Transcript Slide 1

Diversion
Alert
Prescription Monitoring Program Trends
among Individuals Arrested in Maine for
Trafficking Prescription Drugs, 2014
Christina Holt, MD, MSc1, Kenneth McCall, PharmD2, Stephanie Nichols, PharmD, BCPS, BCPP3,
Leslie Ochs, PhD, PharmD, BCPS2, BCPS, Gary Cattabriga, BA4, Chunhao Tu, PhD2
1.
4.
Maine Medical Center, Department of Family Medicine, Portland, ME
2. College of Pharmacy, University of New England, Portland, ME
3. School of Pharmacy, Husson University, Bangor, ME
Center for Community & Public Health, University of New England, Portland, ME
Outline
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•
•
•
Background
Study Objective
Study Design
Preliminary Findings
Number of Controlled Prescriptions
(x1,000): Maine PMP, 2006-2014
Opioids
Sedatives
Stimulants
3,000
2,500
2,000
2,040
2,162
2,342
2,442
2,533
2,471
2,475
2009
2010
2011
2012
2,371
2,437
2013
2014
1,500
1,000
500
0
2006
2007
2008
‘Sedatives’ includes benzodiazepines and ‘z’ hypnotic drugs such as zolpidem.
Which category of drugs account for
the most prescriptions in the PMP?
25%
25%
25%
25%
1.
2.
3.
4.
Sedatives
Opioids
Hypnotics
Stimulants
Number of Opioid Prescriptions (x1,000):
Maine PMP, 2006-2014
1,400
1,200
1,125
1,177
1,251
1,272
1,310
1,223
1,205
1,222
1,137
1,000
800
600
400
200
0
2006
2007
2008
2009
2010
2011
2012
2013
2014
For comparative purposes, the Maine population estimated by the US Census Bureau:
2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
Number of Opioid Prescriptions (x1000)
by Product: Maine PMP, 2010 & 2014
2010
532
393
95
66 39 53 37 69 19 7
2014
416
0%
350
160
74 66
20%
Hydrocodone
40%
Oxycodone
60%
Buprenorphine
80%
Tramadol
Morphine
Fentanyl
Codeine
Methadone
Propoxyphene
Hydromorphone
Other
45 41 35 27 9
100%
*Hydrocodone reclassified to DEA C-II in 2014, Tramadol reclassified to DEA C-IV in 2014,
Propoxyphene withdrawn from US market in 2010
Which opioid has had the greatest increase
in prescriptions over the last five years?
25%
25%
25%
25%
1.
2.
3.
4.
Hydrocodone
Oxycodone
Buprenorphine
Methadone
Number of Sedative Prescriptions
(x1,000): Maine PMP, 2006-2014
1,000
830
800
708
882
904
902
897
857
820
757
600
400
200
0
2006
2007
2008
2009
2010
2011
2012
2013
2014
For comparative purposes, the Maine population estimated by the US Census Bureau:
2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
Number of Sedative Prescriptions
(x1000) by Product: Maine PMP, 2014
16 12 18
79
210
Lorazepam
Clonazepam
Zolpidem
Alprazolam
133
Diazepam
Temazepam
142
178
Eszopiclone
Other
Benzodiazepine prescribing rates increased from 2010 to
2014 for which of the following demographic groups?
20%
20%
20%
20%
20%
1.
2.
3.
4.
5.
Men < 20 years old
Women < 20 years old
Women 20 to 50 years old
Women 60+ years old
Men 20 to 50 years old
Number of Stimulant Prescriptions
(x1,000): Maine PMP, 2006-2014
400
373
377
2012
2013
395
346
319
288
300
261
207
228
200
100
0
2006
2007
2008
2009
2010
2011
2014
For comparative purposes, the Maine population estimated by the US Census Bureau:
2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
Which is the fastest growing PMP category by
prescription count from 2010 to 2014?
25%
25%
25%
25%
1.
2.
3.
4.
Sedatives
Opioids
Hypnotics
Stimulants
Number of Stimulant Prescriptions
(x1000) by Product: Maine PMP, 2014
6
36
145
79
Methylphenidate
Dextro/amphetamine
Lisdexamfetamine
Dexmethylphenidate
Other
129
Background
Proportion of state and local law enforcement agencies (1,226)
reporting prescription drugs as the greatest drug threat, 2014*
35%
33%
30%
25%
21%
20%
15%
10%
5%
0%
US
NE
*US Dept of Justice, Drug Enforcement Administration. National drug threat assessment summary, 2014.
Available at: http://www.dea.gov/resource-center/dir-ndta-unclass.pdf Accessed March 1, 2015.
Study Objective
The objective of this study is to describe PMP
utilization trends of the individuals who were
arrested for controlled substance prescription
trafficking in Maine in 2014.
Study Design
• Population-based, observational study using retrospective
data from the Maine Diversion Alert Program (DAP) and the
Maine Prescription Monitoring Program (PMP).
• Cases were identified from all drug arrests reported by the
Maine DAP between January 1, 2014 and December, 31
2014.
• Cases were included is the arrest offense was trafficking,
aggravated trafficking, furnishing, distributing, or selling of
prescription drugs.
• PMP records within 90 days prior to the date of arrest were
linked into a single database with the arrest records by first
name, last name, date of birth, and gender and deidentified for analysis.
• University of New England Institutional Review Board (IRB
#090914-011).
Preliminary Findings
Drug Arrest Offenses: Maine, 2014*
96
594
Trafficking
Possession
Other
1313
TOTAL = 2,003 Arrests
*Source: Maine Diversion Alert Program
Drug Arrest Offenses: Maine, 2014
3%
5%
9%
1%
Rx trafficking - PMP match
Rx trafficking - no PMP match
17%
Other trafficking
Illicit trafficking
Possession
65%
Non-possession, nontrafficking offense
2,003 Total Arrests
Myth: Drug diversion is almost
entirely an urban problem.
Number of drug arrests involving Prescription Opioids
mapped by municipality (N=363): Maine 2014
TOWN
ARRESTS
ARRESTS per 10K1
Auburn
Augusta
Bangor
Belfast*
Brewer
Caribou
Ellsworth
Gardiner
Gray
Houlton
Lewiston
Old Town
Portland
Presque Isle
Scarborough
South Portland
Swanville*
Thomaston
Waldoboro
Wiscasset
13
6
28
18
3
4
15
3
6
10
30
4
24
15
6
3
5
4
5
5
5.64
3.14
8.48
*27.00
3.16
4.88
19.38
5.17
7.73
16.33
8.20
5.10
3.63
15.48
3.17
1.20
*36.02
14.38
9.85
13.40
*Significant outlier (P<0.05)
1. Maine Municipality Population, 2010, US Census Bureau
*
*
Myth: Drug diversion is almost
entirely an illicit drug problem.
Number of Trafficking Arrests by
Substance: Maine, 2014
5
5
Methylphenidate
Alprazolam
18
21
30
Hydrocodone
Buprenorphine
Cathinones
43
Cannabinoids
Unspecified CS*
77
110
110
Oxycodone
Cocaine
166
Heroin
0
20
40
60
80
100
Number of Arrests
*Unspecified Controlled Substance
120
140
160
180
Trafficking Drug Arrests including furnishing,
distribution, selling: Maine, 2014
13
235
Rx CII-IV
Illicit
Other
346
TOTAL = 594
What is the most commonly diverted
illicit drug in Maine, 2014?
25%
25%
25%
25%
1.
2.
3.
4.
Cocaine
Heroin
Cannabinoids
Cathinones
What is the most commonly diverted
prescription opioid in 2014?
25%
25%
25%
25%
1.
2.
3.
4.
Hydrocodone
Oxycodone
Buprenorphine
Methadone
Myth: The majority of persons
arrested for trafficking prescription
drugs are men in their 20’s.
Demographics of Persons Arrests for
Trafficking CII-CIV Drugs: Maine, 2014
Male: 155
(66%)
Sex
Female: 80
(34%)
2 2
Age 10
87
88
35
11
Mean age = 33 years
0%
20%
10s
40%
20s
30s
60%
40s
50s
80%
60s
70s
100%
Myth: The majority of persons
arrested for trafficking prescription
drugs are “Doctor shopping” and
“Pharmacy hopping”
Proportion of Persons Arrested for Trafficking CII-CIV Drugs
with Matching PMP Rxs within 90 Days of Arrest
57
(24%)
Match
NonMatch
178
(76%)
TOTAL = 295
Number of Pharmacies and Prescribers
1
2 to 4
>4
35
Pharmacies
22
31
Prescribers
0%
20%
25
40%
60%
80%
1
100%
Myth: The majority of persons
arrested for trafficking
pharmaceuticals are paying cash at
the pharmacy.
Payment Method for Matching CII-CIV
Prescription within 90 days of Arrest
Commercial
Medicaid
28
0%
20%
40%
60%
Medicare
Cash
19
5
80%
5
100%
Which of the following statements is true
regarding drug diversion in Maine, 2014?
1. Drug diversion is almost entirely an illicit drug
problem.
20% 2. Drug diversion is almost entirely an urban
problem.
20% 3. A majority of persons arrested for trafficking
drugs are men in their 20s
20% 4. A majority of persons arrested for trafficking Rx
drugs use only 1 pharmacy and 1 prescriber.
20% 5. The majority of persons arrested for trafficking
pharmaceuticals are paying cash at the pharmacy
20%
Questions?
Acknowledgments:
• Office of Substance Abuse, PMP Program
Coordinator: John Liposky
• Diversion Alert Program, Executive Director,
Clare Desrosiers