Kentucky All Schedule Prescription Electronic Reporting (KASPER) Phyllis Millspaugh Manager, Behavioral Health Prevention and Promotion Kentucky Cabinet for Health and Family Services Using PDMP Data to Advance Prevention Planning (Emerging Drug Issues/Trends) September 13, 2016
Painkiller Prescription Rates by State Cabinet for Health and Family Services CDC Vitalsigns July 2014, Source: IMS, National Prescription Audit (NPA tm ), 2012
Top 10 State Drug Overdose Death Rates 2014 Rank State Number of Drug Overdose Deaths Data source: Increases in Drug and Opioid Overdose Deaths United States, 2000-2014. Rudd, Aleshire, Zibbell and Gladdin, CDC Morbidity and Mortality Weekly Report, December 18, 2015 Cabinet for Health and Family Services Age-Adjusted Drug Overdose Death Rate per 100,000 or Population 1 West Virginia 627 35.5 2 New Mexico 547 27.3 3 New Hampshire 334 26.2 4 Kentucky 1,077 24.7 5 Ohio 2,744 24.6 6 Rhode Island 247 23.4 7 Utah 603 22.4 8 Pennsylvania 2,732 21.9 9 Delaware 189 20.9 10 Oklahoma 777 20.3 United States 47,055 14.7
Kentucky Drug Overdose Deaths Sources: 2015 Data: 2015 Overdose Fatality Report. Kentucky Justice and Public Safety Cabinet, June 2016. 2005-2014 Data: U.S. Centers for Disease Control, Multiple Cause of Death Data (CDC Wonder Online Database) Cabinet for Health and Family Services
Regional Prevention Centers Map 6 7 15 8 3 5 9-10 2 11 1 12 13 4 14 Cabinet for Health and Family Services
KASPER Tracks Schedule II V controlled substance prescriptions dispensed within Kentucky as reported by pharmacies and other dispensers Helps address prescription drug abuse and diversion using a real-time, web-accessed database Was not designed to prevent people from obtaining controlled drugs for legitimate medical purposes Cabinet for Health and Family Services
Annual KASPER Records Total / Per Person Cabinet for Health and Family Services 2.39 2.43 2.65 2.65 2.72 2.72 2.47 2.43 2.41 Number of Controlled Substance Prescriptions per Person
Lorazepam 4.0% Ativan Diazepam 4.0% Valium Top Prescribed Controlled Substances by Therapeutic Category & Doses - 2015 Amphetamine 3.9% Adderall Zolpidem 3.2% Ambien Buprenorphine-Naloxone 3.1% Suboxone Hydrocodone 37.6% Lortab Vicodin Clonazepam 7.1% Klonopin Tramadol 9.8% Ultram Alprazolam 10.4% Xanax Cabinet for Health and Family Services Oxycodone 16.9% OxyContin Percocet
Patient-Controlled Substances Reports Can be used to look at controlled substance prescriptions for individual patients across time Captures the morphine equivalent dose
Prescriber Reports
Cabinet for Health and Family Services Opioid Morphine Milligram Equivalent Dose (MED) Data Ages 18-65 - Q1 2016
Cabinet for Health and Family Services Oxycodone Prescribing - Q1 2016
Cabinet for Health and Family Services Oxycodone Usage - Q1 2016
KASPER Threshold Report Q1 2016 Kentucky Injury Prevention and Research Center Cabinet for Health and Family Services
KASPER Advisory Council The duties of the Council shall include, but not be limited to, developing recommendations for guidelines that will enable the KASPER program to focus on potential problem areas and proactively generate information useful to the particular prescriber and dispenser licensing boards to assist the boards in expanding their enforcement activities of identifying and eliminating drug abuse, misuse, diversion and illegal prescription and sale of prescription drugs by their respective licensees. Cabinet for Health and Family Services
Examples of Drug Enforcement and Professional Practices Branch Prescriber Review Criteria Multiple drugs; same therapeutic category Elevating doses Early refills (authorizes new Rx before last Rx refills used) Patients live far from prescriber s office Determine whether the prescriber is querying KASPER for patient reports Long KASPER prescriber report (over 300 pages) Overdose deaths among patients Cabinet for Health and Family Services
Cabinet for Health and Family Services KASPER Prescriber Review Example: Overlapping Benzodiazepine Prescriptions
KASPER Prescriber Review Example: Overlapping Benzodiazepine Prescriptions Cabinet for Health and Family Services 38 of 68 Physician Reviews Completed
Mandatory KASPER Usage Results Drug July 2011 through June 2012 July 2014 through June 2015 Percent Change Hydrocodone 3,303,453 2,603,642-21.2% Oxycodone 977,256 937,530-4.1% Oxymorphone 24,485 18,459-24.6% Tramadol 431,455 542,930 + 25.8% Alprazolam 947,672 769,814-18.8% Diazepam 413,983 350,685-15.3% Buprenorphine/ Naloxone All Controlled Substances 269,488 491,130 + 82.2% 10,417,237 9,927,621-4.7% Figures represent number of prescriptions dispensed as reported to KASPER
Examples of Utility of KASPER Data in Prevention Planning Efforts Identified shared risk and protective factor indicators by crosswalking KASPER data with statewide substance abuse survey data Suggested an increasing risk of substance abuse for students connected to the military Identified trends in prescribing patterns geographically, which connected with two military posts in the state Cabinet for Health and Family Services
Phyllis Millspaugh Kentucky Cabinet for Health and Family Services 275 East Main Street, 4-WG Frankfort, KY 40621 502-564-4456 Phyllis.Millspaugh@ky.gov KASPER Website: www.chfs.ky.gov/kasper
Saves Lives Oklahoma s Plan to Reduce Prescription Drug Abuse and Prevent Overdose Young Onuorah, SPF-Partnerships for Success Manager Oklahoma Department of Mental Health and Substance Abuse Services
Prescription Drug Abuse in Oklahoma In 2013, Oklahoma had the 6 th highest unintentional poisoning death rate in the U.S. Centers for Disease Control (CDC), National Vital Statistics System (NVSS) 4,600 Oklahomans died from unintentional poisonings during 2007-2014; four out of five of those deaths involved prescription drugs. Oklahoma State Department of Health Oklahoma s 2014 rate is 107% higher than the U.S. rate of 5.9. CDC, NVSS
Deaths Involving Prescription Drugs, Illicit Drugs, or Alcohol by Year of Death, Unintentional Poisoning, Oklahoma, 2007-2013 Number of Deaths 800 700 600 500 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 Year of Death All poisonings Prescription drugs Alcohol Methamphetamine Cocaine Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)
Substances Involved in Unintentional Poisoning Deaths, Oklahoma, 2007-2013 Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner reports)
The Solution Multi-faceted approach to prevention is required Gov. Mary Fallin appointed multiple stakeholders to task force; developed comprehensive state plan focusing on all levels of intervention Comprehensive array of efforts are underway in Oklahoma PREVENTION & EDUCATION MONITORING & DIVERSION CONTROL INTERVENTION & TREATMENT
Opioid Prescribing Guidelines Continuing Medical Education Actions Taken Statewide Disposal Program Communication Campaign Community-Level Prevention Medication Assisted Treatment Legislative Action Hydrocodone Limits Overdose Education and Naloxone Distribution Required Use of the PDMP
Community-Level Prevention Oklahoma coordinates and braids Block Grant, state discretionary, and tribal discretionary funds to scale prevention services Infrastructure is developed and shared among the state and tribal prevention systems: Data collection and analysis (SEOW, TEOWs, REOWs) Resource allocation and planning Prevention workforce training Evidence-based practices workgroup
Southern Plains Intertribal Health Board PFS Absentee Shawnee Tribe Cheyenne and Arapaho Tribes Chickasaw Nation Comanche Nation Cherokee Nation PFS ODMHSAS PFS and BG Priority Counties PFS County Block Grant County
Oklahoma SPF-PFS High-Need Communities, Epi Process
Patients Receiving Same Drug While Still Having 20+ Day Supply of Same Drug, 2013 Source: ODMHSAS, Decision Support Services, OK PDMP
Opioid Prescription Access by Zip Code, Tulsa County, 2013 and 2014
Opioid Prescription Access by Zip Code, Tulsa County, 2013 and 2014, cont.
Community Education Decrease Availability Policy Change Used a variety of media outlets: TV, radio, newsprint, flyers Three take-back events collected 1,324 lbs of medication Distributed 238 lockboxes to 50 agencies and 188 individuals Worked with community agencies to improve disposal practices; 50% of contacted agencies enhanced policies Availability of Rx drugs for misuse and abuse decreased. Use of community lock boxes increased 89%. Implementation of take-back events increased 120%. Community members reporting that they did not share leftover prescriptions in the past year increased 6%. Community members reporting they save leftover prescriptions to share decreased 71%.
Past 30-Day Use of Prescription Drugs Among Oklahoma 12 th Grade Students, 2010, 2014 12.0% 10.0% 9.6% 8.3 Goal Percent of Students 8.0% 6.0% 4.0% 2.0% 0.0% 5.2% Past 30 Day Use 2010 2014 Source: OK Prevention Needs Assessment Survey, ODMHSAS
Past-Year Nonmedical Use of Prescription Drugs by Age Group, Oklahoma, 2007-2014 25.0 Percent 20.0 15.0 10.0 5.0 0.0 16.7 15.7 8.6 7.9 10.9 11.6 10.1 7.0 6.0 5.3 4.8 5.3 4.0 4.2 4.0 2007/8 2009/10 2011/12 2012/13 2013/14 12-17 18-25 26+ Source: National Survey on Drug Use and Health, SAMHSA
Data sources: National Survey on Drug Use and Health, National Vital Statistics
Contact www.facebook.com/odmhsas @ODMHSASINFO @terriwhiteok TakeAsPrescribed.org