1. Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication of Community Care Behavioral Health (CCBH) Study Matthew O. Hurford, M.D. Chief Medical Officer, CBH Assistant Professor, Univ. of Penn.

2. Objective Identify Community Behavioral Health (CBH) Members in Philadelphia who are in methadone treatment and concurrently on benzodiazepines or opiates.

3. Data sources Anaylsis period: July 1, 2010 – September 30, 2010 Paid methadone clinic claims from all contracts for the analysis period. Paid Medicaid pharmacy claims for the analysis period.

4. Methodology Identify members in methadone treatment for at least ten days in Q3 2010. Identify members in the above population who also filled prescriptions for benzodiazepines or opiates during the same period. Generate a distribution based on methadone providers in all the contracts. Generate age group, gender, and racial distributions for the above population. Identify the benzodiazepines and opiates used. Identify physicians and specialties to the extent possible. Although this analysis was included in the original study by CCBH, CBH’s data warehouse contains very little information of this kind. Therefore, we were unable to produce a meaningful replication of this analysis.

5. Results Table 1 shows the distribution of members in methadone treatment and those with concurrent benzodiazepine or opiate prescriptions during the analysis period, by Philadelphia zip code.

6. Table 1

7. Table 1, continued

8. Results Tables 2, 3, and 4 show demographics for members with concurrent methadone and benzodiazepine/opiate usage.

9. Table 2: Age Distribution Table 2:

10. Table 3: Gender Distribution

11. Table 4: Racial Distribution

12. Results Table 5 shows the methadone provider distribution.

13. Table 5

14. Results Table 6 shows the distribution of members based on whether a benzodiazepine or opiate was prescribed. (Benzo = 1 if the member had a prescription for a benzodiazepine; otherwise Benzo = 0. Opiate = 1 if the member had a prescription for an opiate; otherwise Opiate = 0.)

15. Table 6

16. Results Tables 7 and 8 show the details of the benzodiazepines or opiates prescribed. Members had 2497 benzodiazepine prescriptions and 3067 opiate prescriptions.

17. Table 7: Benzodiazepines

18. Table 8: Opiates

19. Comparison with CCBH Data CCBH shows that 45.8% of MAT patients have concurrent prescriptions for benzodiazepines or opiates. CBH shows that 45.6% of MAT patients have concurrent benzodiazepine or opiate prescriptions.

20. Comparison with CCBH Data CCBH shows 44.9% of MAT patients with concurrent prescriptions for benzodiazepines or opiates are ages 18-34; for CBH that number is 31.7%. CCBH shows 31.3% of patients with concurrent scripts are ages 35-50 having concurrent scripts; for CBH that number is 42.2%. CCBH shows 23.5% of MAT with concurrent scripts are 51-64; for CBH that number is 25.5%. CCBH shows 0.3% of MAT patients having concurrent scripts are 65 or older; for CBH that number is 0.5%.

21. Comparison with CCBH Data CCBH shows 57.6% of MAT patients having concurrent scripts are female, whereas CBH shows 58.9% of patients who have concurrent scripts are female. Percentages for male patients are 42.4% and 41.1%, respectively.

22. Comparison with CCBH Data CCBH found that 7% of patients having concurrent scripts were African-American. 87.3% were Caucasian, and 5.8% fell into other racial categories. CBH found that 22.5% of patients with concurrent scripts were African-American or Black, 60.7% were Caucasian, and 16.8% fell into other racial categories. Note that racial categories are constructed differently in the two BH/MCOs.

23. Comparison with CCBH Data CCBH providers contributed 0.1% to 33.1% to the sample. CBH providers contributed a range of 2.87% to 22.5%.

24. Comparison with CCBH Data 27.7% of CCBH’s patients with concurrent scripts had a prescription for an opiate. 50.2% had a prescription for a benzo. 22% had a prescription for both. In CBH, 27.8% of patients with concurrent scripts had a prescription for an opiate. 41.9% had a prescription for a benzo. 30.3% had a prescription for both.

25. Comparison to CCBH Data Of 3313 concurrent benzo scripts in CCBH, clonazepam was prescribed the most often, at 17.3% The same was true for CBH, where clonazepam made up 38.4% of concurrent benzo scripts.

26. Comparison to CCBH Data CCBHCBH Alprazolam12.4%33.7% Lorazepam2.7%7.4% Temazepam2%9.9% Diazepam1.6%7.2% Triazolam0.2%0.7% Flurazepam<0.1%0.4% Chlordiazepoxide <.01%0.3% Oxazepam<0.1%----- Estazolam-----0.3% Clorazepate-----<0.1%

27. Comparison to CCBH Data Of 1737 concurrent opiate scripts in CCBH, 19% were for hydrocodone. 21.5% of CBH’s concurrent opiate scripts were for hydrocodone; CBH members were more likely to have scripts for oxycodone (30.2%).

28. Comparison to CCBH Data CCBHCBH Oxycodone17.6%30.2% Tramadol4.7%13.8% Codeine3%14.4% Buprenorphine2.4%5.7% Methadone1.3%5.5% Propoxyphene0.8%4.1% Hydromorpohone0.6%----- Fentanyl0.5%1.2% Morphine-----2.2% Diphenoxylate-----0.9% Meperidine-----0.2% Naltrexone-----<0.1% Oxymorphone-----<0.1%