All about the Data: Opioid Prescribing Trends and Other Opioid Outcome Metrics for Arkansas

Data Sources ADH: Other AR Data: National: Vital Statistics PDMP ED and Hospital Discharge EMS Other AR Data: Crime Lab National: CDC Wonder Medicare Part D CDC National Center for Health Statistics National Inpatient Sample

CDC Prescribing Rate is based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the United States. For this database, a prescription is an initial or refill prescription dispensed at a retail pharmacy in the sample and paid for by commercial insurance, Medicaid, Medicare, or cash. 2018 number should be available in late summer of 2019. *Does not include buprenorphine products

*Raw Data from AR PDMP

Total Morphine Milligram Equivalents Dispensed Total Morphine Milligram Equivalents Dispensed* in Arkansas for a Specific Year *Note: Filled by AR residents Source: Arkansas Prescription Drug Monitoring Program

*Note: Filled by AR residents

Top-Selling* Prescription Drugs by Class in Arkansas in 2018 Rank Drug Type Pills Sold Number of prescriptions 1 Opioid 186,424,459 3,283,428 2 Benzo 86,029,755 1,739,022 3 Stimulant 26,846,338 762,057 4 Zolpidem 14,236,720 499,592 5 Muscle Relaxant 5,869,053 93,071 Total   319,406,325 6,377,170 *Note: Filled by AR residents Source: Arkansas Prescription Drug Monitoring Program

Neonatal Abstinence Syndrome

Incidence of NAS by primary payer. Data Source: 2004–2014 hospital birth data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States (N = 13 102 793) Incidence of NAS by primary payer. Tyler N.A. Winkelman et al. Pediatrics 2018;141:e20173520 ©2018 by American Academy of Pediatrics

NAS by County

NAS Demographics

Opioid Prescribing to Women of Reproductive Age *Raw Data from AR PDMP

Drug Overdose Death Rate vs Motor Vehicle-Related Death Rate for AR

Age-Adjusted Drug Overdose Death Rate

Drug Overdose Death Rate by Demographics Source: ADH Vital Statistics

Rate per 100,000 people of naloxone administrations by Emergency Medical Services (EMS) personnel by county 2017 and 2018 *Note: These data include all instances naloxone was administered by EMS personnel. Naloxone may have been administered for non-opioid overdoses. SOURCE: Arkansas Department of Health Emergency Medical Services and Trauma Branch

Drugs Involved in Fatal Overdoses among AR Residents in 2016 Source: ADH Vital Statistics

Non-Fatal Heroin Overdose Rate from ED hospital discharge data using ICD9/ICD10 Codes Source: ADH and National Statistics System Mortality File

Non-Fatal Heroin Overdose Rate by Demographics

Homicides vs. Drug Overdoses MEDICAL EXAMINER Autopsies Conducted 2014 – 2018 Homicides vs. Drug Overdoses Homicides Drug Overdoses

MEDICAL EXAMINER Autopsies Conducted 2014 – 2018 Drug Overdose Trends Heroin Fentanyl Methamphetamine

Antibiotic and Opioid Prescription Patterns

Takeaway Points The number of opioid prescriptions issued monthly from AR prescribers to AR patients is on the decline, going from roughly a little over 250,000 opioid prescriptions per month in 2014 to close to 220,000 opioid prescriptions per month in the later portions of 2018. That is a 12% decrease of opioid prescriptions in 4 years. The average number of opioid prescriptions per AR prescriber has decreased from about 50 per month to closer to 40 in the end of 2018. The number of days’ supply of opioids per prescription is high and climbing slightly, going from around 17 days’ supply per prescription to over 18 days’ supply per prescription in 2018. The number of Arkansans on chronic opioid therapy in any given 6 month period is between 120,000 to 130,000 and is relatively stable in numbers. However, even at its lowest, that number shows that almost 4% of Arkansans are on chronic opioids in any given 6 month period. NAS is on the rise, being documented more systematically, or both. Uptake in administration of naloxone has been extensive. Overdoses are on the rise, particularly for heroin and likely fentanyl.

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