Oregon PDMP in 2014
Lisa Millet, IVPP Section Manager
Oregon Health Authority, Public Health Division
Opioid Prescribers G...
Objectives
• Provide a brief overview of Oregon’s prescription
opioid overdose epidemic
• Review Oregon’s PDMP history
• P...
Unintentional or undetermined prescription opioid
overdose death rate per 100,000 by year and sex and
annual count by year...
Average unintentional or undetermined prescription opioid
overdose death rate per 100,000 by age group and sex and
annual ...
Unintentional prescription opioid overdose
hospitalization rate per 100,000 by year and sex and
annual count by year, Oreg...
Average unintentional prescription opioid overdose
hospitalization rate per 100,00 by age group and sex and
annual count b...
Who is most at risk?
A CDC policy impact report cites the following
indicators for people at highest risk for
prescription...
Opioid overdose prevention
efforts in Oregon
• PDMP as a healthcare tool
• Opioid prescribing guidelines
• Public educatio...
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 2011
Drug Deaths Hospitaliz...
Comparison of overdose hospitalizations
across ICD-9 codes for select drugs, Oregon,
2012
Primary diagnosis
(unintentional...
About Oregon’s PDMP
• Operated and maintained by the Oregon Health
Authority (OHA)
• Established in statute in 2009:
ORS 4...
Oregon PDMP collects pharmacy data
Patient information
• First and last names, middle initial
• Date of birth
• Address
• ...
PDMP Data: Select controlled substances
dispensed to residents, Oregon, 2012
Controlled Substance
Prescription
Recipient C...
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 ...
Oregon Health Authority. 2013 Annual Report to the Advisory Commission
Rate per 10,000 residents using 4 or more
prescribe...
PDMP use and access data
June 2011 through December 2013
• Almost 17 million Rx records in the database
• Approximately 98...
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...
Historically who has been able to
obtain PDMP information?
• Oregon-licensed healthcare providers & pharmacists
authorized...
Comparison of Oregon licensees who have PDMP
accounts through 12/31/13 and who prescribed in
2013 by discipline
Licensed D...
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 re...
How PDMPs can facilitate better
health and health care
• Support medically necessary uses of controlled
substances
• Help ...
Reported barriers to
PDMP access and use 1, 2
• Difficulty registering – i.e. application
notarization
• Difficulty access...
Provider recommendations to increase the
usefulness of the PDMP in clinical practice*
• Delegate access for support staff
...
System changes and new system user
interface for 2014
• Delegate access for office staff
• Audit of delegate access
• Pres...
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 Millet
IVPP Section Manager
Oregon Health Authority
lisa.m.millet@state.or.us
503-572-8585
...
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OR PDMP Program Details 2014

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OR PDMP Program Details 2014

  1. 1. Oregon PDMP in 2014 Lisa Millet, IVPP Section Manager Oregon Health Authority, Public Health Division Opioid Prescribers Group March 19, 2014
  2. 2. 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
  3. 3. Unintentional or undetermined prescription opioid overdose death rate per 100,000 by year and sex and annual count by year, Oregon, 2000-2012
  4. 4. 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
  5. 5. Unintentional prescription opioid overdose hospitalization rate per 100,000 by year and sex and annual count by year, Oregon, 2000-2012
  6. 6. Average unintentional prescription opioid overdose hospitalization rate per 100,00 by age group and sex and annual count by age group, Oregon, 2010-2012
  7. 7. 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/
  8. 8. 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
  9. 9. Unintentional or undetermined prescription opioid and heroin overdose death rate by year, Oregon, 2000-2012
  10. 10. Primary diagnosis for unintentional prescription opioid and heroin overdose hospitalization rate by year, Oregon, 2000-2012
  11. 11. Increase in overdose death & hospitalization rates per 100,000 for selected drugs, OR, 2000 to 2011 Drug Deaths Hospitalizations 2000 2011 2000 2011 Heroin 0.8 3.1 3.8 0.6 1.8 2.8 Prescription opioid drugs 1.0 4.6 4.8 2.0 10.0 5.1 Methadone 0.5 2.1 4.2 0.3 2.4 7.6 Benzodiazepines 0 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 Alcohol 0.4 3.0 6.8 0.7 1.2 1.6
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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 47.1 286.3 1 Opioids include: Hydrocodone, Oxycodone, Morphine, Methadone, Fentanyl, and Hydromorphone. 2 Does not include methadone used to treat addiction. 3 Benzodiazepines include: Zolpidem, Lorazepam, Alprazolam, Clonazepam, Diazepam, and Temazepam. 4 Opioids include all listed above. Benzodiazepines include all listed above except Zolpidem which represents a chemically
  16. 16. Comparing overdose death rates per 100,000 by drug using NCHS population estimates and PDMP recipients, Oregon 2012
  17. 17. 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
  18. 18. 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
  19. 19. PDMP use and access data June 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
  20. 20. 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%
  21. 21. 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
  22. 22. 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
  23. 23. Number of PDMP queries by all disciplines, Oregon, Jan. 2012 to Dec. 2013, N=903,225
  24. 24. Average monthly number of PDMP queries per querying user by discipline, Oregon, Jan. – Dec. 2013
  25. 25. 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
  26. 26. 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
  27. 27. 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 award 2 April 2013 provider survey conducted by Acumentra Health and Oregon Health and Sciences University through a National Institutes of Health grant award.
  28. 28. 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.
  29. 29. 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
  30. 30. Same old Website
  31. 31. New landing page and login
  32. 32. Query page with new functions
  33. 33. Slightly revised liability statement
  34. 34. New patient query interface
  35. 35. New query Web output
  36. 36. New user management menu
  37. 37. Link and unlink delegates
  38. 38. Successfully linked delegates
  39. 39. Questions about the PDMP? Lisa Millet IVPP Section Manager Oregon Health Authority lisa.m.millet@state.or.us 503-572-8585 www.orpdmp.com

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