1. Maine’s Prescription Monitoring Program Maine Benzodiazepine Study Group Conference 2007 UPDATE Daniel J. Eccher, MPH Project Coordinator

2. Outline for Presentation Program overview Aggregate PMP data PMP data on benzodiazepines How health care providers can use patient- specific PMP data Time for questions at the end?

3. PMP Description Data collection since July 1, 2004 Data submission from over 300 pharmacies (100%) dispensing controlled substances in Maine (including out-of-state mail order and Internet pharmacies, and the VA-Togus Med. Cnt.) Schedules II-IV Data stored in centralized, relational database

4. OSA’s Goals for PMP Improve patient care by giving health care providers comprehensive information Curb prescription drug misuse Get those who are addicted into appropriate treatment

5. OSA’s Goals for PMP Help stop prescription drug overdoses Educate the public on the dangers of prescription drug abuse Ensure that those who do need prescription medications still receive them

6. PMP Database Description Patient identifiers: Name, DOB, Address(es) Prescriber identifiers: DEA number (from which we derive name) Drug identifiers: NDC Code, Name, dosage, days supply Pharmacy identifiers: Pharmacy DEA number, pharmacy address Possible to derive other info (e.g. patient county)

7. Drug Type Proportions (State of Maine, PMP Data, SFY07)

8. Drug Types Per Age Group (State of Maine: PMP Data, SFY07)

9. Maine’s PMP “Top 10” List (SFY 2007) DRUGCOUNTRX % OF TOTAL HYDROCODONE/ACETAMINOPHEN448,43020.73 LORAZEPAM173,2288.01 CLONAZEPAM149,8156.92 ALPRAZOLAM136,7296.32 OXYCODONE HCL127,5415.89 OXYCODONE/ACETAMINOPHEN124,4835.75 PROPOXYPHENE-N/ACETAMINOP100,5464.65 AMBIEN73,9663.42 DIAZEPAM73,9453.42 CONCERTA63,4112.93 TOTAL (for “Top 10”)1,472,09468.04

10. Prescriptions per Person by County (Maine PMP Data, SFY07) 1.40 1.79 1.63 1.67 1.59 1.70 1.56 1.81 1.60 1.40 1.56 1.62 1.51 1.54 1.70 1.83 State Average: 1.60 Scripts/Person

11. Benzodiazepines PMP Data

12. Benzodiazepines (PMP SFY 2006) Drug NameRx Count% Total Benzos Alprazolam132,61224.09% Chlordiazepoxide HCl4,1980.76% Clonazepam139,00925.25% Clorazepate Dipotassium4,4280.80% Diazepam70,85512.87% Diazepam (Anticonvulsant)6080.11% Estazolam3830.07% Flurazepam HCl1,6630.30% Lorazepam162,99929.61% Midazolam HCl520.01% Oxazepam6,1971.13% Quazepam390.01% Temazepam22,6494.11% Triazolam4,8820.89% Total Benzo's550,574100%

13. Benzodiazepines (PMP SFY 2006)

14. Benzodiazepines - Percent of Total (PMP SFY 2006)

15. Benzodiazepines (PMP SFY 2007) Drug NameRx Count% Total Benzos Alprazolam13619323.76% Chlordiazepoxide HCl40260.70% Clonazepam14808225.84% Clorazepate Dipotassium40470.71% Diazepam7308512.75% Diazepam (Anticonvulsant)7870.14% Estazolam3530.06% Flurazepam HCl15410.27% Lorazepam17129029.89% Midazolam HCl490.01% Oxazepam60891.06% Quazepam140.00% Temazepam228953.99% Triazolam46750.82% Total Benzo's573126100.00%

16. Benzodiazepines (PMP SFY 2007)

17. Benzodiazepines - Percent of Total (PMP SFY 2007)

18. Trend in Counts of Top 4 Benzos (SFY’s 2005 – 2007)

19. Please analyze our data … and then, publish the results.

20. Patient-specific PMP Data Using PMP data in the healthcare setting

21. Patient History Reports “Unsolicited” reports (automatically sent to prescribers) – Quarterly Patient Threshold Reports – Monthly Buprenorphine/Narcotics Reports (new) – Quarterly APAP Threshold Reports (in devlpmt.) “Solicited” reports – registration for anyone with a DEA number, including pharmacists; data available online, through secure portal

22. Registraton as a “Requestor” Go to: http://www.maine.gov/pmphttp://www.maine.gov/pmp Follow the “GHS Web Site” link. Scroll to the bottom and click the “Sign Up” button in the “New Users” section. Fill in the required information on the sequential forms. (Select “Requestor” in the User Type section; last step: entering DEA #.) Wait for confirmation by fax. (The approval process takes about two business days.)

23. Prescription Data Portal

24. Patient History Report

25. Registration as Requestors Free service Easy to use Immediate access to reports “Sub-accounts” allowed under prescriber accounts Of 6200+ eligible prescribers, only 1557 registered (about 25%)

26. OSA’s Focus: Treatment Addiction = disease (non-judgemental approach) Helping people find treatment Office of Substance Abuse - questions about PMP or how to find treatment options for a patient

27. OSA’s Treatment Resources OSA’s Web Site: http://www.maine.gov/dhhs/osawww.maine.gov/dhhs/osa Treatment Directory: “Find Help” link Information and Resource Center: Plethora of substance abuse literature Treatment team Treatment Data System

28. For more information about PMP, … … log on to our web site: http://www.maine.gov/dhhs/osa/data/pmp Or contact me: Phone: (207) 287-3363 Email: daniel.eccher@maine.govdaniel.eccher@maine.gov Any questions now?