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Prescription Monitoring Program Trends among Individuals Arrested in Maine for
Trafficking Prescription Drugs, 2014
Christina Holt, MD, MSc1, Kenneth McCall, PharmD2, Stephanie Nichols, PharmD, BCPS, BCPP3, Leslie Ochs, PhD, PharmD, BCPS2, BCPS, Gary Cattabriga, BA4, Chunhao Tu, PhD2
1. Maine Medical Center, Department of Family Medicine, Portland, ME2. College of Pharmacy, University of New England, Portland, ME
3. School of Pharmacy, Husson University, Bangor, ME4. Center for Community & Public Health, University of New England, Portland, ME
Number of Controlled Prescriptions (x1,000): Maine PMP, 2006-2014
2006 2007 2008 2009 2010 2011 2012 2013 20140
500
1,000
1,500
2,000
2,500
3,000
2,0402,162
2,3422,442 2,533 2,471 2,475 2,371 2,437
Opioids Sedatives Stimulants
‘Sedatives’ includes benzodiazepines and ‘z’ hypnotic drugs such as zolpidem.
Which category of drugs account for the most prescriptions in the PMP?
25%
25%
25%
25% 1. Sedatives2. Opioids3. Hypnotics4. Stimulants
Number of Opioid Prescriptions (x1,000): Maine PMP, 2006-2014
2006 2007 2008 2009 2010 2011 2012 2013 20140
200
400
600
800
1,000
1,200
1,400
1,1251,177
1,251 1,272 1,3101,223 1,205
1,1371,222
For comparative purposes, the Maine population estimated by the US Census Bureau:2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
416
532
350
393
160
95
74 66
66
45
39
41
53
35
37
27
19
9
769
Hydrocodone Oxycodone Buprenorphine TramadolMorphine Fentanyl Codeine MethadonePropoxyphene Hydromorphone Other
Number of Opioid Prescriptions (x1000) by Product: Maine PMP, 2010 & 2014
*Hydrocodone reclassified to DEA C-II in 2014, Tramadol reclassified to DEA C-IV in 2014, Propoxyphene withdrawn from US market in 2010
2010
2014
Which opioid has had the greatest increase in prescriptions over the last five years?
25%
25%
25%
25% 1. Hydrocodone2. Oxycodone3. Buprenorphine4. Methadone
Number of Sedative Prescriptions (x1,000): Maine PMP, 2006-2014
2006 2007 2008 2009 2010 2011 2012 2013 20140
200
400
600
800
1,000
708757
830882 904 902 897
857820
For comparative purposes, the Maine population estimated by the US Census Bureau:2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
Number of Sedative Prescriptions (x1000) by Product: Maine PMP, 2014
210
178142
133
79
16 1218
Lorazepam
Clonazepam
Zolpidem
Alprazolam
Diazepam
Temazepam
Eszopiclone
Other
Benzodiazepine prescribing rates increased from 2010 to 2014 for which of the following demographic groups?
20%
20%
20%
20%
20% 1. Men < 20 years old2. Women < 20 years old3. Women 20 to 50 years old4. Women 60+ years old5. Men 20 to 50 years old
Number of Stimulant Prescriptions (x1,000): Maine PMP, 2006-2014
2006 2007 2008 2009 2010 2011 2012 2013 20140
100
200
300
400
207228
261288
319346
373 377395
For comparative purposes, the Maine population estimated by the US Census Bureau:2006 = 1,324,000; 2010 = 1,328,000; 2014 = 1,330,000
Which is the fastest growing PMP category by prescription count from 2010 to 2014?
25%
25%
25%
25% 1. Sedatives2. Opioids3. Hypnotics4. Stimulants
Number of Stimulant Prescriptions (x1000) by Product: Maine PMP, 2014
145
129
79
36
6
MethylphenidateDextro/amphetamineLisdexamfetamineDexmethylphenidateOther
BackgroundProportion of state and local law enforcement agencies (1,226) reporting prescription drugs
as the greatest drug threat, 2014*
US NE0%
5%
10%
15%
20%
25%
30%
35%
21%
33%
*US Dept of Justice, Drug Enforcement Administration. National drug threat assessment summary, 2014. Available at: http://www.dea.gov/resource-center/dir-ndta-unclass.pdf Accessed March 1, 2015.
Study Objective
The objective of this study is to describe PMP utilization trends of the individuals who were arrested for controlled substance prescription trafficking in Maine in 2014.
Study Design• Population-based, observational study using retrospective data
from the Maine Diversion Alert Program (DAP) and the Maine Prescription Monitoring Program (PMP).
• Cases were identified from all drug arrests reported by the Maine DAP between January 1, 2014 and December, 31 2014.
• Cases were included is the arrest offense was trafficking, aggravated trafficking, furnishing, distributing, or selling of prescription drugs.
• PMP records within 90 days prior to the date of arrest were linked into a single database with the arrest records by first name, last name, date of birth, and gender and de-identified for analysis.
• University of New England Institutional Review Board (IRB #090914-011).
Drug Arrest Offenses: Maine, 2014*
594
1313
96
TraffickingPossessionOther
TOTAL = 2,003 Arrests*Source: Maine Diversion Alert Program
3%
9%1%
17%
66%
5%
2,003 Total Arrests
Rx trafficking - PMP matchRx trafficking - no PMP matchOther traffickingIllicit traffickingPossessionNon-possession, non-traffick-ing offense
Drug Arrest Offenses: Maine, 2014
Number of drug arrests involving Prescription Opioids mapped by municipality (N=363): Maine 2014
TOWN ARRESTS ARRESTS per 10K1
Auburn 13 5.64 Augusta 6 3.14 Bangor 28 8.48 Belfast* 18 *27.00 Brewer 3 3.16 Caribou 4 4.88 Ellsworth 15 19.38 Gardiner 3 5.17 Gray 6 7.73 Houlton 10 16.33 Lewiston 30 8.20 Old Town 4 5.10 Portland 24 3.63 Presque Isle 15 15.48 Scarborough 6 3.17 South Portland 3 1.20 Swanville* 5 *36.02 Thomaston 4 14.38 Waldoboro 5 9.85 Wiscasset 5 13.40
*Significant outlier (P<0.05)1. Maine Municipality Population, 2010, US Census Bureau
**
Number of Trafficking Arrests by Substance: Maine, 2014
Heroin
Oxycodone
Cannabinoids
Buprenorphine
Alprazolam
0 20 40 60 80 100 120 140 160 180
166110110
7743
3021
1855
*
*Unspecified Controlled Substance
Number of Arrests
Trafficking Drug Arrests including furnishing, distribution, selling: Maine, 2014
235
346
13
Rx CII-IVIllicitOther
TOTAL = 594
What is the most commonly diverted illicit drug in Maine, 2014?
25%
25%
25%
25% 1. Cocaine2. Heroin3. Cannabinoids4. Cathinones
What is the most commonly diverted prescription opioid in 2014?
25%
25%
25%
25% 1. Hydrocodone2. Oxycodone3. Buprenorphine4. Methadone
Demographics of Persons Arrests for Trafficking CII-CIV Drugs: Maine, 2014
Age
Sex
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
10
Male: 155 (66%)
87
Female: 80 (34%)
88 35 11
22
10s 20s 30s 40s 50s 60s 70s
Mean age = 33 years
Myth: The majority of persons arrested for trafficking prescription drugs are “Doctor
shopping” and “Pharmacy hopping”
Proportion of Persons Arrested for Trafficking CII-CIV Drugs with Matching PMP Rxs within 90 Days of Arrest
57(24%)
178(76%)
MatchNonMatch
TOTAL = 295
Number of Pharmacies and Prescribers
Prescribers
Pharmacies
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
31
35
25
22
1
1 2 to 4 >4
Myth: The majority of persons arrested for trafficking pharmaceuticals are paying cash at
the pharmacy.
Payment Method for Matching CII-CIV Prescription within 90 days of Arrest
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
28 19 5 5
Commercial Medicaid Medicare Cash
Which of the following statements is true regarding drug diversion in Maine, 2014?
20%
20%
20%
20%
20% 1. Drug diversion is almost entirely an illicit drug problem.
2. Drug diversion is almost entirely an urban problem.
3. A majority of persons arrested for trafficking drugs are men in their 20s
4. A majority of persons arrested for trafficking Rx drugs use only 1 pharmacy and 1 prescriber.
5. The majority of persons arrested for trafficking pharmaceuticals are paying cash at the pharmacy.
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