Transcript Document

Epidemiology of Benzodiazepine
Prescribing and Use
Gerry & Marci’s Story
4nd Annual Benzodiazepine
Conference
Portland, Maine
2006
J. Gerry Mugford, PhD, CMH
Asst. Prof. of Medicine, Pharmacy, & Psychiatry
Memorial University of Newfoundland
©JGM 2006
Marcella H. Sorg, RN, PhD
Margaret Chase Smith Policy Center
University of Maine
Credit Where Credit is Due
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Stevan Gressitt
Karen Simone
Todd Mandell
Len Kaye
Bill Flagg
Office of Substance Abuse, State of Maine
Dorothy Rhodes, IMS Health
Maine Care, Anthem, Express Scripts
Office of Chief Medical Examiner
Credit Where Credit is Due
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All contributors to Maine Benzodiazepine
Study Group data collection
All you here today and tomorrow
All those who have made commitments to
US/Canada BSG and couldn’t be here
Focus on Research
Why more numbers??
 Build effective feedback loops between
practice and policy to change behavior
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INFORMATION SYSTEMS
New DAWN
 New Prescription Monitoring Program
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Monitor change:
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CONTEXT & PLAYERS CHANGING
History
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Maine Benzodiazepine Study Group created
in 2002 –collecting data
5th. year of data
 4th. year of Annual Benzodiazepine Conferences
 Published “white papers” summarizing data
from diverse links in the benzodiazepine “life
cycle”
 Journal articles under development
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Epidemiology: Inform Public Health
and Clinical Practice
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Increased morbidity in particular populations and
potential need to screen & treat underlying
problem (e.g., anxiety in women)
Variation in clinical prescribing practices and
potential need to set guidelines (e.g., issues of
polypharmacy or long-term treatment)
Increased individual and public health risks posed
by high prescriptive & misuse prevalence and the
potential need to regulate (e.g., driving with BZDs)
What Patterns are Consistent?
(a preview of what we will show)
Prescriptions
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Females > males
Older > younger, generally, with peak in 50s
Associated risks
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Accidents: falls, motor vehicle
Polypharmacy adverse events
Suicides (multiple drug)
Illicit drug use (associated with opiates, alcohol)
Drug dependency with long-term use
Anxiolytic
Amnesic
BZD
Uses
Anticonvulsant
Hypnotic
Myorelaxant
NNEPC: Maine BZD Citings, Human
Poisoning Exposures by Gender
800
700
600
Female
500
Male
400
Unknown
300
Total
200
100
0
2002
2003
2004
2005
2006est
NNEPC: Maine BZD Citings, Information Calls by
Gender
5,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
Female
Male
UNK/INV
Total
2002
2003
2004
2005
2006est
Maine Medicaid Total BZD Users & BZD Scripts
350000
300000
250000
Total Enrollees
200000
Total Users
150000
Total Scripts
100000
50000
0
1998 1999 2000 2001 2002 2003 2004 2005
Maine Medicaid: Number of Scripts per
BZD User
10
9
8
7
6
5
4
3
2
1
0
12.8% of enrollees
12.5%
of enrollees
1998 1999 2000 2001 2002 2003 2004 2005
Ratio
Vermont Medicaid: Enrollees with Paid BZD Claims
2,500
2,000
Males
1,500
Females
1,000
Total
500
80
+
70
-7
4
60
-6
4
50
-5
4
40
-4
4
30
-3
4
20
-2
4
10
-1
4
04
0
Percent with BZD
Script
BZD Prevalence Comparison by Age & Gender
Anthem 2003 & Medicaid 2004
30
25
FE Anthem 03
20
15
10
FE Medicaid 04
MA Anthem 03
MA Medicaid 04
5
0
0-9 10- 20- 30- 40- 50- 60- 70- 80+
19 29 39 49 59 69 79
Age Group
Express Scripts 2002 (2003)
N = 206,675; n= RS 4,993
50
40
30
Females
Males
20
10
0
0-9 10- 2019 29
30- 40- 5039 49 59
60- 70- 80+
69 79
Percent by Age/Sex
Category
BZD Prevalence by Age and Gender
Anthem 2002 (N=367,907)and 2003 (N=276,101)
30.0%
25.0%
FE 02
20.0%
FE 03
15.0%
MA 02
10.0%
MA 03
5.0%
0.0%
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Age Group
US Per Capita Retail Scripts: Age/Gender
50
40
30
20
10
0
19-64
19-64
65+
65+
Males
Females
Males
Females
US
8.1
13.8
20.8
28.9
Maine
8.4
14.2
17.1
20.4
TN
13.3
22.9
29.5
41.6
Anthem 2003 Highlights
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10% of 2003 subscribers with
prescriptions had at least 1 prescription for
a BZD (n=27,308 out of 276,101)
Of those with a BZD prescription
4% had a prescription for more than one type
 16% had a prescription for >180 days
 67% of subscribers with a BZD scrip were
female (similar across age groups 15+)
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Note about Express Scripts
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Express Scripts states 2003 rates are unlikely
to be significantly different from 2002
From sample n=8267: 3.3%
 Population size is 206,675 (possibly includes
subscribers without any prescriptions)
 Possibly does not cover all BZDs (Anthem 10%)
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Comparison of BZD Prescription Prevalence
Express Scripts
3.3
3.3
2006
Anthem
9.85
6.15
2005
2004
2003
10.08
VT-Medicaid
2002
10.76
10.74
ME-Medicaid
9.75
0
2
4
6
8
10
12
Percent Female Among BZD Prescription
Recipients
Express Scripts % Female
2006
Anthem % Female
2005
NNEPC Poisonings % Female
2004
2003
VT-Medicaid % Female
2002
ME-Medicaid % Female
0
10
20
30
40
50
60
70
80
Maine Nursing Home
Sample “H” 2003-04
Drug
Class
Anti anxiety
Sedative/hypnot
ic
H
Range
H
Ave.
Maine
Ave.
12-28%
21%
18–19%
0-8%
3%
4%
Some Nursing Home Estimates
Important –Patterns Do Vary!
Antianxiety
Hypnotic
Canada
12.7%
12.2%
US
15.7%
5.0%
Low
6.0 %
HI
1.9%
CO/WI
High
24.0%
TN
8.5%
LA
Maine
19.4%
ME
4.3%
ME
CI: Why Do They Give It?
Indication
Global %
Anxiety
48.6
Depression
14.4
Agitated Depression
9.9
Insomnia
16.0
Alcoholism
1.7
Organic disorder
9.4
Is there a problem?
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Women more likely than men to have
prescription–why? (genders more equal for
emergency room)
Higher prescribing rates for
Medicare/Medicaid –why?
Older age has rates > 2X general population
for prescriptions (younger ages for
emergency room)
24% increase in hip fracture comparing
seniors take BDZ vs. no BDZ
Is there a problem?
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Implication in suicide rates in persons >65
as high as 39% [BZD sole agent in 72% of
cases]
Associated with illicit drug use
Associated with substance abuse
Associated with automobile accidents [BDZ
established main cause]
Associated with drug overdose [BDZ
established cause]
Thank you
On to Marci