Oregon Prescription Drug Monitoring Program Lisa Millet, Section Manager Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section, Public Health Division Roseburg Opioid Summit, Umpqua Community College, March 21, 2017

Overview How PDMP can help, PDMP registration, and operation Use of de-identified aggregated PDMP data for policy, practice and evaluation Use of de-identified aggregated PDMP data for research Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section Oregon Public Health Division

How PDMPs Can Help Support medically necessary uses of controlled substances Identify risks to patient safety Facilitate coordination of care among providers Aid in the identification of potential misuse, abuse, or diversion of prescription drugs Assist in initiating compassionate conversations Help the intervention and treatment of people addicted to prescription drugs Help provide safer and more effective pain management for persons with chronic pain and limit risky prescribing to opioid naive Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section Oregon Public Health Division

Oregon Law Allows the PDMP to Provide Retail Prescription Data to Prescribers (MD, DO, NP, PA) Pharmacists Delegates (non-licensed staff of prescribers and pharmacists) Licensing Boards Patients Medical Examiners Law enforcement (with a court order) Evaluation and research Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section Oregon Public Health Division

Using the PDMP Registration starts online with a second step of printing out a registration form and sending it to the PDMP office Authorized account holders - prescribers and pharmacists (or their delegates) can query a 3 year prescription history of their patients Can also query their DEA number to see all prescriptions filled under that number Patients can request their own prescription history Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section Oregon Public Health Division

Contact Information for PDMP Operations Password resets and general help desk (866) 205-1222 Orpdmp-info@hidinc.com Prescription Drug Monitoring Program (971) 673-0741 Pdmp.health@state.or.us Oregon Prescription Drug Monitoring Program Injury and Violence Prevention Section, Oregon Public Health Division

Use of Aggregated De-Identified PDMP Data Prescription Drug Overdose Prevention Grant Create a “data dashboard” to VISUALIZE data Displays prescribing trends and overdose outcomes At the county, region and state levels Interactive Publically available Useful for grantee regions and public Embed on our website

The Dashboard https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx Healthoregon.org/opioids and look for the “Data Dashboard” link on the left Tabs to navigate for deeper looks at prescribing, hospitalization, death, and technical notes Scroll down for statewide hospitalization and death data

Statewide Measures – Prescribing (PDMP) https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

County Measures – Prescribing (PDMP) Benzodiazepine Prescribing Opioid Prescribing https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

County Measures – Prescribing (PDMP) High Dose Opioid Prescribing (>120 MED from single dose) Opioid Prescribing https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

County Measures – Prescribing (PDMP) High Dose Opioid Prescribing (>120 MED from single dose) Opioid Prescribing Age Group https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

Statewide Measures – Hospitalization and Death https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

County Measures – Hospitalizations Any Opioid Hospitalization by County Any Opioid Hospitalization by Age https://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/data.aspx

Research Using De-Identified PDMP Data, 2016 Josh Van Otterloo, MPH, PDMP Research Analyst And Researchers at HealthInsight, OSU and OHSU

(Clackamas, Multnomah, Washington) County Requests Counties wanting to understand prescribing in their area Central Oregon Health Council (Crook, Deschutes, Jefferson) Metro Counties (Clackamas, Multnomah, Washington)

OSU School of Pharmacy – Medicaid - Takeaways Quantifies the amount of opioid fills dispensed to the Medicaid population that aren’t in the claims database (~13%) Long acting opioids are more commonly paid out of pocket Risky prescribing practices associated with cash payment Only analyzing claims data to evaluate policy (such as prior authorization) overstates the impact of the policy

Acumentra / HealthInsight – Rick Deyo Takeaways ~5% of opioid initiators became long term users Initial prescribing characteristics associated with long term use Number of fills Dose Long-acting opioids Suggests initiation with a single fill, low dose, short acting opioid Supports CDC guideline

Acumentra / HealthInsight – Peter Geissert - Takeaways Proactive alerts using only PDMP variables are going to have a low PPV and need to be carefully formulated so to avoid “alert fatigue”

Summary Coordinating community efforts will reduce drug overdose, misuse, substance use disorder, diversion, and improve pain care. Risk reduction is an important public health goal. Government + Private Sector + Community partnership focused on simultaneous implementation of key strategies will result in improved outcomes for patients, communities, and provide a return on investments made to address this multifaceted problem Key strategies: implement prescribing guidelines, ensure access to MAT, expanding chronic pain care options, nalxone rescue This is a winnable battle – we are: saving lives, improving pain care, patient safety & community safety, and we can create a bridge to recovery for those that need it

Contact Lisa Millet, MSH Injury and Violence Prevention Program Director Oregon Public Health Division Oregon Health Authority PH: 503.572.8585 Email: Lisa.M.Millet@state.or.us http://public.health.oregon.gov/PreventionWellness/SubstanceUse/Opioids/Pages/index.aspx