2008 International Symposium on Pharmaceuticals in the Home

PMP/TDS UpdateDebra Brucker, M.P.A., Ph.D.

Daniel Eccher, M.P.H.Maine Office of Substance Abuse

PMP Overview

• Data collection began July 1, 2004

• Data submitted by over 300 pharmacies in and out of state

• DEA Schedules II, III, and IV

• Patient-specific data directly accessible to a select few people (e.g., physicians)

• Intent: health care tool for reducing accessibility of controlled substances for non-medical use

PMP Limitations

• Accuracy and completeness of data up to pharmacies

• Many new data submitters came online in 2008

• No unique identifiers; no legal ID requirement

• Prescriptions written for various time periods and quantities – best way to analyze unknown

Overall CS Counts SFY08Patient Location Rx Count

Androscoggin 175,859Aroostook 135,701Cumberland 470,441Franklin 45,887Hancock 95,916Kennebec 210,785Knox 81,404Lincoln 64,981Oxford 97,115Penobscot 293,267Piscataquis 30,710Sagadahoc 59,383Somerset 90,023Waldo 65,774Washington 68,214York 314,250ME 2,299,710

Tranquilizer Rx Counts SFY08County Tranquilizer Count Population * Tranqs/personAndroscoggin 56,949 106,815 0.53Aroostook 44,951 72,047 0.62Cumberland 182,323 275,374 0.66Franklin 15,102 29,927 0.50Hancock 33,605 53,278 0.63Kennebec 71,347 120,839 0.59Knox 29,578 40,781 0.73Lincoln 22,149 34,800 0.64Oxford 31,692 56,734 0.56Penobscot 98,127 148,784 0.66Piscataquis 9,420 17,180 0.55Sagadahoc 20,954 36,387 0.58Somerset 28,901 51,658 0.56Waldo 20,810 38,511 0.54Washington 23,503 32,751 0.72York 116,657 201,341 0.58ME 806,068 1,317,207 0.61

SFY08 * 2007 Estimate

Lorazepam by Age GroupMaine Patients, SFY 2008

Drug Age Gp Rx CountLORAZEPAM 0 - 17 1,213LORAZEPAM 18 - 19 940LORAZEPAM 20 - 21 1,347LORAZEPAM 22 - 29 9,318LORAZEPAM 30 - 39 19,371LORAZEPAM 40 - 49 32,731LORAZEPAM 50 - 59 37,543LORAZEPAM 60 - 64 15,888LORAZEPAM 65 + 69,198TOTAL 187,549

ClonazepamMaine Patients, SFY 2008

Drug Age Gp Rx CountCLONAZEPAM 0 - 17 1,661CLONAZEPAM 18 - 19 1,485CLONAZEPAM 20 - 21 2,088CLONAZEPAM 22 - 29 17,525CLONAZEPAM 30 - 39 30,293CLONAZEPAM 40 - 49 42,067CLONAZEPAM 50 - 59 36,773CLONAZEPAM 60 - 64 10,531CLONAZEPAM 65 + 20,910TOTAL 163,333

AlprazolamMaine Patients, SFY 2008

Drug Age Gp Rx CountALPRAZOLAM 0 - 17 920ALPRAZOLAM 18 - 19 704ALPRAZOLAM 20 - 21 1,214ALPRAZOLAM 22 - 29 9,990ALPRAZOLAM 30 - 39 19,197ALPRAZOLAM 40 - 49 30,364ALPRAZOLAM 50 - 59 30,744ALPRAZOLAM 60 - 64 11,552ALPRAZOLAM 65 + 37,007TOTAL 141,692

DiazepamMaine Patients, SFY 2008

Drug Age Gp Rx CountDIAZEPAM 0 - 17 1,654DIAZEPAM 18 - 19 431DIAZEPAM 20 - 21 599DIAZEPAM 22 - 29 4,820DIAZEPAM 30 - 39 10,262DIAZEPAM 40 - 49 19,253DIAZEPAM 50 - 59 18,966DIAZEPAM 60 - 64 6,458DIAZEPAM 65 + 15,567TOTAL 78,010

Benzodiazepine Rx Counts: TrendsMaine Patients, 2004 - 2008

Drug Name (Generic) SFY05 SFY06 SFY07 SFY08Lorazepam 146,108 163,184 171,823 188,788Clonazepam 129,684 139,162 148,474 164,225Alprazolam 128,573 132,787 136,573 144,107Diazepam 69,355 70,947 73,241 78,532Temazepam 22,120 22,678 22,971 23,141Oxazepam 6,679 6,199 6,098 5,528Triazolam 5,137 4,893 4,695 5,070Chlordiazepoxide HCl 4,527 4,206 4,036 4,048Clorazepate Dipotassium 4,768 4,434 4,051 3,813Flurazepam HCl 2,007 1,668 1,552 1,429Diazepam (Anticonvulsant) 611 608 789 907Estazolam 486 382 353 345Midazolam HCl 42 52 55 32Quazepam 69 39 14 9All Benzodiazepines 520,166 551,239 574,725 619,974

All Benzodiazepines, Maine Pts.

0

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200,000

300,000

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700,000

SFY05 SFY06 SFY07 SFY08

STATE FISCAL YEAR

PR

ES

CR

IPT

ION

CO

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“Top 5” Benzos by Rx Count (Maine Patients, 2004 - 2008)

Generic Drug Name SFY05 SFY06 SFY07 SFY08Lorazepam 146,108 163,184 171,823 188,788Clonazepam 129,684 139,162 148,474 164,225Alprazolam 128,573 132,787 136,573 144,107Diazepam 69,355 70,947 73,241 78,532Temazepam 22,120 22,678 22,971 23,141

“Top 5” Benzos by Rx Count (Maine Patients, 2004 - 2008)

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40000

60000

80000

100000

120000

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200000

Lorazepam Clonazepam Alprazolam Diazepam Temazepam

GENERIC NAME

RX

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SFY05 SFY06 SFY07 SFY08

Treatment Data System (TDS)

• Data submitted to OSA by substance abuse treatment providers throughout Maine

• Government-funded programs required• Some privately funded programs voluntarily

submit• Monthly checks on accuracy and

completeness of data• Comprehensive picture of SA treatment in

Maine

Admissions to Treatment:Primary Drug = Benzodiazepine

Drug Name (Brand Name) 2006 2007 2008Alprazolam (Xanax) 29 49 45Diazepam (Valium) 13 22 10Lorazepam (Ativan) 4 10 11Other Benzodiazepine 29 39 26

Admissions to Treatment:Secondary Drug = Benzodiazepine

Drug Name (Brand Name) SFY06 SFY07 SFY08ALPRAZOLAM (XANAX) 150 168 166DIAZEPAM (VALIUM) 41 52 40LORAZEPAM (ATIVAN) 54 45 43OTHER BENZODIAZEPINE 132 167 229

Admissions to Treatment:Tertiary Drug = Benzodiazepine

Drug Name (Brand Name) SFY06 SFY07 SFY08ALPRAZOLAM (XANAX) 135 146 164DIAZEPAM (VALIUM) 47 47 42LORAZEPAM (ATIVAN) 22 32 20OTHER BENZODIAZEPINE 121 130 107

Treatment Admissions by Primary Drug, 1999 - 2008

0

500

1000

1500

2000

2500

3000

3500

4000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Marijuana Cocaine/Crack Heroin/Morphine Methadone

Opiates PCP or PCP Combo Hallucinogens Methamphetamine

Amphetamine Other Stimulants Benzo's Other Tranquilizers

Barbiturates Other Sedatives & Hypnotics Inhalants Over the Counter

Other Drugs

Questions?

debra.brucker@maine.gov

daniel.eccher@maine.gov

http://www.maine.gov/dhhs/osa/data

(207) 287-2595