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Schedule II-V Prescription Drug Dispensing Rates & Pattern Among

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Schedule II-V Prescription Drug Dispensing Rates & Pattern Among An Investigation of Schedule II-V Prescription Drug Dispensing Rates & Patterns among Youth and Young Adults in Maryland 0 | P a g e CONTRIBUTORS This report was compiled by the following faculty and staff of the Behavioral Health Research Team in the School of Pharmacy at the University of Maryland, Baltimore: Fadia T. Shaya, PhD Professor and Director / Lead Evaluator Nicole Sealfon, MPH Associate Director Meg Robertson, MPH Program Specialist Shardai Jones, MPH Research Specialist Vanessa Michel Research Specialist Zach Leppert PharmD Student ACKNOWLEDGEMENTS We thank the staff at the Maryland Department of Health (MDH) for their support and guidance on this report. We also thank the staff within Pharmaceutical Researching Computing for analytical support. 1 | P a g e EXECUTIVE SUMMARY This is the study of Maryland Prescription Drug Motoring Program (PDMP) data. The purpose of this assessment is to provide a snapshot of what is being prescribed for youth and young adults (ages 12-29) in Maryland. Using the PDMP data, this report characterizes trends in dispensing rates over time from January 2015 through June 2018. It identifies prescribing patterns of the therapeutic classes of interest among healthcare providers to identify prescription rates and trends with particular emphasis on opioids. This analysis is an essential first step in evaluating the need for further education or interventions at the prescriber-level. Interventions and education to prescribers of adolescents can decrease exposure and prevent future misuse of prescription drugs. Youth and young adults prescribing patterns are important to monitor and this is an important step in surveillance of prescription drug dispensing patterns. Early exposure to prescription opioids in adolescence is significantly associated with non- medical use of prescription opioid (NMUPO) use at age 351. The specific aims of this assessment are to review Schedule II-V prescription drug dispensing rates and patterns across therapeutic classes, and at both the state and jurisdiction level and with particular emphasis on Maryland youth (12-17 year olds) and young adults (18-24; 25-29 year olds) from January 2015 – June 2018. Additionally, the assessment will characterize the prescribing patterns of healthcare providers across therapeutic classes for youth and young adults. The most current PDMP data from Chesapeake Regional Information System for our Patients (CRISP) was used for this assessment (updated as of November 2018). Records from January 2015 through June 2018 in the state of Maryland were selected for analyses, broken up into six- month intervals. The data was analyzed at the statewide, jurisdictional and provider level for youth and young adults (ages 12-29) in Maryland. The majority of prescription fills to youth recipients (12-17) and young adults (18-24) were stimulant medications. The young adults in their late twenties (25-29) fill proportionately more opioids than their younger counterparts do. Prescription opioids fills dispensed to young adults (18-29) demonstrate the greatest decrease in fills from 2015 to mid-2018 out of all the prescription drug classes. Doctors followed by dentists prescribed the greatest amount of fills dispensed to Maryland youth and young adults. Proportionately, doctors prescribe more stimulants than any medication in the other drug categories. Among dentists, just over 90% of prescriptions prescribed for youth and young adults are opioids. There are proportion differences of drugs dispensed to youth and young adults within the jurisdictions relative to the Maryland proportion of the dispensed drug. Overall, this assessment provides a first step in data analysis to begin the discussions with other key stakeholders for developing education and interventions for providers, youth and young adults in Maryland. 2 | P a g e TABLE OF CONTENTS EXECUTIVE SUMMARY 2 LIST OF TABLES 5 LIST OF FIGURES 6 1.0 INTRODUCTION 9 1.1. PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) 9 1.2 IMPORTANCE OF MONITORING PRESCRIBING PATTERNS IN YOUTH & YOUNG ADULTS 9 1.3 CURRENT ASSESSMENT 10 1.4 SPECIFIC AIMS 10 2.0 METHODOLOGY 11 2.1 PDMP DATA & TIMELINE 11 2.2 DRUG CATEGORIES BASED ON THERAPEUTIC CLASS 11 2.3 DEMOGRAPHICS 11 2.4 PRESCRIBER IDENTIFICATION 11 2.5 FILL-LEVEL ANALYSIS 12 2.5.1 STATE-WIDE 12 2.5.2 JURISDICTION-LEVEL 12 2.5.3 PRESCRIBER-LEVEL 12 2.6 PERSON-LEVEL ANALYSIS 13 2.6.1 STATE-WIDE 13 2.6.2 JURISDICTION-LEVEL 13 2.6.3 PRESCRIBER-LEVEL 13 3.0 DATA ANALYSIS 14 3.1 PRESCRIBING & DISPENSING RATES IN THE STATE OF MARYLAND 14 3.1.1 MARYLAND RECIPIENTS OF ALL AGES 14 3.1.2 MARYLAND YOUTH & YOUNG ADULTS 15 3.2 PRESCRIBING PATTERNS OF HEALTHCARE PROVIDERS 23 3.3 PRESCRIBING PATTERNS ACROSS JURISDICTIONS 30 4.0 DISCUSSION 45 4.1 KEY FINDINGS 45 3 | P a g e 4.2 LIMITATIONS 46 REFERENCES 47 APPENDIX 1: DRUG CATEGORY ASSIGNMENT FROM GNN 48 APPENDIX 2: ALL PRESCRIBERS TABLE 49 APPENDIX 3: JURISDICTION FILLS DATA TABLES 52 APPENDIX 4: JURISDICTION DISPENSER FILLS DATA TABLES 65 4 | P a g e LIST OF TABLES Table 1 - Total Schedule II-V Prescription Drug Fills to Youth & Young Adults in the State of Maryland from January 2015 - June 2018 Table 2. Census data population estimates of 12-17, 18-24, and 25-29 year olds in the state of Maryland in 2017 Appendix 1: Drug Category Assignment from GNN Appendix 2: All Prescribers Table Appendix 3: Jurisdiction Fills by Recipient Data Tables Appendix 4: Prescription Fills by Jurisdiction where prescriptions were filled by registered dispensers within each Jurisdiction 5 | P a g e LIST OF FIGURES Figure 1A - Total Schedule II-V Prescription Drug Fills to Recipients (all ages) in the State of Maryland Figure 1B - Total Recipients (all ages) of Schedule II-V Prescription Drugs in the State of Maryland Figure 2 – Proportion of Schedule II-V Prescription Drugs Fills by Youth & Young Adults in the State of Maryland Figure 3A - Percentage of Youth and Young Adults who Filled Any Prescription Medication from their Total Respective Populations in the State of Maryland in 2017 Figure 3B - Percentage of Youth and Young Adults who filled a prescription from their Total Respective Populations in the State of Maryland in 2017 Figure 4A - Total Prescription Drug Fills to Youth Recipients (12-17 year olds) Figure 4B – Total Prescription Drug Fills to Young Adult Recipients (18-24 year olds) Figure 4C - Total Prescription Drug Fills to Young Adult Recipients (25-29 year olds) Figure 5A - Youth Recipients of Prescription Drugs in Maryland (12-17 years old) Figure 5B – Young Adult Recipients (ages 18-24) of Prescription Drugs Figure 5C - Young Adult Recipients (ages 25-29) of Prescription Drugs Figure 6 - Proportion of Prescription Fills by Drug Category in Youth & Young Adults Figure 7 - Total Prescription Fills by Drug Category Dispensed to Youth & Young Adults Figure 8 - Total Prescription Drug Fills Prescribed to Maryland Youth and Young Adults by Maryland Healthcare Providers Figure 9A – All Benzodiazepine Prescription Fills by Healthcare Provider Figure 9B– Benzodiazepine Prescription Fills Dispensed to Youth and Young Adults Over Time Figure 10A – All Opioid Prescription Fills by Healthcare Provider Figure 10B– Opioid Prescription Fills Dispensed to Youth and Young Adults Over Time Figure 11A – All Stimulant Prescription Fills by Healthcare Provider Figure 11B– Stimulant Prescription Fills Dispensed to Youth and Young Adults Over Time Figure 12A – All Other Prescription Fills by Healthcare Provider Figure 12B– Other Prescription Fills Dispensed to Youth and Young Adults Over Time 6 | P a g e Figure 13A – Proportion of Prescription Drugs Prescribed by Doctors to Maryland Youth and Young Adults Figure 13B– All Dispensed Prescription Medication Fills Prescribed by Doctors to Youth and Young Adults Over Time Figure 14A – Proportion of Prescription Drugs Prescribed by Dentists to Maryland Youth and Young Adults Figure 14B– All Dispensed Prescription Medication Fills Prescribed by Dentists to Youth and Young Adults Over Time Figure 15A - Proportion of Benzodiazepine Fills Dispensed to Youth (12-17 year olds) within Jurisdictions relative to the Maryland State Average for Youth Figure 15B - Proportion of Opioid Fills Dispensed to Youth (12-17 year olds) within Jurisdictions relative to the Maryland State Average for Youth Figure 16A - Proportion of Stimulant Fills Dispensed to Youth (12-17 year olds) within Jurisdictions relative to the Maryland State Average for Youth Figure 16B - Proportion of Other Fills Dispensed to Youth (12-17 year olds) within Jurisdictions relative to the Maryland State Average for Youth Figure 17A - Proportion of Benzodiazepine Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions relative to the Maryland State Average for Young Adults Figure 17B - Proportion of Opioid Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions relative to the Maryland State Average for Young Adults Figure 18A - Proportion of Stimulant Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions relative to the Maryland State Average for Young Adults Figure 18B - Proportion of Other Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions relative to the Maryland State Average for Young Adults Figure 19A - Proportion of Benzodiazepine Fills Dispensed to Young Adults (25-29 year olds) within Jurisdictions relative to the Maryland State Average for Young Adults Figure 19B - Proportion of Opioid Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions relative to the Maryland
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