OR PDMP Program Details 2014

Oregon PDMP in 2014

Lisa Millet, IVPP Section ManagerOregon Health Authority, Public Health DivisionOpioid Prescribers GroupMarch 19, 2014

Objectives

• Provide a brief overview of Oregon’s prescription opioid overdose epidemic

• Review Oregon’s PDMP history

• Provide an overview of system use to date and barriers to adoption

• Review amended PDMP legislation and related system changes

• Discuss how the PDMP can be used to assess treatment and coordinate care

Unintentional or undetermined prescription opioid overdose death rate per 100,000 by year and sex and

annual count by year, Oregon, 2000-2012

Average unintentional or undetermined prescription opioid overdose death rate per 100,000 by age group and sex and

annual count by age group, Oregon, 2008-2012

Unintentional prescription opioid overdose hospitalization rate per 100,000 by year and sex and

annual count by year, Oregon, 2000-2012

Average unintentional prescription opioid overdose hospitalization rate per 100,00 by age group and sex and

annual count by age group, Oregon, 2010-2012

Who is most at risk?A CDC policy impact report cites the following

indicators for people at highest risk for prescription painkiller overdose:

• Take high doses of prescription painkillers• Have low incomes• Live in rural areas• Have a history of mental illness• Have a history of substance misuse are at highest risk

for overdosing

Source: Policy Impact: Prescription Painkiller Overdoses: http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

Opioid overdose prevention efforts in Oregon

• PDMP as a healthcare tool

• Opioid prescribing guidelines

• Public education on dangers of opioids

• Drug take back

• Access to treatment and recovery support

• Naloxone and buprenorphine

• Surveillance

• Evaluation

Unintentional or undetermined prescription opioid and heroin overdose death rate by year, Oregon,

2000-2012

Primary diagnosis for unintentional prescription opioid and heroin overdose hospitalization rate by

year, Oregon, 2000-2012

Increase in overdose death & hospitalization rates per 100,000 for selected drugs, OR, 2000 to 2011Drug Deaths Hospitalizations

2000 2011 2000 2011

Heroin0.8 3.1 3.8 0.6 1.8 2.8

Prescription opioid drugs1.0 4.6 4.8 2.0 10.0 5.1

Methadone0.5 2.1 4.2 0.3 2.4 7.6

Benzodiazepines0 0.9 30.3 1.3 3.9 3.0

Antiepileptic, sedative-hypnotic, antidepressant

0.8 2.8 3.6 5.6 13.1 2.4

Methamphetamines and other psychostimulants

0.5 1.4 3.1 0.8 2.0 2.5

Alcohol0.4 3.0 6.8 0.7 1.2 1.6

Comparison of overdose hospitalizations across ICD-9 codes for select drugs, Oregon,

2012

Primary diagnosis (unintentional)

Multiple diagnoses 1-10 (unintentional)

Induced dependency or abuse impacting health and daily life

activities across diagnoses 1-10

Other specified and unspecified drugs 831 1101 5995

Opioid and/or pharmaceutical opioids 584 884 4501

Heroin 101 117

Methadone 97 131

Benzodiazepine 518 914

About Oregon’s PDMP

• Operated and maintained by the Oregon Health Authority (OHA)

• Established in statute in 2009: ORS 431.962 - 431.978 & 431.992• Statute amended in 2013 legislative session• Data are protected health information• System is Web-based and access is limited• Pharmacies began uploading Schedules II-IV controlled

substances on June 1, 2011• Online system went live on September 1, 2011 and is

accessible 24/7 • System use is voluntary

Oregon PDMP collects pharmacy data

Patient information• First and last names, middle initial • Date of birth• Address• Patient sex*Drug Information• Drug code number • Date drug was prescribed and date dispensed• Quantity of drug dispensed• Days supplied and prescription number*• Refills authorized and refill number*Pharmacy and practitioner information• Dispensing pharmacy • Prescriber *Began collecting these data on January 1, 2014

PDMP Data: Select controlled substances dispensed to residents, Oregon, 2012

Controlled Substance

Prescription

Recipient Count

in 12 months

Number of

prescriptions

dispensed in 12

months

Number of

prescriptions

dispensed per

prescription

recipient in 12

months

Number of

people receiving

prescription, per

1,000 residents

Number of

prescriptions

dispensed per 1,000

residents

Opioids1 908,162 3,495,888 3.8 233.8 900.1

Hydrocodone 676,105 1,947,074 2.9 174.1 501.3

Oxycodone 334,805 1,122,642 3.4 86.2 289.1

Morphine 40,004 234,233 5.9 10.3 60.3

Hydromorphone 22,998 68,274 3.0 5.9 17.6

Methadone2 16,259 123,665 7.6 4.2 31.8

Fentanyl 14,941 88,331 5.9 3.8 22.7

Benzodiazepines3 413,754 1,833,426 4.4 106.5 472.1

Lorazepam 132,705 416,302 3.1 34.2 107.2

Zolpidem 123,824 530,485 4.3 31.9 136.6

Alprazolam 99,024 373,609 3.8 25.5 96.2

Diazepam 70,421 184,657 2.6 18.1 47.5

Clonazepam 63,783 328,373 5.1 16.4 84.6

Temazepam 15,836 69,202 4.4 4.1 17.8

Opioid-Benzo Combo4 182,763 1,111,838 6.1 47.1 286.31Opioids include: Hydrocodone, Oxycodone, Morphine, Methadone, Fentanyl, and Hydromorphone.2Does not include methadone used to treat addiction.3Benzodiazepines include: Zolpidem, Lorazepam, Alprazolam, Clonazepam, Diazepam, and Temazepam.4Opioids include all listed above. Benzodiazepines include all listed above except Zolpidem which represents a chemically

different class of benzodiazepine, and in which the risk of combination with opioids is thought to be somewhat lower.

Comparing overdose death rates per 100,000 by drug using NCHS population estimates and PDMP recipients, Oregon 2012

Distribution of Schedule II – IV controlled substances prescriptions among prescribers,

Oregon, as of 12/31/13

Percent of prescribers Percent of CS prescriptions

Oregon Health Authority. 2013 Annual Report to the Advisory Commission

Oregon Health Authority. 2013 Annual Report to the Advisory Commission

Rate per 10,000 residents using 4 or more prescribers and 4 or more pharmacies, Oregon,

7/1/12 to 12/31/12

PDMP use and access dataJune 2011 through December 2013

• Almost 17 million Rx records in the database

• Approximately 98 percent of pharmacies required to upload data are reporting within the required 7-day period

• More than 7,200 authenticated users with active access accounts

• More than 940,000 patient record queries conducted by providers and pharmacists

Top 12 Prescriptions, JUN 2011—DEC 2013

Drug Number of Rx % of all Rx

Hydrocodone 4,697,183 27.7%

Oxycodone 2,832,151 16.7%

Zolpidem 1,292,356 7.6%

Lorazepam 1,040,223 6.1%

Alprazolam 927,742 5.5%

Clonazepam 817,372 4.8%

Amphet ASP/AMPHET/D-AMPHET

609,217 3.6%

Morphine 572,415 3.4%

Methylphenidate 555,423 3.3%

Diazepam 456,718 2.7%

Methadone 305,466 1.8%

Acetaminophen with Codeine

266,7161.6%

Historically who has been able to obtain PDMP information?

• Oregon-licensed healthcare providers & pharmacists authorized by the OHA can get online access

• Patients may obtain a free copy of their record which includes a list of system users who accessed their PDMP information

• Regulatory boards may request information on a licensee if they certify it is necessary for an active investigation

• Law enforcement agencies may request information on an individual pursuant to a valid court order based on probable cause

Comparison of Oregon licensees who have PDMP accounts through 12/31/13 and who prescribed in

2013 by discipline

Licensed Discipline Number who

prescribed at least

one controlled

substance Schedule

II-IV in 2013

Number with PDMP

accounts by December, 2013

(% of those who prescribed

any CS II-IV)

Estimated

total number

of licensees

Nurse Practitioners 1,887 945 (50.1) 2,600

Dentists 2,409 506 (21.0) 3,750

Osteopathic physicians 750 378 (50.4) 875

Medical Physicians (MD) 8,822 3,201 (36.3) 12,700

Naturopathic physicians 344 87 (25.3) 850

Physician Assistants 1,136 457 (40.2) 1,500

Optometrists 85 8 (9.4) 750

Totals 15,433 5,582 (36.2) 23,025

Number of PDMP queries by all disciplines, Oregon, Jan. 2012 to Dec. 2013, N=903,225

Average monthly number of PDMP queries per querying user by discipline, Oregon, Jan. – Dec. 2013

2013 Legislative Changes Senate Bill 470

• Permits the PDMP to collect additional data (patient sex, days supplied, and refill data)

• Permits prescribers and pharmacists to authorize delegate access to members of staff

• Permits prescribers to review prescriptions dispensed under their own DEA number

• Allows the State Medical Examiner and designees to access PDMP information for autopsies and death investigations

• Authorizes prescribers in neighboring states (WA, ID, and CA) and who treat Oregonians to access the Oregon PDMP

• Allows public health authorities to use de-identified PDMP data

How PDMPs can facilitate better health and health care

• Support medically necessary uses of controlled substances

• Help identify risks to patient safety• Facilitate coordination of care among providers• Facilitate pharmacology consultation• Aid in the identification of potential drug misuse,

abuse, or diversion of prescription drugs• Facilitate the intervention and treatment of persons

addicted to prescription drugs• Educate individuals and communities about the

dangers of prescription drugs • Inform public health initiatives through outlining use

and misuse trends

Reported barriers to PDMP access and use 1, 2

• Difficulty registering – i.e. application notarization

• Difficulty accessing and using the system• Not comfortable using a computer or the

internet• Time constraints• Lack of access by support staff• Not aware of the program

1 April 2012 provider and pharmacist survey conducted by Program Design and Evaluation Services through a Bureau of Justice Assistance PDMP grant award2 April 2013 provider survey conducted by Acumentra Health and Oregon Health and Sciences University through a National Institutes of Health grant award.

Provider recommendations to increase the usefulness of the PDMP in clinical practice*

• Delegate access for support staff• Training on access or use of the PDMP• Training on how to respond to PDMP information• Training on non-confrontational communication of findings

to patients• Linking multiple state systems• Automatic system notification when a prescription pattern

suggests potential misuse or diversion• Faster availability of data in the system• Unique patient identifier to reduce mistaken identity or use

of aliases• Better insurance coverage for mental health or addiction

referrals

* From an April 2013 provider survey conducted by Acumentra Health and Oregon Health and Sciences University through a National Institutes of Health grant award.

System changes and new system user interface for 2014

• Delegate access for office staff

• Audit of delegate access

• Prescriber audit of dispensation under their DEA number

• Simplified query screen

• Easier-to-read Web output for patient queries

Same old Website

New landing page and login

Query page with new functions

Slightly revised liability statement

New patient query interface

New query Web output

New user management menu

Link and unlink delegates

Successfully linked delegates

Questions about the PDMP?

Lisa MilletIVPP Section Manager

Oregon Health [email protected]

503-572-8585

www.orpdmp.com