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URL:https://www.deadiversion.usdoj.gov/...ne_alert/2008/droz.pdf
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Modified:2013-07-08 11:40:36
Categories:-None-
Title:Methadone and Ohio's Experience
Description:Methadone and Ohio's Experience
Keywords:methadone
Meta data:-None-
Body:Methadone and Methadone and Ohio Ohio ' ' s Experience s Experience

Danna E. Droz, RPh, JD Danna E. Droz, RPh, JD PMP Administrator, Ohio State Board of Pharmacy PMP Administrator, Ohio State Board of Pharmacy

614 614 - - 466 466 - - 4143; 4143; exec@ohiopmp.gov exec@ohiopmp.gov

Methadone Methadone " " Alert Alert " " Conference Conference November 13 November 13 - - 14, 2008 14, 2008

Number of Methadone Prescribers Number of Methadone Prescribers

0

500

1,000

1,500

2,000

2,500

3,000

2006 Q1 2006 Q2 2006 Q3 2006 Q4 2007 Q1 2007 Q2 2007 Q3 2007 Q4 2008 Q1 2008 Q2

5

10

40

Liq

Source: Ohio Automated Rx Reporting System

FDA Alert Nov 2006

Jan 2008 40mg Distribution restricted

Number of Patients Number of Patients Receiving Methadone Receiving Methadone

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2006 Q1 2006 Q2 2006 Q3 2006 Q4 2007 Q1 2007 Q2 2007 Q3 2007 Q4 2008 Q1 2008 Q2

5 mg

10mg

40 mg

Liq

Source: Ohio Automated Rx Reporting System

FDA Alert Nov 2006

Jan 2008 40mg Distribution restricted

Number of Prescriptions Number of Prescriptions for Methadone for Methadone

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2006 Q1 2006 Q2 2006 Q3 2006 Q4 2007 Q1 2007 Q2 2007 Q3 2007 Q4 2008 Q1 2008 Q2

5

10

40

Liq

Source: Ohio Automated Rx Reporting System

FDA Alert Nov 2006

Jan 2008 40mg Distribution restricted

Doses of Methadone Dispensed Doses of Methadone Dispensed

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

2006 Q1 2006 Q2 2006 Q3 2006 Q4 2007 Q1 2007 Q2 2007 Q3 2007 Q4 2008 Q1 2008 Q2

5

10

40

Liq

Source: Ohio Automated Rx Reporting System

FDA Alert Nov 2006

Jan 2008 40mg Distribution restricted

Death rates Death rates 1 1 for leading causes of injury for leading causes of injury death by year, Ohio 1989 death by year, Ohio 1989 - - 2007* 2007* 2 2

* preliminary 2007 data; numbers may increase

1 per 100,000 2 Source: ODH Office of Vital Statistics

Number of leading causes of injury Number of leading causes of injury death by year, Ohio, 1999 death by year, Ohio, 1999 - - 2007 2007 1* 1*

1 Source: Ohio Dept of Health, Office of Vital Statistics * preliminary 2007 data; numbers may increase

Poison death rates (per 100,000) of Ohio Poison death rates (per 100,000) of Ohio residents by manner, year, 1999 residents by manner, year, 1999 - - 2005* 2005*

*Source: WISQARS

Number of Unintentional Poisoning Deaths Number of Unintentional Poisoning Deaths by Substance, year, Ohio, 1999 by Substance, year, Ohio, 1999 - - 2006 2006 *Source: Ohio Dept of Health, Office of Vital Statistics **includes alcohol poisoning

From 334 in 1999 to 1,261 in 2007 - unintentional drug/medication- related deaths increased 277%.

Ohio Department of Health Injury Prevention Program 10

Unintentional drug/medication poisoning Unintentional drug/medication poisoning deaths by sex, Ohio, 1999 deaths by sex, Ohio, 1999 - - 2005 2005

Source: CDC WONDER

Number of admissions for Number of admissions for substance abuse treatment for non substance abuse treatment for non - - heroin opiates, heroin opiates, Ohio, 1993 Ohio, 1993 - - 2006* 2006*

*SOURCE: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 10.3.06.

Cumulative distribution of scheduled opioids Cumulative distribution of scheduled opioids in grams per 100,000 population by drug, in grams per 100,000 population by drug, year, Ohio, 1997 year, Ohio, 1997 - - 2007* 2007*

*Data for drug not available for 2000; average of '99 and '01 shown +data only for 2002, 2005-07

Source: DOJ, DEA, ARCOS reports

Percent change in cumulative distribution of Percent change in cumulative distribution of scheduled opioids in grams per 100,000 scheduled opioids in grams per 100,000 population by drug, Ohio, 1997 to 2007* population by drug, Ohio, 1997 to 2007*

+data only for 2005 to 2007

Source: DOJ, DEA, ARCOS reports

Number of unintentional poisoning deaths Number of unintentional poisoning deaths with specific drugs mentioned on death with specific drugs mentioned on death certificate by year, Ohio, 2000 certificate by year, Ohio, 2000 - - 2007* 2007*

1 Source: ODH Office of Vital Statistics

2 preliminary data for 2007; numbers may increase

*includes only cases where no other drug/medicament than other/unspecified is listed as contributing cause of death

Percent change in number of unintentional fatal drug Percent change in number of unintentional fatal drug - - related poisonings with specific drugs mentioned on related poisonings with specific drugs mentioned on death certificate, Ohio, from 2000 to 2007 death certificate, Ohio, from 2000 to 2007 1,2 1,2

1 Source: ODH Office of Vital Statistics

2 preliminary data for 2007; numbers may increase

*includes only cases where no other drug/medicament than other/unspecified is listed as contributing cause of death

Proportion of all unintentional poisoning deaths in Proportion of all unintentional poisoning deaths in which drug is mentioned on death certificate, which drug is mentioned on death certificate, Ohio 2007* Ohio 2007* 1 1 1 Source: ODH Office of Vital Statistics

2 preliminary data for 2007

*

Proportion of all unintentional poisoning Proportion of all unintentional poisoning deaths in which drug is mentioned on death deaths in which drug is mentioned on death certificate by year, Ohio 2000 certificate by year, Ohio 2000 - - 07* 07* 1 1

1 Source: ODH Office of Vital Statistics

2 preliminary data for 2007; numbers may increase

* Oth and unspecified includes only cases where no other drug/medicament than other/unspecified is listed as contributing cause of death

A Face on the Problem A Face on the Problem 14 14 - - yr old Caitlin yr old Caitlin Holdren Holdren of Logan, OH died in her of Logan, OH died in her sleep from a methadone sleep from a methadone OD OD Took 8 Took 8 - - 1/2 pills from a 1/2 pills from a friend at a football game friend at a football game Friend obtained drug from Friend obtained drug from grandfather grandfather ' ' s medicine s medicine cabinet cabinet Friend charged for Friend charged for providing narcotics providing narcotics

"A 14 "A 14 - - year year - - old girl is not going to old girl is not going to have the means to purchase drugs, have the means to purchase drugs, but she does have the ability to get but she does have the ability to get into her family's pill cabinet," into her family's pill cabinet," Cummin Cummin said. "If you're going to said. "If you're going to lock up your gun to prevent lock up your gun to prevent someone from shooting themselves someone from shooting themselves or children from shooting each or children from shooting each other, you should lock your other, you should lock your narcotics up. narcotics up. " "

Dr. David Dr. David Cummin Cummin , MD, Hocking County , MD, Hocking County Coroner Coroner

What we know so far.. What we know so far.. Overall Overall -- -- #1 poisonings involve medications #1 poisonings involve medications Increased access to opioid medications from Increased access to opioid medications from late late ' ' 90 90 ' ' s on s on Increase in medication abuse by youth and Increase in medication abuse by youth and adults adults - - don don ' ' t expect problem to subside t expect problem to subside anytime soon anytime soon Ohio Ohio ' ' s rates are greater than US; particularly s rates are greater than US; particularly in Southern Ohio in Southern Ohio All age groups and races are affected by All age groups and races are affected by prescription drug use/abuse. prescription drug use/abuse.

What we know so far.. What we know so far.. Males at higher risk for death; females Males at higher risk for death; females hospitalized more. hospitalized more. Black males aged 45 Black males aged 45 - - 54 have the highest 54 have the highest death rates of all. death rates of all. Most deaths are associated with Most deaths are associated with opiods opiods /narcotics. /narcotics. Most rapid increases associated with Most rapid increases associated with synthetic synthetic opiods opiods (e.g., Methadone, Fentanyl) (e.g., Methadone, Fentanyl) Multiple substance use ( Multiple substance use ( polypharmacy polypharmacy ) is a ) is a factor in many of these deaths, complicating factor in many of these deaths, complicating issue. issue. Polypharmacy Polypharmacy is a risk factor for fatal is a risk factor for fatal overdose. overdose.

Lessons Lessons Learned by Others Learned by Others

. . Regulated prescription drugs taken mostly Regulated prescription drugs taken mostly by mouth can produce a larger overdose by mouth can produce a larger overdose epidemic than illicit drugs of uncertain epidemic than illicit drugs of uncertain strength taken intravenously, such as strength taken intravenously, such as heroin. heroin.

. . Just as a drug that is efficacious in clinical Just as a drug that is efficacious in clinical trials may not be effective in the trials may not be effective in the community, drugs community, drugs " " safe safe " " in terms of in terms of abuse in controlled settings may be abuse in controlled settings may be abused in the community. abused in the community.

From: From: " " Addressing the Problem Addressing the Problem " " , , Drug Overdose Deaths: The Allegheny Drug Overdose Deaths: The Allegheny County and National Experience, County and National Experience, May 2008 May 2008

Epidemiology of opioid use Epidemiology of opioid use versus opioid abuse versus opioid abuse

. Males are more likely to abuse and overdose with opioids; females are more likely to use.

. People in 20s and 40s are more likely to abuse opioids; people over 65 are more likely to use.

. Many people dying of prescription overdoses have a history of substance abuse.

. Overdoses are therefore more likely to represent abuse than overmedication.

From: From: " " Addressing the Problem Addressing the Problem " " , , Drug Overdose Deaths: The Allegheny Drug Overdose Deaths: The Allegheny County and National Experience, County and National Experience, May 2008 May 2008

Using PMP Data Using PMP Data in Drug Diversion Investigations in Drug Diversion Investigations Large numbers do not equal diversion Large numbers do not equal diversion Sometimes PMP data supports Sometimes PMP data supports anecdotal evidence anecdotal evidence Sometimes PMP data indicates Sometimes PMP data indicates potential investigations potential investigations PMP data can increase the efficiency PMP data can increase the efficiency of a diversion investigation of a diversion investigation PMP data PMP data cannot cannot document diversion document diversion

Large PMP Large PMP numbers numbers do not do not equal diversion equal diversion

Doctor shopping? Doctor shopping?

Patient A Patient A . . 217 prescriptions in the past 217 prescriptions in the past 12 months 12 months

. . Drugs include long acting Drugs include long acting opioids, short acting opioid, opioids, short acting opioid, and benzodiazepine/sedative and benzodiazepine/sedative

Not doctor shopping Not doctor shopping BUT Patient A BUT Patient A . . Utilized 1 physician Utilized 1 physician and 2 pharmacies and 2 pharmacies

. . Each dispensing was Each dispensing was only 7 day supply only 7 day supply

Sometimes Sometimes PMP data PMP data supports supports anecdotal anecdotal evidence evidence

Data includes all of 2006, and all CS, carisoprodol, and tramadol

2006 PMP Data 2006 PMP Data

Source: Ohio Automated Rx Reporting System

PMP data PMP data can supplement an can supplement an investigation investigation

ABC ABC ABC ABC

ABC ABC ABC ABC

ABC ABC ABC ABC

ABC ABC ABC ABC

XYZ Pharmacy Prescriber Zip codes 2005-2006

XYZ Leader Pharmacy Patient Zip codes 2005-2006

Sometimes Sometimes PMP data PMP data indicates indicates potential potential investigations investigations

A C D E R

Phar maci es

Pr escr i ber s 1 2 6

8 8

8 3 8 2 8 0

4 1

5 8 6 5

4 8 5 3

0

20

40

60

80

100

120

140

IN D IV ID UA LS

TOP PRESCRIBER/PHARMACY COMBINATIONS 7/1/2006-6/30/2007

Source: Ohio Automated Rx Reporting System

D L X Y Z

Phar maci es

Pr escr i ber s 5 2

4 3 4 3

4 0 4 0

4 3

2 9

2 4 2 2

1 7

0

10

20

30

40

50

60

IN D IV ID UA LS

PRESCRIBERS-PHARMACIES FOR CII

7/ 1/ 2006-6/ 30/ 2007

Source: Ohio Automated Rx Reporting System

Take Take - - home message home message PMP data can substantiate an PMP data can substantiate an allegation of diversion allegation of diversion PMP data can increase the PMP data can increase the efficiency of a diversion efficiency of a diversion investigation investigation PMP data cannot document PMP data cannot document diversion diversion - - investigation is still investigation is still necessary necessary

QUESTIONS? QUESTIONS?