How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Jennifer Donnelly, MPH Assistant Director K-TRACS Kansas Board of Pharmacy Kansas Association of Osteopathic Medicine Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Background Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
In The News… Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds Congress searches for prescription to help fight growing opioid epidemic
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic U.S. Drug Overdose Deaths 1980 – 2018 (Provisional) Beginning of the Opioid Crisis Crack-cocaine epidemic Image Source: https://www.nytimes.com/interactive/2019/07/17/upshot/drug-overdose-deaths-fall.html Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic A “Fourth Wave?” Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Opioid- Involved Deaths Are “The Tip of the Iceberg” People died every day in 2017 from an 130 + opioid-involved overdose 81,000 People used heroin for the first time in 2016 11.4 People misused prescription opioids in 2016 million Increase in overdose Deaths involving 37 % psychostimulants between 2016 & 2017 Image Source: Gregory Reid (https://www.aarp.org/health/drugs-supplements/info-2017/opiates- prescription-pain-medication-information.html Data Source: https://www.hhs.gov/opi1oids/about-the-epidemic/index.html Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Implementation of the Kansas Prescription Drug Monitoring Program (2008- 2019) Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic VOLUNTARY controlled substance registry that is available 24/7 through a web based portal. Primary goals are: ▪ Provide education and information to prescribers and pharmacies ▪ Monitor trends and address controlled substance prescribing and utilization for public health ▪ Prevent misuse, abuse and diversion of controlled substances ▪ Give prescribers and pharmacies access to controlled substance history at the patient level ▪ Alert prescribers to patients that may benefit from a referral to treatment for substance abuse disorders Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic REGISTERED K-TRACS USERS Registered Prescribers Registered Dispensers 3099 72% of the controlled substances dispensed in Kansas are 2400 prescribed by 1976 K-TRACS registrants 1652 12823 1272 1042 8968 7755 6747 5724 5287 2013 2014 2015 2016 2017 2018 Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Prescriber Registration has 14,000 160.0% 142.5% increased by 142.5% since 12,000 140.0% December 31, 2013 Number of Registered Prescribers 120.0% 10,000 The total number of 100.0% registered prescribers has 8,000 increased by 142.5% between 69.6% 80.0% 6,000 2013 to 2018. 60.0% 46.7% 4,000 The total number of 27.6% 40.0% prescribers registered in 2,000 8.3% 20.0% KTRACS as of 12/31/2018 is - 12,823 compared to 5,287 in 0.0% 2013 2014 2015 2016 2017 2018 12/31/2013. Total Number of Registered Prescribers Percent Change of Registered Prescribers Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic 3,500 250.0% Pharmacist Registration 3,000 197.4% has increased by 197.4% Number of Registered Pharmacists 200.0% since December 31, 2013 2,500 The total number of 130.3% 150.0% 2,000 registered pharmacists has increased by 197.4% 1,500 89.6% 100.0% between 2013 to 2018. 58.5% 1,000 The total number of 50.0% 22.1% 500 pharmacists registered in KTRACS as of 12/31/2018 - 0.0% is 3,099 compared to 2013 2014 2015 2016 2017 2018 1,042 in 12/31/2013. Total Number of Registered Pharmacists Percent Change of Registered Pharmacists Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
PDMP Electronic Health Kroger NARxCheck Expanded Records (EHRs) Integration and integration/interoperability • Kroger pharmacy chain Interoperability Expansion statewide to all EHRs and PMS. collaborated with Appriss Health (PEHRIIE) project • Started in August 2017 and funds to connect their pharmacy • Via Christi Health – started in 2014- Gateway connection cost with Center management system (PMS) to a for Disease Control and Prevention 2015 and provided access within predictive algorithm and care (CDC) Data-Driven Prevention their electronic medical record management platform for Initiative (DDPI) Grant. system through a single-sign on controlled substances. (SSO) for physicians in emergency department. Expand upon past successes to build a statewide project. 14
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Kansas is connected with 33 states and Washington D.C. Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
K-TRACS - PMP Interconnect (PMPi) Data Sharing Kansas is sharing with 31 States as of 2018
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Do Prescription Drug Monitoring Programs have an Impact? Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic U.S. and Kansas Opioid Prescribing Rate per 100 Persons Source: CDC and IQVIA Xponent 2006 – 2017. Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Multiple Prescriber Episodes
2006 2017 Data Source: https://www.cdc.gov/drugoverdose/maps/rxcounty2017.html United State Prescribing Rate of Opioids per 100 Residents Technical Note – These maps display opioid prescription dispensations as reported to IQVIA Xponent 2006 – 2017. IQVIA Xponent is based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the United States. A prescription is an initial or refill prescription dispensed at a retail pharmacy in the sample and paid for by commercial insurance, Medicaid, Medicare, or cash or its equivalent. This database does not include mail order pharmacy data . Data Source: -APPRISS Health Data Dashboard – Dispensations by County
Prescriptions per Capita by Patient County 2016 2015 2017 2,555,858 Opioid Prescriptions were 2,604,203 Opioid Prescriptions were 2,396,957 Opioid Prescriptions were dispensed to Kansas Residents in dispensed to Kansas Residents in dispensed to Kansas Residents in 2015 2017 2016 (89.6 per 100 population) (84.0 per 100 population) (91.3 per 100 population) Kansas Prescribing Rate of Opioids per 100 Residents Technical Note – These maps display opioid prescription dispensations as reported to K-TRACS. Reporting to K- TRACS is voluntary. Rates are calculated using 2000 US census standard population. Data Source: -APPRISS Health Data Dashboard – Dispensations by County
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic The fourth wave of the drug overdose crisis? Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic National and State Epidemiologic Data Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
How far have we come? The Kansas Drug Monitoring Program (K-TRACS) & the Impact on the Opioid Epidemic Percent Change in Reported 12 Month-ending Count of Drug Overdose Deaths, by Jurisdiction: March 2018 – March 2019 14.3% increase Kansas Association of Osteopathic Medicine * Wichita, Kansas * November 8, 2019
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