CommStat 08/31/17 VERMONT PRESCRIPTION MONITORING SYSTEM QUARTERLY - PowerPoint PPT Presentation

CommStat 08/31/17

VERMONT PRESCRIPTION MONITORING SYSTEM QUARTERLY REPORT 2 ND QUARTER 2017 August 2017

Caveats  VPMS is a clinical tool  Includes only VT licensed pharmacies  Hubs (OTP) are not included – 42 CFR Part 2  Report is based on patient residence, not the prescriber or pharmacy location  Use number of prescriptions information with caution – it is not a full indication of how much is prescribed  Trend are shown in the annual report rather than quarterly reports 4 Data Source: VPMS 2017 Quarter 1 4

Definitions  Morphine Milligram Equivalent (MME) – the amount of morphine equivalent to the strength of opioid dose prescribed. Allows comparison between types and strengths of opioids.  50 MME/day is equivalent to:  10 tablets of hydrocodone/ acetaminophen 5/300  2 tablets of oxycodone sustained-release 15 mg  <3 tablets of methadone 5 mg  Rate per 100 Residents – allows a comparison between dissimilar sized entities. County Population Opioid Analgesic Rate Per Rx 100 Chittenden 161,382 20,578 12.8 Grand Isle 6,861 1,494 21.8 5 Data Source: VPMS 2017 Quarter 1 5

Vermont is in the bottom 5 states for non-medical use of pain relievers and the top 5 for heroin use Non Medical Use of Prescription Heroin Use Age 12+ (NSDUH* Pain Relievers Age 12+ (NSDUH* 2014/2015) 2013/2014) 3.50% 3.45% 3.40% 3.35% 3.30% 3.25% 3.20% 3.15% 3.10% 6 *National Survey on Drug Use and Health

Rate of Prescriptions Per 100 Residents by Drug Class During the Quarter OPIOID ANALGESIC MAT BENZODIAZEPINE STIMULANT ADDISON 13.1 4.2 8.2 6.3 BENNINGTON 15.8 13.9 12.1 9.9 CALEDONIA 13.7 2.5 7.8 7.2 CHITTENDEN 12.8 4.7 9.2 8.2 ESSEX 10.6 0.9 5.5 4.1 FRANKLIN 22.0 14.6 9.5 6.3 GRAND ISLE 21.8 10.6 9.3 7.8 LAMOILLE 14.8 8.2 8.3 7.3 ORANGE 10.9 3.8 8.5 6.1 ORLEANS 17.5 3.2 11.5 7.7 RUTLAND 18.1 8.8 12.1 7.2 WASHINGTON 13.9 4.3 11.3 8.7 WINDHAM 15.1 4.3 12.3 11.1 WINDSOR 10.1 5.9 7.5 4.8 Vermont 14.5 6.4 9.8 7.6 Opioid Analgesic: Opioid for pain relief Benzodiazepine: Sedative for anxiety, insomnia, & other conditions MAT: Buprenorphine to treat opioid use disorders Stimulants: Medication to increase alertness, attention, energy 7 Data Source: VPMS 2017 Quarter 2 7

Percent of Population Receiving At Least One Prescription in Drug Class During the Quarter OPIOID ANALGESIC MAT BENZODIAZEPINE STIMULANT ADDISON 5% 1% 4% 2% BENNINGTON 7% 1% 6% 3% CALEDONIA 6% 0% 4% 2% CHITTENDEN 5% 1% 5% 3% ESSEX 4% 0% 3% 1% FRANKLIN 7% 1% 4% 2% GRAND ISLE 8% 1% 5% 2% LAMOILLE 6% 1% 4% 3% ORANGE 5% 1% 4% 2% ORLEANS 7% 0% 6% 3% RUTLAND 7% 1% 6% 2% WASHINGTON 6% 1% 5% 3% WINDHAM 6% 1% 6% 4% WINDSOR 4% 1% 3% 2% Vermont 6% 1% 5% 3% Opioid Analgesic: Opioid for pain relief Benzodiazepine: Sedative for anxiety, insomnia, & other conditions MAT: Buprenorphine to treat opioid use disorders Stimulants: Medication to increase alertness, attention, energy 8 Data Source: VPMS 2017 Quarter 2 8

Average Days’ Supply and Daily Morphine Milligram Equivalent (MME) for Opioid Analgesics Average Days Supply Average MME 70 66 65 63 62 60 57 56 56 56 55 53 51 51 49 20 19 19 18 18 18 18 18 18 17 17 17 17 17 17 Morphine Milligram Equivalent (MME) – the amount of morphine an opioid dose is equal to when prescribed, often used as a gauge of the abuse and overdose potential of the amount of opioid that is being given at a particular time* Days Supply – the estimated number of days that the medication will last 9 Data Source: VPMS 2017 Quarter 2 9

Proportion of Opioid Analgesic Prescriptions in Daily Morphine Milligram Equivalent (MME) Categories Less Than 50 MME 50 to 90 MME Greater than 90 MME 55% 57% 63% 65% 64% 66% 67% 68% 68% 68% 68% 69% 70% 70% 72% 23% 27% 19% 19% 22% 19% 18% 20% 19% 17% 20% 19% 21% 18% 17% 20% 17% 17% 17% 14% 15% 14% 13% 13% 13% 12% 12% 11% 11% 11% Although there is not a single dosage threshold below which overdose risk is eliminated, holding dosages <50 MME/day is associated with a reduction in risk for fatal overdose than at higher prescribed dosages. Most experts also agreed that opioid dosages should not be increased to ≥90 MME/day without careful justification based on diagnosis 10 and on individualized assessment of benefits and risks. (CDC Guideline for Prescribing Opioids for Chronic Pain) Data Source: VPMS 2017 Quarter 2 10

Number of Prescriptions in Each Drug Class During the Quarter OPIOID ANALGESIC MAT BENZODIAZEPINE STIMULANT ADDISON 4,837 1,541 3,041 2,321 BENNINGTON 5,748 5,052 4,398 3,599 CALEDONIA 4,212 759 2,408 2,202 CHITTENDEN 20,578 7,638 14,897 13,191 ESSEX 652 53 342 252 FRANKLIN 10,729 7,126 4,627 3,064 GRAND ISLE 1,494 725 638 533 LAMOILLE 3,746 2,063 2,090 1,850 ORANGE 3,144 1,102 2,446 1,758 ORLEANS 4,735 878 3,113 2,083 RUTLAND 10,805 5,278 7,250 4,317 WASHINGTON 8,139 2,499 6,621 5,091 WINDHAM 6,550 1,873 5,315 4,830 WINDSOR 5,613 3,287 4,180 2,676 Vermont 90,996 39,885 61,373 47,779 Opioid Analgesic: Opioid for pain relief Benzodiazepine: Sedative for anxiety, insomnia, & other conditions MAT: Buprenorphine to treat opioid use disorders Stimulants: Medication to increase alertness, attention, energy 11 Data Source: VPMS 2017 Quarter 2 11

Feedback on Quarter 1 Please complete the survey on the usefulness of the Quarter 1 VPMS Report. Feedback is encouraged and will inform future quarterly reports. http://www.surveygizmo.com/s3/3807746/VPMS-Quarter- 1-Report-Usefulness-Survey 12 12

Contact VPMS  Programmatic questions can be directed to the program manager, Hannah Hauser at: Hannah.Hauser@vermont.gov or (802) 652-4147  Data-related questions can be directed to the program analyst, Lela Kretzer at: Lela.Kretzer@vermont.gov or (802) 863-6354 13 13

UVM MC Opioid Prescription Levels Number er of Opioid id Presc scrip iptio tions ns >50 Pills Per UVM MC Presc scriber iber 80 70 60 50 40 30 20 10 0 10/15-12/15 10/16-12/16 01/17-03/17 4/17-6/17 Data Source: UVM Medical Center

UVM MC Opioid Prescription Levels Number er of Opioid id Presc scrip iptio tions ns >50 Pills Per 3 Month th Period iod 1600 1305 1200 862 770 800 660 400 0 10/15-12/15 10/16-12/16 01/17-03/17 4/17-6/17 Data Source: UVM Medical Center

Chittenden Hub Active Waitlist Chittenden Hub Active Waitlist # and Avg Wait Days 160 138 130 140 120 93 87 100 84 80 80 71 62 59 53 58 75 58 60 67 67 41 40 47 44 23 20 0 # Waiting Average Days Waiting Median Days Waiting Data Source: Howard Center Triage Report

Chittenden Hub Admission List Chittenden Hub Admission List # and Avg Wait Days 60 53 46 50 46 43 40 40 39 38 40 37 35 34 35 28 30 25 23 20 23 21 15 14 10 0 # Admitted Average Days Waiting Median Days Waiting Data Source: Howard Center Triage Report

Number of People Treated in Hub & Spokes 1800 1600 498 514 1400 1200 984 1000 932 800 600 400 200 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2016 2017 Total Spoke Hub CHCB Community Lund Maple Leaf Total UVM MC Howard Spoke COGS ATP Data Source: Vermont Department of Health and Opioid Care Alliance of Chittenden County * Last reported value, not updated for month of May

EMS Overdose Incident Responses Monthly thly EMS Inciden idents ts with h Primar ary Provide ider Monthly thly EMS Inciden idents ts with h Primar ary Provide ider Impression of “Overdose / …” in VT , 2017 Imp mpression ession of “Overdose / …” in District 03 (Chitt ttenden nden Cty), ), 2017 130 130 126 120 120 110 110 100 100 90 90 80 80 70 70 60 60 59 50 50 40 40 30 30 28 20 20 12 10 10 0 0 May June July August May June July August Overdose / Opiate Overdose / Any Overdose / Opiate Overdose / Any Average Opiate Average Any Average Opiate Average Any Data Source: Siren Daily Reports

VT Opioid-Related Accidental Fatal OD Number er of Ac Accident dental al Fatal Over erdos doses es Invol olving ng Opioids ids in Vermont nt by Opioi oid d Type 120 106 110 100 102 90 80 75 75 69 69 70 61 61 61 61 60 50 50 42 42 50 41 41 38 38 40 30 20 10 0 2010 2011 2012 2013 2014 2015 2016 2017 (to May) All Opioids Rx Opioid (No Fentanyl) Heroin & Fentanyl Data Source: Vermont Department of Health

UVM MC Opioid Related ED Visits Monthly thly UVM Medical cal Center er ED Encount unter ers s Average age Monthl hly UVM Medica ical Center er Coded as “Opioid OD” & “Opioid Poisoning” Opioi oid-Coded Coded ED Encou ount nters ers 30 30 25 25 20 20 15 15 10 10 5 5 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 2016 2017 2017 15 & '16 Average Data Source: UVM MC ED