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Policy Evaluation: Ohio’s Pill Mill Law Cameron McNamee, MPP

May 21, 2013

Special Thanks

Ohio’s Drug Overdose Epidemic

327 411

555

702 658

904 1,020

1,261 1,351

1,475 1,423

1,544

1,765

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Year

Death Rate per 100,000

Number of Deaths

Source: ODH Office of Vital Statistics

The number of drug overdose

deaths in Ohio increased

440% from 1999-2011.

~5

deaths

per day

~1 per

day

HB 93 – Ohio’s Pill Mill Law 1. Requires the licensure of pain management

clinics by the Ohio Board of Pharmacy to address unscrupulous prescribers also known as “pill mills”. (Eff. 6/19/2011)

9.7 million doses of prescription pain medications were dispensed last year in the southern Ohio country of Scioto (population 79,000) in 2010.

9 “pain management clinics” in Scioto in 2010.

HB 93 – Ohio’s Pill Mill Law

2. Adoption of administrative rules whereby health care providers are required to utilize the state’s prescription drug monitoring program (OARRS – Ohio Automated Rx Reporting System) (Eff. 11/30/2011).

~15% of all prescribers were registered in the system in 2009.

HB 93 – Ohio’s Pill Mill Law

3. Creates a coordinated services program (also known as a “lock-in” program) for Ohio Medicaid and Bureau of Workers’ Compensation (Eff. 1/31/2012).

Why Do Policy Evaluation?

1. Demonstrating impacts and value of a policy.

2. Informing an evidence base.

3. Informing future policies.

Develop an Evaluation Plan

Evaluation Team

Evaluation Goals and Questions

Evaluation Design

Data Collection Plan

Data Analysis Plan

Dissemination Plan

Evaluation Timetable

Evaluation Team

• First step in the planning process.

• Identify your “core team”.

• Your core team will be involved from the beginning to the end.

Evaluation Team

• Ohio’s Core Team

Epidemiologist (expertise in quantitative methods and results).

Subject matter experts.

Policy experts.

Evaluation Team

• Additional members of the evaluation team

Data owners (Board of Pharmacy, Ohio BWC)

Implementers (Health Care Regulatory Boards)

Additional subject matter experts.

• Remember! Clearly define the roles of responsibilities of your team members.

Evaluation Goals and Questions

• Important to clarify the goals and expectations.

• HB 93 is a legislative policy that had already been implemented our evaluation focuses on short-term and intermediate outcomes with the hope of having an impact on long term changes.

Evaluation Goals and Questions

1. Did HB 93 increase the number of administrative actions/investigations by the Board of Pharmacy / State Medical Board related to prescription drug diversion/inappropriate prescribing?

Evaluation Goals and Questions

2. Did HB 93 increase the number of prescribers and pharmacists who are registered and review information in OARRS?

3. Did HB 93 decrease the amount of opioids prescribed (dispensed)?

Evaluation Goals and Questions

4. Did HB 93 decrease the prescribed doses of opioids Ohio Bureau of Workers’ Compensation patients?

5. Did HB 93 result in an overall cost savings for BWC?

Logic Model – Enactment of HB 93

Outputs

Establishment of Pill Mill Regulations / Authority to

Suspend Licenses

Adoption of PDMP Rules

Coordinated Services or “Lock In” Program

Established

Outcomes

Short Term

Investigations by Regulatory Boards

Increased Awareness of PDMP and Registration

Increased Awareness of Risks Associated with

Opioid Pain Medications

Outcomes

Intermediate

Increased License Revocations/Suspensions

Regulatory Boards

Increased Utilization of the PDMP

Reduction in Opioid Dispensing for BWC and

Cost Savings

Reduction in Opioid Dispensing for General

Population

Impacts

Long-Term

Reduction in Prescription Opioid Related Overdose Hospitalizations/ED Visits

Reduction in Prescription Opioid Related Overdose

Deaths

Evaluation Design

• Comparison of cross-sectional data from the period of one year before the bill’s enactment with one year after the bill’s enactment.

• Quasi-experimental design (i.e. time comparison).

Data Collection Plan

• Three data sources (2010, 2011, 2012):

1. Ohio Board of Pharmacy: PDMP opioid dispensing data, PDMP utilization and registration data and enforcement actions.

2. State Medical Board: investigations and administrative actions taken against prescribers.

3. Ohio Bureau of Workers’ Compensation: an analysis of claims data.

Data Analysis Plan

• Data owners have provided the aggregate results of the requested data.

• The Core Evaluation Team is in process of comparing the results from before and after the enactment of HB 93 and provide interpretation of the findings.

Dissemination Plan

• Report provided to members of the evaluation team

• Report provided to sponsors of the legislation as well as proponents of the bill

• Posted to the Department of Health’s Web Site

• Disseminated to the state wide injury prevention coalition

• Presented to the Governor’s Cabinet Opiate Action Team

• Presented to the Ohio Board of Pharmacy / Ohio State Medical Board

• Presented to the Director/Board of the Bureau of Workers Compensation

Evaluation Timetable • By December 30th, 2012, ODH will secure commitments

from stakeholders to serve on the evaluation team.

• By January 30th, 2013, ODH will submit a formal data request to external stakeholders outlining the types of data required to complete the evaluation.

• By May 1st, 2013, ODH will receive the requested data from external stakeholders and will begin analysis.

• By June 30th, 2013, submit final draft report to evaluation team and data owners for review and comment.

• By August 1st, 2013, disseminate report as outlined in the dissemination plan.

Lessons Learned…Thus Far • Be patient. Pulling data from multiple sources takes

time.

• Expect to change/modify your plan.

• Build relationships and secure commitments from data owners early.

• Consider alternate explanations for the findings/external factors.

Preliminary Findings

• Prescribers and Delegates – 39% increase in OARRS registration, 159% increase in patient reports requested.

• Pharmacists – 85% increase in OARRS registrations; 475% increase in patient reports requested.

Contact Information

Cameron McNamee

Violence and Injury Prevention Program

Ohio Department of Health

246 N. High Street, 8th Floor

Columbus, Ohio 43215

cameron.mcnamee@odh.ohio.gov