Prescription Drug Monitoring Programs: Adopting Best & Promising PDMP Practices

Transcription

1 Prescription Drug Monitoring Programs: Adopting Best & Promising PDMP Practices National Governors Association Policy Academy: Reducing Prescription Drug Abuse June 8, 2015 Burlington, VT

2 Improving Interstate PDMP Data Sharing

3 Improving Interstate PDMP Data Sharing: Complete linking of all states through hubs and linking of the hubs so they can share data. Consider sending unsolicited reports to prescribers in adjoining states, not just those in-state Consider automatically requesting data from adjoining states when a prescriber or other requester asks for data from a PDMP. Would bring in about 97% of all applicable prescriptions. Also allow requester to designate other states, as needed, e.g. Florida.

4 Comprehensively Mandate Prescribers Use PDMP Data Before Prescribing? Kentucky July 2012 Tennessee April 2013 New York August 2013 Also, Massachusetts, Ohio, Oklahoma, Nevada, New Mexico, West Virginia

5 Kentucky All Schedules Prescription Electronic Reporting

6 KY Mandate Prescribers Use PDMP Data

7 TN Controlled Substances Monitoring Data

8 NY State I-STOP Mandate Prescribers use PMP

9

10 MPE rates per 1,000 state residents Multiple Provider Episodes by State and Quarter Rates per 1,000 Residents Kentucky mandatory PDMP use law implemented CA DE FL ID KY LA ME OH WA WV Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q4

11 Proactive Unsolicited Prescription Monitoring Program Reports / Alerts

12 Unsolicited Reports and Alerts PDMP data -- vigorously analyze to identify potential misuse and diversion, e.g.: Potential doctor shopping, Organized drug rings, Prescription forgery Pill Mills Fraudulent sales of prescriptions by prescribers Send analyzed data rapidly to those who can intervene Prescribers and Pharmacists Law Enforcement Health Professional Licensing Agencies

13 Numbers of histories Numbers of histories Notes from the Field : Wyoming PDMP Unsolicited Prescription Histories per Month, 10/2008 9/ Solicited Prescription Histories per Month, 10/2008 9/ Source: Wyoming PDMP Source: Wyoming PDMP

14 Why Unsolicited Reports Are Important MA PMP survey physicians receiving unsolicited reports: Only 8% of respondents were aware of all or most of other prescribers Only 9% said based on current knowledge, including PMP report, patient appears to have legitimate medical reason for prescriptions from multiple prescribers. Alert prescribers of persons receiving more than 100 mg morphine equivalents of opioids per day 8.9 times higher risk of death than low dose

15 PDMPs A Disease Registry - Can Help Save Lives Identify and intervene - persons doctor shopping West Virginia study of deaths 2005 to 2007: A significantly greater proportion of deceased subjects were doctor shoppers (25.21% vs. 3.58%) Pierce, et al; Doctor and Pharmacy Shoppers for Controlled Substances; Medical Care, Volume 00, Number 00, 2012 If PDMP identifies them and intervenes, lives can be saved Alerts / unsolicited report should be automated to distribute more rapidly

16 Identify Areas of Highest Risk for Opioid Overdoses and Deaths, including Heroin:

17 Rx Opioid Abuse as a Predictor of Heroin Abuse 4 out of 5 persons abusing heroin first abused Rx opioids.*,** Only 1 out of 100 persons abusing Rx opioids first abused heroin.** Analysis of MA PMP data shows the rate of doctor shopping (multiple provider episodes) with Rx opioids is a strong predictor of overdoses and deaths involving all opioids, including heroin.*** *Jones, Heroin use among non-medical users of Rx opioids see notes ** Muhuri, Nonmedical Pain Reliever Use and Initiation of Heroin Use, 2013 *** Kreiner, Analysis of MA PMP Data

18 2005 Prescriptions Associated with Questionable Activity (Rates per 100,000 Prescriptions) by Pharmacy Town Questionable activity rates

19 2005 Opioid-related Health Problems Rate per 100,000 by Town Rate per 100,000 Quintiles

20 The Prescription Behavior Surveillance System (PBSS) A longitudinal, multi-state database of de-identified PDMP data, to serve as: 1. An early warning surveillance tool 2. An evaluation tool, in relation to state and local policies and initiatives, such as prescriber educational initiatives

21 Prescription Behavior Surveillance System Longitudinal, multi-state database of de-identified PDMP data Currently: CA, DE, FL, ID, ME, OH, LA, WA Data use agreements completed with: KY, PDMP data much more timely than most health data Supported by the CDC and FDA Identify areas at high risk for opioid overdoses Examine emerging trends, risk indicators associated with new drug introductions (e.g., Zohydro)

22 California 2012: Multiple Provider Episode Rates by Zip Code MPE rates, Zip Code quintiles

23 Multiple Provider Episode Rates, 2012: Enlargement of Greater Los Angeles MPE rates, Zip Code quintiles

24

25

26 70 California, 2012: Proportion of Total Opioid, Stimulant, and Benzodiazepine Prescriptions Written by Prescriber Deciles Percent of total opioid prescriptions Percent of total stimulant prescriptions Percent of total benzodiazepine prescriptions st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th

27 Average daily dosage of patients in MMEs California 2012: Average Daily Dosage of Patients by Prescriber Decile Based on Volume of Opioid Prescriptions st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Prescriber decile based on volume of opioid prescriptions

28 Ratio of Opioid Prescribing, Females to Males Opioid Prescribing Rates, 2013: Ratio of Prescribing Rates to Females versus to Males, by Age Group CA DE FL ID LA ME OH < > 64 Age Groups

29 Opioid Prescription Rates (per 1,000 residents) Florida ZCTA s

30 Percent of Residents in ZCTA who are Latinos Florida ZCTA s

31 Third Party Payers and PDMP Data

32 PDMPs and Third Party Payers Meeting December 2012 PDMPs should share patient Rx histories with all 3 rd Party Payers Challenges to sharing require collaborative work Safeguards to protect PDMP data and assure proper use are needed and are possible PDMPs should provide data to health care systems and facilities quality assurance programs Data regarding questionable providers should be shared 3 rd Party Payers should support PDMPs PDMPs & 3 rd Party Payers should help providers to identify and refer persons to substance abuse treatment

33

34 Contact Information John Eadie, MPA Director PDMP Center of Excellence Brandeis University Peter Kreiner, Ph.D. Principal Investigator PDMP Center of Excellence Brandeis University