1. Diversion Alert

2. Prescription Monitoring Program Trends among Individuals Arrested in Maine for Trafficking Prescription Drugs, 2014 Christina Holt, MD, MSc 1, Kenneth McCall, PharmD 2, Stephanie Nichols, PharmD, BCPS, BCPP 3, Leslie Ochs, PhD, PharmD, BCPS 2, BCPS, Gary Cattabriga, BA 4, Chunhao Tu, PhD 2 1.Maine Medical Center, Department of Family Medicine, Portland, ME 2.College of Pharmacy, University of New England, Portland, ME 3.School of Pharmacy, Husson University, Bangor, ME 4.Center for Community & Public Health, University of New England, Portland, ME

3. Outline Background Study Objective Study Design Preliminary Findings

4. Number of Controlled Prescriptions (x1,000) : Maine PMP, 2006-2014 ‘Sedatives’ includes benzodiazepines and ‘z’ hypnotic drugs such as zolpidem.

5. Which category of drugs account for the most prescriptions in the PMP? 1.Sedatives 2.Opioids 3.Hypnotics 4.Stimulants

6. Number of Opioid Prescriptions (x1,000) : Maine PMP, 2006-2014 For comparative purposes, the Maine population estimated by the US Census Bureau: 2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000

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2010 & 2014 *Hydrocodone reclassified to DEA C-II in 2014, Tramadol reclassified to DEA C-IV in 2014, Propoxyphene withdrawn from US market in 2010 2010 2014

8. Which opioid has had the greatest increase in prescriptions over the last five years? 1.Hydrocodone 2.Oxycodone 3.Buprenorphine 4.Methadone

9. Number of Sedative Prescriptions (x1,000) : Maine PMP, 2006-2014 For comparative purposes, the Maine population estimated by the US Census Bureau: 2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000

10. Number of Sedative Prescriptions (x1000) by Product: Maine PMP, 2014

11. Benzodiazepine prescribing rates increased from 2010 to 2014 for which of the following demographic groups? 1.Men < 20 years old 2.Women < 20 years old 3.Women 20 to 50 years old 4.Women 60+ years old 5.Men 20 to 50 years old

12. Number of Stimulant Prescriptions (x1,000) : Maine PMP, 2006-2014 For comparative purposes, the Maine population estimated by the US Census Bureau: 2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000

13. Which is the fastest growing PMP category by prescription count from 2010 to 2014? 1.Sedatives 2.Opioids 3.Hypnotics 4.Stimulants

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

15. Background Proportion of state and local law enforcement agencies (1,226) reporting prescription drugs as the greatest drug threat, 2014* *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.http://www.dea.gov/resource-center/dir-ndta-unclass.pdf

16. 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.

17. 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).

18. Preliminary Findings

19. Drug Arrest Offenses: Maine, 2014* TOTAL = 2,003 Arrests *Source: Maine Diversion Alert Program

20. Drug Arrest Offenses: Maine, 2014

21. Myth: Drug diversion is almost entirely an urban problem.

22. Number of drug arrests involving Prescription Opioids mapped by municipality (N=363): Maine 2014 TOWNARRESTSARRESTS per 10K 1 Auburn135.64 Augusta63.14 Bangor288.48 Belfast*18*27.00 Brewer33.16 Caribou44.88 Ellsworth1519.38 Gardiner35.17 Gray67.73 Houlton1016.33 Lewiston308.20 Old Town45.10 Portland243.63 Presque Isle1515.48 Scarborough63.17 South Portland31.20 Swanville*5*36.02 Thomaston414.38 Waldoboro59.85 Wiscasset513.40 *Significant outlier (P<0.05) 1. Maine Municipality Population, 2010, US Census Bureau * *

23. Myth: Drug diversion is almost entirely an illicit drug problem.

24. Number of Trafficking Arrests by Substance: Maine, 2014 * *Unspecified Controlled Substance Number of Arrests

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

26. What is the most commonly diverted illicit drug in Maine, 2014? 1.Cocaine 2.Heroin 3.Cannabinoids 4.Cathinones

27. What is the most commonly diverted prescription opioid in 2014? 1.Hydrocodone 2.Oxycodone 3.Buprenorphine 4.Methadone

28. Myth: The majority of persons arrested for trafficking prescription drugs are men in their 20’s.

29. Demographics of Persons Arrests for Trafficking CII-CIV Drugs: Maine, 2014

30. Myth: The majority of persons arrested for trafficking prescription drugs are “Doctor shopping” and “Pharmacy hopping”

31. Proportion of Persons Arrested for Trafficking CII-CIV Drugs with Matching PMP Rxs within 90 Days of Arrest TOTAL = 295

32. Number of Pharmacies and Prescribers

33. Myth: The majority of persons arrested for trafficking pharmaceuticals are paying cash at the pharmacy.

34. Payment Method for Matching CII-CIV Prescription within 90 days of Arrest

35. W hich of the following statements is true regarding drug diversion in Maine, 2014? 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.

36. Questions?

37. Acknowledgments: Office of Substance Abuse, PMP Program Coordinator: John Liposky Diversion Alert Program, Executive Director, Clare Desrosiers