9, 257.4) 241.1 (228.3, 253.8) 107.3 (104.3, 110.3) Male 6.0 (4.6, 7.4) 40.0 (33.8, 46.2) 49.9 (44.2, 55.6) 85.3 (78.1, 92.6) 100.4 (93.0, 107.8) 238.7 (225.0, 252.4) 205.7 (192.3, 219.1) 86.6 (83.9, 89.4) >90 0.3 (0.1, 0.6) 24.3 (20.9, 27.8) 82.4 (77.2, 87.5) 100.2 (94.7, 105.7) 79.8 (75.2, 84.4) 152.9 (145.3, 160.5) 87.9 (82.1, 93.7) 67.0 (65.3, 68.6) Female * * 19.4 (14.9, 23.8) 62.0 (55.7, 68.3) 82.2 (75.2, 89.2) 69.9 (63.8, 76.0) 122.1 (112.7, 131.5) 86.0 (78.4, 93.6) 57.2 (55.0, 59.4) Male * * 25.5 (20.6, 30.5) 91.0 (83.3, 98.7) 97.7 (89.9, 105.4) 65.5 (59.5, 71.4) 153.4 (142.4, 164.4) 69.9 (62.0, 77.7) 62.5 (60.2, 64.9) Total 59.2 (56.1, 62.4) 256.8 (245.5, 268.1) 510.4 (497.5, 523.2) 759.0 (743.9, 774.2) 836.0 (821.1, 851.0) 1596.2 (1571.7, 1620.7) 1848.6 (1822.1, 1875.2) 732.0 (726.4, 737.5) Female 53.8 (49.6, 58.1) 255.3 (239.2, 271.5) 534.3 (515.9, 552.8) 735.3 (714.3, 756.3) 801.4 (780.8, 822.0) 1435.8 (1403.7, 1468.0) 1894.7 (1859.0, 1930.5) 736.3 (728.5, 744.2) Male 50.2 (46.2, 54.3) 184.4 (171.1, 197.7) 363.1 (347.6, 378.5) 555.4 (536.9, 573.9) 607.4 (589.2, 625.6) 1301.0 (1269.0, 1333.0) 1410.7 (1375.6, 1445.8) 537.0 (530.2, 543.8) * indicates the rate has been suppressed. Table 7. Opioid dispensation rates per 1,000 population for total PDMP by MME category. Total <18 18-24 25-34 35-44 45-54 55-64 65+ Total Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI <50 33.2 (32.5, 33.9) 122.5 (120.4, 124.6) 272.5 (269.8, 275.2) 429.4 (425.9, 433.0) 514.8 (511.3, 518.4) 906.4 (901.1, 911.7) 1038.8 (1033.5, 1044.2) 432.0 (430.8, 433.3) Female 30.4 (29.4, 31.4) 137.9 (134.8, 141.1) 309.7 (305.7, 313.8) 459.0 (453.9, 464.1) 530.1 (525.0, 535.1) 897.7 (890.4, 904.9) 1076.2 (1069.1, 1083.4) 464.9 (463.1, 466.7) Male 29.2 (28.3, 30.1) 80.0 (77.6, 82.4) 178.6 (175.5, 181.7) 297.2 (293.0, 301.4) 382.0 (377.6, 386.4) 715.8 (709.0, 722.6) 785.6 (778.4, 792.8) 308.2 (306.7, 309.8) 50-90 4.0 (3.7, 4.2) 30.0 (29.0, 31.1) 61.6 (60.3, 62.9) 108.1 (106.4, 109.9) 148.1 (146.2, 150.0) 265.3 (262.5, 268.2) 216.7 (214.2, 219.1) 107.9 (107.3, 108.5) Female 4.1 (3.7, 4.4) 29.7 (28.3, 31.2) 64.7 (62.9, 66.5) 105.7 (103.3, 108.2) 142.0 (139.3, 144.6) 235.7 (232.0, 239.4) 201.7 (198.5, 204.8) 104.9 (104.0, 105.7) Male 3.1 (2.8, 3.4) 22.9 (21.6, 24.2) 44.2 (42.7, 45.7) 82.3 (80.1, 84.5) 118.5 (116.1, 121.0) 233.3 (229.4, 237.2) 189.8 (186.2, 193.3) 86.3 (85.5, 87.1) >90 0.3 (0.3, 0.4) 17.8 (17.0, 18.6) 76.9 (75.4, 78.3) 94.2 (92.5, 95.8) 84.6 (83.2, 86.1) 136.8 (134.7, 138.8) 83.9 (82.4, 85.4) 64.1 (63.6, 64.6) Female 0.2 (0.1, 0.3) 14.9 (13.9, 16.0) 66.2 (64.3, 68.0) 78.7 (76.6, 80.8) 74.1 (72.2, 76.0) 110.0 (107.5, 112.6) 75.4 (73.5, 77.3) 55.6 (54.9, 56.2) Male 0.4 (0.3, 0.5) 17.0 (15.9, 18.1) 73.7 (71.7, 75.7) 87.9 (85.7, 90.2) 74.5 (72.6, 76.5) 133.4 (130.4, 136.3) 76.2 (74.0, 78.5) 58.8 (58.1, 59.4) Total 46.8 (46.0, 47.7) 202.3 (199.6, 205.0) 475.8 (472.3, 479.4) 739.6 (735.0, 744.2) 883.5 (878.9, 888.2) 1536.1 (1529.2, 1543.0) 1542.3 (1535.7, 1548.8) 705.8 (704.2, 707.4) Female 41.7 (40.6, 42.9) 207.2 (203.3, 211.0) 495.5 (490.5, 500.6) 735.3 (728.8, 741.7) 858.9 (852.5, 865.3) 1421.5 (1412.3, 1430.6) 1519.0 (1510.5, 1527.5) 710.8 (708.5, 713.0) Male 39.4 (38.4, 40.5) 133.6 (130.5, 136.7) 328.4 (324.2, 332.6) 526.7 (521.2, 532.3) 659.4 (653.6, 665.2) 1240.8 (1231.8, 1249.7) 1194.6 (1185.7, 1203.4) 515.7 (513.7, 517.7) PDMP Report Q1 2018 21

Table 8. Opioid dispensation counts for total PDMP by primary drug ingredient. Primary Drug Ingredient Dispensation Count Rate 95% CI Buprenorphine 27,284 25.9 (25.5, 26.2) Butorphanol 596 0.6 (0.5, 0.6) Codeine 47,453 45.0 (44.6, 45.4) Dihydrocodeine 6 0.0 (0.0, 0.0) Diphenoxylate 793 0.8 (0.7, 0.8) Fentanyl 12,986 12.3 (12.1, 12.5) Hydrocodone 282,279 267.5 (266.5, 268.4) Hydromorphone 5,670 5.4 (5.2, 5.5) Levorphanol 109 0.1 (0.1, 0.1) Meperidine 494 0.5 (0.4, 0.5) Methadone 6,434 6.1 (5.9, 6.2) Morphine 24,010 22.7 (22.5, 23.0) Opium 360 0.3 (0.3, 0.4) Oxycodone 169,472 160.6 (159.8, 161.3) Oxymorphone 882 0.8 (0.8, 0.9) Paregoric 8 0.0 (0.0, 0.0) Pentazocine 113 0.1 (0.1, 0.1) Tapentadol 1,708 1.6 (1.5, 1.7) Tramadol 147,650 139.9 (139.2, 140.6) Total 728,307 690.1 (688.5, 691.7) PDMP Report Q1 2018 22

Appendix B: Sources & Calculations Population counts obtained from U.S. Census Bureau, 2010 Census. Dispensation data pulled from the St. Louis County PDMP by DPH staff. Dispensation rates were calculated per 1,000 population using the formula below; dispensation rates represent projected annual rates based on one quarter of data. Dispensation Rate = ( # dispensations ) 1000 population 4 Morphine milligram equivalent (MME) was calculated using the CDC calculation (formula below). units MME = strength ( ) MME conversion factor days supply Appendix C: Suggested Citation Varner E, Donaldson K, Schmidt S. Prescription Drug Monitoring Program Report Q1 2018, St. Charles County. St. Louis County, MO: Department of Public Health. June 2016. PDMP Report Q1 2018 23