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

CommStat 08/31/17

August 2017

VERMONT PRESCRIPTION MONITORING SYSTEM

QUARTERLY REPORT 2ND QUARTER 2017

4

4

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

Data Source: VPMS 2017 Quarter 1

5

5

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.

Data Source: VPMS 2017 Quarter 1

County Population Opioid Analgesic Rx Rate Per 100 Chittenden 161,382 20,578 12.8 Grand Isle 6,861 1,494 21.8

6

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 Pain Relievers Age 12+ (NSDUH* 2013/2014) Heroin Use Age 12+ (NSDUH* 2014/2015)

*National Survey on Drug Use and Health

3.50% 3.45% 3.40% 3.35% 3.30% 3.25% 3.20% 3.15% 3.10%

7

7

Rate of Prescriptions Per 100 Residents by Drug Class During the Quarter

Data Source: VPMS 2017 Quarter 2 13.1 15.8 13.7 12.8 10.6 22.0 21.8 14.8 10.9 17.5 18.1 13.9 15.1 10.1 14.5 4.2 13.9 2.5 4.7 0.9 14.6 10.6 8.2 3.8 3.2 8.8 4.3 4.3 5.9 6.4 8.2 12.1 7.8 9.2 5.5 9.5 9.3 8.3 8.5 11.5 12.1 11.3 12.3 7.5 9.8 6.3 9.9 7.2 8.2 4.1 6.3 7.8 7.3 6.1 7.7 7.2 8.7 11.1 4.8 7.6 ADDISON BENNINGTON CALEDONIA CHITTENDEN ESSEX FRANKLIN GRAND ISLE LAMOILLE ORANGE ORLEANS RUTLAND WASHINGTON WINDHAM WINDSOR Vermont OPIOID ANALGESIC MAT BENZODIAZEPINE STIMULANT

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

8

Percent of Population Receiving At Least One Prescription in Drug Class During the Quarter

Data Source: VPMS 2017 Quarter 2

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

9

9

Average Days’ Supply and Daily Morphine Milligram Equivalent (MME) for Opioid Analgesics

17 18 18 17 20 17 17 18 19 19 17 18 18 18 17 56 53 51 66 57 70 65 56 49 56 62 51 55 63 60 Average Days Supply Average MME Data Source: VPMS 2017 Quarter 2 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

10

10

Proportion of Opioid Analgesic Prescriptions in Daily Morphine Milligram Equivalent (MME) Categories

Data Source: VPMS 2017 Quarter 2 13% 11% 11% 17% 13% 20% 17% 13% 11% 14% 14% 12% 12% 17% 15% 20% 19% 21% 19% 22% 23% 27% 19% 17% 18% 17% 18% 20% 19% 19% 67% 70% 68% 65% 64% 57% 55% 68% 72% 68% 69% 70% 68% 63% 66% Less Than 50 MME 50 to 90 MME Greater than 90 MME

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 and on individualized assessment of benefits and risks. (CDC Guideline for Prescribing Opioids for Chronic Pain)

11

11

Number of Prescriptions in Each Drug Class During the Quarter

Data Source: VPMS 2017 Quarter 2

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

12

12

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

13

13

 Programmatic questions can be directed to the program manager,

Hannah Hauser at: Hannah.Hauser@vermont.gov

• r

(802) 652-4147

 Data-related questions can be directed to the program analyst,

Lela Kretzer at: Lela.Kretzer@vermont.gov

• r

(802) 863-6354

Contact VPMS

10 20 30 40 50 60 70 80

Number er of Opioid id Presc scrip iptio tions ns >50 Pills Per UVM MC Presc scriber iber

10/15-12/15 10/16-12/16 01/17-03/17 4/17-6/17

UVM MC Opioid Prescription Levels

Data Source: UVM Medical Center

1305 862 770 660 400 800 1200 1600 10/15-12/15 10/16-12/16 01/17-03/17 4/17-6/17

Number er of Opioid id Presc scrip iptio tions ns >50 Pills Per 3 Month th Period iod

UVM MC Opioid Prescription Levels

Data Source: UVM Medical Center

Chittenden Hub Active Waitlist

Data Source: Howard Center Triage Report 138 130 93 87 62 53 59 80 84 71 58 58 41 23 67 75 67 44 47

20 40 60 80 100 120 140 160

Chittenden Hub Active Waitlist # and Avg Wait Days

# Waiting Average Days Waiting Median Days Waiting

Chittenden Hub Admission List

Data Source: Howard Center Triage Report 35 37 46 43 34 25 38 40 28 46 53 39 40 23 21 14 23 35 15

10 20 30 40 50 60

Chittenden Hub Admission List # and Avg Wait Days

# Admitted Average Days Waiting Median Days Waiting

Number of People Treated in Hub & Spokes

514 498 932 984 200 400 600 800 1000 1200 1400 1600 1800 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

* Last reported value, not updated for month of May

Data Source: Vermont Department of Health and Opioid Care Alliance of Chittenden County

EMS Overdose Incident Responses

12 28 10 20 30 40 50 60 70 80 90 100 110 120 130 May June July August

Monthly thly EMS Inciden idents ts with h Primar ary Provide ider Imp mpression ession of “Overdose / …” in District 03 (Chitt ttenden nden Cty), ), 2017

Overdose / Opiate Overdose / Any Average Opiate Average Any 59 126 10 20 30 40 50 60 70 80 90 100 110 120 130 May June July August

Monthly thly EMS Inciden idents ts with h Primar ary Provide ider Impression of “Overdose / …” in VT, 2017

Overdose / Opiate Overdose / Any Average Opiate Average Any

Data Source: Siren Daily Reports

VT Opioid-Related Accidental Fatal OD

41 41 61 61 50 50 69 69 61 61 75 75 106 42 42 38 38 102 10 20 30 40 50 60 70 80 90 100 110 120 2010 2011 2012 2013 2014 2015 2016 2017 (to May)

Number er of Ac Accident dental al Fatal Over erdos doses es Invol

• lving

ng Opioids ids in Vermont nt by Opioi

• id

d Type

All Opioids Rx Opioid (No Fentanyl) Heroin & Fentanyl Data Source: Vermont Department of Health

UVM MC Opioid Related ED Visits

5 10 15 20 25 30

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 2015 2016 2017

Monthly thly UVM Medical cal Center er ED Encount unter ers s Coded as “Opioid OD” & “Opioid Poisoning”

5 10 15 20 25 30

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Average age Monthl hly UVM Medica ical Center er Opioi

• id-Coded

Coded ED Encou

• unt

nters ers

2017 15 & '16 Average

Data Source: UVM MC ED

UVM MC Opioid Related ED Visits

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2015 2016 2017

Discharge Disposition of UVM MC ED Encounters With DX Code “Opioid OD/ Poisoning”, by Year

D/T COURT/LAW ENFORCEMENT D/T PSYCH HSP/PSYCH DIST PRT UNIT HSP w/PACHIPR TRANSFER OTH REHAB DISCH/TRAN TO SNF W/ MCR CERT DECEASED D/T DIFF TYPE HEALTHCARE FACILITY HOSPICE-HOME OTHER HOSPITAL AGAINST MEDICAL ADVICE PSY HOSP OR PSYCH DISTINCT UNIT HOME HEALTH CARE HOM HOME E OR OR S SEL ELF CA CARE ( RE (RO ROUT UTINE) INE) Data Source: UVM MC ED

UVM MC Opioid Related ED Visits

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul

2017 Discharge Disposition of UVM MC ED Encounters With DX Code “Opioid OD/ Poisoning”, by Month

DISCH/TRAN TO SNF W/ MCR CERT DECEASED D/T DIFF TYPE HEALTHCARE FACILITY PSY HOSP OR PSYCH DISTINCT UNIT AGAINST MEDICAL ADVICE HOM HOME E OR OR S SEL ELF CA CARE ( RE (RO ROUT UTINE) INE) Data Source: UVM MC ED

UVM MC Opioid Prescription Levels

984 1746 2215 1138 1447 2929 6123 3286 2000 4000 6000 8000 2014 2015 2016 2017 (Q1 & Q2)

Tot

• tal Numbe

mber of Clients ts and Kits s Distribut tributed ed by OOPRP PRP per Year

Total Clients Total Kits Dispensed Data Source: Vermont Department of Health

In Init itial 2018 Legislativ ive Considerations

25

• 1. Follow up on 2017 H468 / MAT in prison
• 1. Consistent 120d application across VT facilities
• 2. Consistent transition protocol
• 3. Consider operational changes as well – integrate DOC rep into triage team?
• 2. Enable Medicaid to be utilized for out-of-State treatment options when

supported by ASAM level assessment

• 3. Expand infrastructure for chronic mental health , addiction and co-occurring

diagnosis’

• 4. Explore means to extend treatment regimes, perhaps including by sentencing

guidelines (i.e., 21 days of treatment may not be impactful)

• 5. Documenting sobriety to change or shorten sentencing
• 6. Insurance industry incentives regarding pain management alternatives such as

acupuncture, reiki, massage therapy etc…

• 7. Enhancing Prevention Infrastructure

SubStat Opioid OD Incidents

2 4 6 8 10 12 14 16

Opioid-Related “Overdose” Calls Responded to by BPD, CPD, SBPD, MPD, EPD & WPD per SubStat Period

Overdose Incidents Data Source: Valcour Incident Report

25

Non-Fatal Opioid-Related Overdose Incidents Among SubStat Partners Since July 1st

3

Fatal Opioid-Related Overdose Incidents Among SubStat Partners Since July 1st

http://www.ecosproject.com/chittenden-county-opioid-alliance/scorecard-and-outcomes

Next CommStat Meeting

• 9/28 (Thursday) 8:30-11:00 AM
• Contois Auditorium