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. Maine Medical Center, Department of Family Medicine, Portland, ME2. College of Pharmacy, University of New England, Portland, ME

3. School of Pharmacy, Husson University, Bangor, ME4. Center for Community & Public Health, University of New England, Portland, ME

Outline

• Background• Study Objective• Study Design• Preliminary Findings

Number of Controlled Prescriptions (x1,000): Maine PMP, 2006-2014

2006 2007 2008 2009 2010 2011 2012 2013 20140

500

1,000

1,500

2,000

2,500

3,000

2,0402,162

2,3422,442 2,533 2,471 2,475 2,371 2,437

Opioids Sedatives Stimulants

‘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. Sedatives2. Opioids3. Hypnotics4. Stimulants

Number of Opioid Prescriptions (x1,000): Maine PMP, 2006-2014

2006 2007 2008 2009 2010 2011 2012 2013 20140

200

400

600

800

1,000

1,200

1,400

1,1251,177

1,251 1,272 1,3101,223 1,205

1,1371,222

For comparative purposes, the Maine population estimated by the US Census Bureau:2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

416

532

350

393

160

95

74 66

66

45

39

41

53

35

37

27

19

9

769

Hydrocodone Oxycodone Buprenorphine TramadolMorphine Fentanyl Codeine MethadonePropoxyphene Hydromorphone Other

Number of Opioid Prescriptions (x1000) by Product: Maine PMP, 2010 & 2014

*Hydrocodone reclassified to DEA C-II in 2014, Tramadol reclassified to DEA C-IV in 2014, Propoxyphene withdrawn from US market in 2010

2010

2014

Which opioid has had the greatest increase in prescriptions over the last five years?

25%

25%

25%

25% 1. Hydrocodone2. Oxycodone3. Buprenorphine4. Methadone

Number of Sedative Prescriptions (x1,000): Maine PMP, 2006-2014

2006 2007 2008 2009 2010 2011 2012 2013 20140

200

400

600

800

1,000

708757

830882 904 902 897

857820

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

210

178142

133

79

16 1218

Lorazepam

Clonazepam

Zolpidem

Alprazolam

Diazepam

Temazepam

Eszopiclone

Other

Benzodiazepine prescribing rates increased from 2010 to 2014 for which of the following demographic groups?

20%

20%

20%

20%

20% 1. Men < 20 years old2. Women < 20 years old3. Women 20 to 50 years old4. Women 60+ years old5. Men 20 to 50 years old

Number of Stimulant Prescriptions (x1,000): Maine PMP, 2006-2014

2006 2007 2008 2009 2010 2011 2012 2013 20140

100

200

300

400

207228

261288

319346

373 377395

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. Sedatives2. Opioids3. Hypnotics4. Stimulants

Number of Stimulant Prescriptions (x1000) by Product: Maine PMP, 2014

145

129

79

36

6

MethylphenidateDextro/amphetamineLisdexamfetamineDexmethylphenidateOther

BackgroundProportion of state and local law enforcement agencies (1,226) reporting prescription drugs

as the greatest drug threat, 2014*

US NE0%

5%

10%

15%

20%

25%

30%

35%

21%

33%

*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 de-identified for analysis.

• University of New England Institutional Review Board (IRB #090914-011).

Preliminary Findings

Drug Arrest Offenses: Maine, 2014*

594

1313

96

TraffickingPossessionOther

TOTAL = 2,003 Arrests*Source: Maine Diversion Alert Program

3%

9%1%

17%

66%

5%

2,003 Total Arrests

Rx trafficking - PMP matchRx trafficking - no PMP matchOther traffickingIllicit traffickingPossessionNon-possession, non-traffick-ing offense

Drug Arrest Offenses: Maine, 2014

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 13 5.64 Augusta 6 3.14 Bangor 28 8.48 Belfast* 18 *27.00 Brewer 3 3.16 Caribou 4 4.88 Ellsworth 15 19.38 Gardiner 3 5.17 Gray 6 7.73 Houlton 10 16.33 Lewiston 30 8.20 Old Town 4 5.10 Portland 24 3.63 Presque Isle 15 15.48 Scarborough 6 3.17 South Portland 3 1.20 Swanville* 5 *36.02 Thomaston 4 14.38 Waldoboro 5 9.85 Wiscasset 5 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

Heroin

Oxycodone

Cannabinoids

Buprenorphine

Alprazolam

0 20 40 60 80 100 120 140 160 180

166110110

7743

3021

1855

*

*Unspecified Controlled Substance

Number of Arrests

Trafficking Drug Arrests including furnishing, distribution, selling: Maine, 2014

235

346

13

Rx CII-IVIllicitOther

TOTAL = 594

What is the most commonly diverted illicit drug in Maine, 2014?

25%

25%

25%

25% 1. Cocaine2. Heroin3. Cannabinoids4. Cathinones

What is the most commonly diverted prescription opioid in 2014?

25%

25%

25%

25% 1. Hydrocodone2. Oxycodone3. Buprenorphine4. 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

Age

Sex

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

10

Male: 155 (66%)

87

Female: 80 (34%)

88 35 11

22

10s 20s 30s 40s 50s 60s 70s

Mean age = 33 years

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%)

178(76%)

MatchNonMatch

TOTAL = 295

Number of Pharmacies and Prescribers

Prescribers

Pharmacies

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

31

35

25

22

1

1 2 to 4 >4

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

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

28 19 5 5

Commercial Medicaid Medicare Cash

Which of the following statements is true regarding drug diversion in Maine, 2014?

20%

20%

20%

20%

20% 1. Drug diversion is almost entirely an illicit drug problem.

2. Drug diversion is almost entirely an urban problem.

3. A majority of persons arrested for trafficking drugs are men in their 20s

4. A majority of persons arrested for trafficking Rx drugs use only 1 pharmacy and 1 prescriber.

5. The majority of persons arrested for trafficking pharmaceuticals are paying cash at the pharmacy.

Questions?

Acknowledgments:

• Office of Substance Abuse, PMP Program Coordinator: John Liposky

• Diversion Alert Program, Executive Director, Clare Desrosiers