an investigation of schedule ii-v prescription drug dispensing rates & patterns … · 2020. 1....

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An Investigation of Schedule II-V

Prescription Drug Dispensing Rates

& Patterns among Youth and Young

Adults in Maryland

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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.

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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.

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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

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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

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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

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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

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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


Figure 18A - Proportion of Stimulant Fills Dispensed to Young Adults (18-24 year olds) within


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


Figure 19B - Proportion of Opioid Fills Dispensed to Young Adults (18-24 year olds) within


Figure 20A - Proportion of Stimulants Fills Dispensed to Young Adults (18-24 year olds) within


Figure 20B - Proportion of Other Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions

relative to the Maryland State Average for Young Adults

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Figure 21 – Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12-17 years

old) Across January 2015 – June 2018

Figure 22 – Proportion of Opioids within each Maryland Jurisdiction among Youth (12-17 years old)

Across January 2015 – June 2018

Figure 23 – Proportion of Stimulants within each Maryland Jurisdiction among Youth (12-17 years old)


Figure 24 – Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (18-24 years


Figure 25 – Proportion of Opioids within each Maryland Jurisdiction among Youth (18-24) years old)


Figure 26 - Proportion of Stimulants within each Maryland Jurisdiction among Youth (18-24 years old)


Figure 27 - Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (25-29 years


Figure 28 - Proportion of Opioids within each Maryland Jurisdiction among Youth (25-29 years old)


Figure 29 - Proportion of Stimulants within each Maryland Jurisdiction among Youth (25-29 years old)


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1.0 INTRODUCTION

1.1. PRESCRIPTION DRUG MONITORING PROGRAM (PDMP)

The Maryland Prescription Drug Monitoring Program (PDMP) data contain records of all

controlled dangerous substances (CDS) prescription history for patients. Chesapeake Regional

Information System for our Patients (CRISP) is Maryland’s designated health information

exchange service which contracts with PDMP to allow healthcare providers to access PDMP

data from within CRISP. As of October 2016, Maryland law dictates that all prescribers and

pharmacists register with the PDMP.

Each patient is designated a unique “CRISP ID” which allows healthcare providers to track their

patients’ prescription and dispensing history in Maryland. Pharmacies are required to report a

record of dispensing patients’ prescriptions within CRISP, so the PDMP is kept updated. As of

July 2018, it was required by law that all prescribers refer to their patient’s PDMP records prior

to prescribing a new course of treatment with an opioid or benzodiazepine medication (with a

few exceptions for some clinical settings). Prescribers must also query their patient’s PDMP

record every 90 days as a follow-up if they recommend the patient continue the same course of

treatment.

The PDMP is a key component of Maryland’s strategy and prevention plan for reducing drug-

related overdoses by carefully monitoring and recording all schedule II-V controlled dangerous

substances prescribed and dispensed in Maryland. While the PDMP is particularly important for

monitoring opioid prescribing and dispensing history, it is also a valuable record of other

Controlled Dangerous Substances (CDS) such as benzodiazepines, stimulants, and other

therapeutic classes. These medications can be abused in combination with opioids medications.

Importantly, these data reflect a high level of reliability due to the State’s mandated standards of

CRISP usage among Maryland healthcare providers and pharmacists for every patient that is

provided a prescription for medication. The availability of these data present an important

opportunity to review dispensing rates of prescription medications and assess patterns in usage

across the state of Maryland.

1.2 IMPORTANCE OF MONITORING PRESCRIBING PATTERNS IN

YOUTH & YOUNG ADULTS

Early exposure to prescription opioids in adolescence is significantly associated with non-

medical use of prescription opioid (NMUPO) use at age 351. Additionally, high school aged

recipients of opioid prescriptions are 33% more likely to misuse opioids after high school2.

Interventions and education to prescribers of adolescents can decrease exposure and prevent

future misuse of prescription drugs. A substantial source of NMUPO among high school seniors

were from their own previous prescription leftovers3.

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1.3 CURRENT ASSESSMENT

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. This assessment is an important step in surveillance of

prescription drug dispensing patterns across the state of Maryland, within each jurisdiction, and

characterizing the rate of prescriptions from Maryland healthcare providers. This report

characterizes trends in dispensing rates prescription medications over time from January 2015

through June 2018. Importantly, this assessment 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 will be an essential first step in evaluating the need

for further education or intervention at the prescriber-level.

1.4 SPECIFIC AIMS

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.

Aim 1 Characterize the prescribing patterns of schedule II-V prescription drugs state-wide in

Maryland from January 2015 – June 2018. How many and what proportion of

prescription drugs are filled by youth, and young adults?

Aim 2 Characterize the prescribing patterns of schedule II-V prescription drugs on a local-

level in each jurisdiction within Maryland from January 2015 – June 2018. How many

prescription drugs are filled by youth and young adults?

Aim 3 Characterize the proportion of prescription fills by therapeutic class from each

jurisdiction compare with the State average from January 2015 – June 2018 for youth

and young adults.

Aim 4 Characterize the prescribing patterns of healthcare providers (e.g., doctor, dentist, etc.)

practicing in the State of Maryland across therapeutic classes for youth and young adult

recipients.

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2.0 METHODOLOGY

2.1 PDMP DATA & TIMELINE

The most current PDMP data from 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. Data were further analyzed by 6 month periods for a total of seven time

intervals: Jan-Jun 2015, Jul-Dec 2015, Jan-Jun 2016, Jul-Dec 2016, Jan-Jun 2017, Jul-Dec 2017,

and Jan-Jun 2018.

2.2 DRUG CATEGORIES BASED ON THERAPEUTIC CLASS

All prescription medications in the PDMP database were sorted by their generic name (GNN)

and grouped into four categories of interest: Benzodiazepines, Opioids, Stimulants, and Other.

The ‘Other’ drug category includes sedatives, muscle relaxants, etc, (all GNNs by each of the

four drug categories can be found in Appendix 1).

Records of prescription fills were assigned to each of the seven time periods based on the date

they were dispensed. All other prescription fill records outside of these time intervals were not

included in the present analyses.

2.3 DEMOGRAPHICS

All recipients are designated a unique CRISP identification number, or CRISP ID within the

PDMP database which provides demographic information within each record. The age of the

prescription fill recipient was determined by their date of birth. Recipients’ age was designated

as of the end of the year for the year of their prescription fill. State-wide, jurisdiction, and

prescriber totals include all recipients of all ages, including those without a complete or valid

record of their age entered into CRISP. From that data, only those recipients with a complete or

valid record of the age and within the 12 – 29 year old range, were grouped into the following

age categories: 12- 17 year olds, 18 -24 year olds, and 25-29 year olds for analyses.

2.4 PRESCRIBER IDENTIFICATION

All healthcare providers who are licensed to prescribe schedule II-V prescription drugs in the

state of Maryland and are also registered in CRISP and PDMP were included in analyses.

Healthcare providers were determined by their Enforcement Agency (DEA) degree to identify

types of healthcare providers: Dentists (DDS or DMD), Doctors (DO or MD), Podiatrists (DPM),

Nurse Practitioners (NP), Optometrists (OD), Physician Assistants (PA), and Veterinarians

(DVM). All prescribers registered in CRISP with all other degree types or missing degree entries

were included in an ‘Other’ category.

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2.5 FILL-LEVEL ANALYSIS

Analyses were conducted at both the fill and person-level. All fills from all drug categories

dispensed to each person (identified by unique CRISP ID) were captured in the fill-level

analyses. Multiple prescriptions filled by the same person in the same six month time interval

would be captured for each drug category.

2.5.1 STATE-WIDE

Quantification of prescription fills were analyzed by state-wide totals for those recipients

aged 12-17, 18-24, 25-29, and a state-wide total for all records of prescription fills

dispensed to recipients of all ages regardless of incomplete or missing demographic data

available through CRISP. Data were also analyzed at a state-level by prescription fills to

Maryland residents only, to control for recipients who may be travelling from surrounding

states and filled a prescription in Maryland. Finally, a state-level analysis was conducted

to quantify all prescription fills provided by a dispenser located in Maryland to control for

all instances when a Maryland resident travelled outside of the state to fill their

prescription.

2.5.2 JURISDICTION-LEVEL

Quantification of prescription fills were analyzed at a local level by each of Maryland’s 24

jurisdictions: Allegany, Anne Arundel, Baltimore, Baltimore City, Calvert, Caroline,

Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Howard, Kent,

Montgomery, Prince George’s, Queen Anne’s, St. Mary’s, Somerset, Talbot, Washington,

Wicomico, Worcester. Missing or incomplete were included in a separate

‘Other/Unknown’ category.

Within each jurisdiction, prescription fills were quantified by those dispensed to registered

residents of each jurisdiction, regardless of whether the fill was dispensed within their

home jurisdiction. Additionally, prescription fills were quantified by those provided by a

registered dispenser within each jurisdiction, regardless of whether the recipient was a

resident of that jurisdiction.

2.5.3 PRESCRIBER-LEVEL

Quantification of all prescription fills were analyzed by type of healthcare provider who

provided each prescription. Data were analyzed by the total number of fills provided by all

prescribers and the total for each prescriber type for each drug category of interest, across

age groups of interest, and within January 2015 – June 2018.

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2.6 PERSON-LEVEL ANALYSIS

Analyses conducted at the person-level quantified all persons or recipients of a prescription fill.

Persons were identified by their unique CRISP ID and were counted once for each drug category

where they had at least one dispensed prescription within a six month time interval, and by their

age group. In other words, if a recipient had four prescription fills within the opioid drug

category from February to May, that person would be represented once within the opioid drug

category, time interval, and age group.

2.6.1 STATE-WIDE

Quantification of unique persons were analyzed by state-wide totals for those recipients

aged 12-17, 18-24, 25-29, and a state-wide total for all recipients of all ages regardless of

incomplete or missing demographic data available through CRISP. Data were also

analyzed at a state-level by only those unique persons who are also Maryland residents.

Finally, a state-level analysis was conducted to quantify all unique persons that filled their

prescriptions at a dispenser.

2.6.2 JURISDICTION-LEVEL

Quantification of unique persons that filled a prescription medication were also analyzed

at a local level by each of Maryland’s 24 jurisdictions: Allegany, Anne Arundel,

Baltimore, Baltimore City, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester,

Frederick, Garrett, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s,

St. Mary’s, Somerset, Talbot, Washington, Wicomico, Worcester. All records where the

recipient’s address was missing or incomplete were included in a separate

‘Other/Unknown’ category.

Within each jurisdiction, unique persons were quantified by those who were registered

residents of each jurisdiction, regardless of whether the fill was dispensed within their

home jurisdiction. Additionally, unique persons were quantified by those who filled their

prescription at a registered dispenser within each jurisdiction, regardless of whether the

recipient was a resident of that jurisdiction.

2.6.3 PRESCRIBER-LEVEL

Unique persons were represented once in each age group, time period, and drug category

if they had at least one prescription from a prescriber. If a recipient received three

prescriptions within the stimulant category prescribed by a doctor, and two stimulant

prescription from a nurse practitioner, they would be counted once within the

stimulant/doctor analyses, and once within the stimulant/nurse practitioner analyses for

each time period of interest.

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3.0 DATA ANALYSIS

3.1 PRESCRIBING & DISPENSING RATES IN THE STATE OF MARYLAND

3.1.1 MARYLAND RECIPIENTS OF ALL AGES

In Maryland, opioid medication fills are the most dispensed schedule II-V prescription drugs across all

age groups and all drug categories from January 2015 through June 2018 shown in Figure 1A. The rate

of Maryland dispensers filling opioid prescriptions shows a trending decrease from the beginning of 2015

(n=2.3 million fills) to mid-2018 (n= 1.9 million fills). This trend is reflected in the number of persons

receiving prescription opioids from Maryland dispensers in the beginning of 2015 (n=865,762) through

mid-2018 (n=697,792) as demonstrated in Figure 1B.

Figure 1. Prescription drug dispensing patterns in the state of Maryland from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to

recipients of all ages. ‘MD Residents’ denotes all records of prescription fills that were dispensed in MD to recipients of all ages and who are registered MD residents. ‘MD Dispenser’ denotes

all records of prescriptions fills for recipients of all ages provided by a registered dispenser of Maryland. (A) Total number of prescription drug fills to recipients of all ages within Maryland

(MD); (B) Total number of unique recipients (of all ages) who received a prescription medication fill in Maryland.

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3.1.2 MARYLAND YOUTH & YOUNG ADULTS

Total prescription drug fills for 12-17, 18-24, and 25-29 year olds, and total percentages of drug category

fills within each age group for six-month intervals from early 2015 to mid-2018 are displayed in Table 1.

Although overall fills across all age groups and drug categories have decreased over time, percentages

within age group have remained steady.

Of the Maryland youth (12-17 year olds) and young adults (18-29), youth have the highest proportion of

stimulant prescription and lowest proportion of opioid prescription fills from combined 2015 to 2018 fill

totals as shown in Figure 2. Proportions of prescription fill rates of benzodiazepines and opioids show a

stepwise increase from the youth to the late-20 year old recipients.

Table 1. Total Schedule II-V Drug Fills to Youth & Young Adults in the State of Maryland from January 2015- June 2018

Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total

Benzodiazepines

12 to 17 7,812 4.6 8,696 5.1 7,542 4.3 7,948 4.8 7,242 4.2 7,700 4.8 6,638 3.9

18 to 24 27,152 13.0 30,783 14.0 27,096 13.2 28,640 13.9 24,768 12.6 25,210 13.4 23,091 12.8

25 to 29 42,714 17.2 44,907 17.6 41,534 17.2 42,310 17.5 38,964 16.8 38,497 17.3 34,885 16.6

Opioids

12 to 17 22,537 13.3 26,375 15.6 21,259 12.2 24,151 14.5 19,348 11.1 20,729 12.9 15,072 8.8

18 to 24 85,022 40.7 88,404 40.1 75,470 36.7 74,986 36.4 66,793 34.1 61,093 32.5 53,511 29.6

25 to 29 123,819 49.7 123,031 48.2 110,945 45.9 108,932 45.1 100,004 43.2 92,252 41.4 83,302 39.6

Stimulants

12 to 17 134,517 79.3 129,578 76.4 140,521 80.7 129,149 77.8 142,400 81.9 126,853 79.1 144,366 84.5

18 to 24 88,569 42.4 92,214 41.9 95,615 46.5 94,175 45.7 96,697 49.3 93,265 49.7 95,393 52.8

25 to 29 67,354 27.1 71,477 28.0 74,851 31.0 75,557 31.3 79,134 34.2 78,556 35.2 80,305 38.2

Other

12 to 17 4,810 2.8 4,896 2.9 4,872 2.8 4,803 2.9 4,980 2.9 5,090 3.2 4,746 2.8

18 to 24 8,051 3.9 8,892 4.0 7,598 3.7 8,080 3.9 7,779 4.0 8,264 4.4 8,535 4.7

25 to 29 15,101 6.1 15,600 6.1 14,215 5.9 14,561 6.0 13,318 5.8 13,703 6.1 11,918 5.7

Drug Category by

Age Groups (Yrs)Jan-Jun

2015 2016 2017 2018

Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec

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Table 2. Census data population estimates of 12-17, 18-24, and 25-29 year olds in the State of Maryland (2017)

in 2017 (Census)

‘

Based on the most recent year of available Census data in 2017 (Table 2), approximately 11-12% of

Maryland youth (12-17 years old), 9-10% and 12-13% of Maryland young adult (18-24 and 25-29 years

old, respectively) filled a prescription drug from January through June 2018 (Figure 3A). The vast

majority of fills for all age groups were stimulant medications (Figure 3B).

Age Categories of Interest Population % of MD’s Total Population

12-17 years old 454, 523 7.51%

18-24 years old 553, 039 9.14%

25-29 years old 417, 161 6.89%

Figure 2. The proportion of schedule II-V prescription drug fills by age group; dispensed to 12-17 year olds, 18-24 year olds, and 25-29 year olds in Maryland from 2015-2018 combined. ‘All’

denotes all records of prescription fills that were dispensed in Maryland to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were

dispensed in Maryland to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered

dispenser of Maryland.

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PProportion of Schedule II-V Prescription Drugs Fills by Youth & Young Adults in the

State of Maryland


MD Dispenser

17 | P a g e

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Percentage of Youth and Young Adults who Filled a Prescription (by Drug

Categories of Interest) from their Total Respective Populations in the State of

Maryland from Jan-Jun 2018

12 to 17 18 to 24 25 to 29

Figure 3. The percentage of people of each age group from their respective total population in Maryland based on the most recent 2017 Census data (12-17, 18-24, and 25-29 years old) who

(A) received any prescription drug fill in Jan-Jun 2018; and (B) by drug categories of interest in Jan-Jun 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to

recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD

Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

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SPercentage of Youth and Young Adults who Filled Any Prescription Medication from their

Total Respective Populations in the State of Maryland from Jan-Jun 2018

12 to 17 18 to 24 25 to 29

A

18 | P a g e

The majority of prescription fills to youth recipients (12-17 years old) were consistently stimulant

medications from January 2015 through June 2018 (Figure 4A). Young adults (18-24 years old) filled

nearly equal amounts of opioid and stimulant prescriptions at the start of 2015, but opioid prescription

fills have gradually decreased by mid-2018 (Figure 4B). Young adults (25-29 years old) demonstrate the

same trending decrease in opioid prescription fills from 2015 to mid-2018, but recipients in their mid-to–

late twenties fill the most opioid medications across all age groups (Figure 4C).

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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018


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Total Prescription Drug Fills to Youth Recipients (12-17 years old)


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Total Prescription Drug Fills to Young Adult Recipients (18-24 years old)


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19 | P a g e

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Total Prescription Drug Fills to Young Adult Recipients (25-29 year olds)


Figure 4. Total number of prescription drug fills to (A) Maryland youth (ages 12-17); (B) young adult (ages 18-24); and (C) young adult (25-29) recipients from January 2015 through June

2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that

were dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered

dispenser of Maryland.

C

20 | P a g e

The majority of recipients across all age groups of interest represent unique persons who filled a stimulant

prescription (Figures 5A, B, C). There are approximately half as many unique persons who filled an opioid

prescription within the same time period of January 2015 to June 2018.

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Youth Recipients of Prescription Drugs in Maryland (12-17 year olds)


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Young Adult Recipients of Prescription Drugs in Maryland (18-24) years old)


B

21 | P a g e

Figure 5. Total number of unique people who received prescription drug fills, specifically (A) Maryland youth (ages 12-17); (B) young adult (ages 18-24); and (C) young adult (25-29)

recipients from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of

prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each

age group provided by a registered dispenser of Maryland.

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DYoung Adult Recipients of Prescription Drugs in Maryland (25-29 years old)


22 | P a g e

Proportionally, youth (12-17 year olds) fill more stimulant prescriptions than all young adults but young adults

in their late twenties (25-29) fill proportionally more benzodiazepines, opioids, and other prescription

medications than their younger counterparts (Figure 7).

Figure 6. Total prescription fills by drug category of interest in Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) from all 12-29 year old recipients’ fills. ‘All’

denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were

dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of

Maryland.

Figure 7. Proportion of prescription fills by drug category for all youth and young adult recipients (12-29 years old). ‘All’ denotes all records of prescription fills that were dispensed in MD to

recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD

Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

0

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Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other

All Only MD Residents MD Dispenser

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Proportion of Prescription Fills by Drug Category in Youth & Young Adults

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Total Prescription Fills by Drug Category Dispensed to Youth & Young Adults

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23 | P a g e

3.2 PRESCRIBING PATTERNS OF HEALTHCARE PROVIDERS

Unsurprisingly, the greatest amount of fills dispensed to Maryland youth and young adults were prescribed by doctors followed by dentists (Figure

8). Aside from opioid prescriptions to all age groups of interest, there was no data to support podiatrist providing any other prescriptions. Notably,

the ‘Other’ category captures records where the prescriber’s degree fill is missing, therefore capturing an unknown percentage of all other listed

prescriber types. As such, these rates may underrepresent accurate prescription rates and should be considered an estimate.

Insert prescription fills by prescriber type (drug categories on separate graphs)

Particular interest: dentist breakdown, doctor breakdown

Figure 8. Overview of all dispensed prescription medications prescribed to Maryland youth (12-17 years old) and young adults (18-24; 25-29 years old) by registered healthcare providers (by DEA degree) in the state of Maryland from Jan 2015 through

June 2018. The ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing an unknown percentage of listed prescriber types. * denotes drug categories with a fill quantity unavailable from data, or specifically

unavailable for an age group.

0

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Dentist Podiatrist Doctor Nurse Practioner Physician Assistant Veterinarian Other

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Total Prescription Drug Fills Prescribed to Maryland Youth and Young Adults by Maryland Healthcare

Providers

12 to 17 18 to 24 25 to 29

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Nurse Practitioner

24 | P a g e

Benzodiazepines

Overall, the rate of prescription benzodiazepines demonstrates a trending decline in fills to young adults (18-29

years old), with an increase in dispensed rates noted within the second half of each year suggesting a seasonal

influence (Figure 9B). The rate of prescription benzodiazepines in youth has remained steady at just under

10,000 prescription fills every six months from 2015 through mid-2018.

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Benzodiazepine Prescription Drug Fills Dispensed to

Youth and Young Adults Over Time

12 to 17 18 to 24 25 to 29

Figure 9. Prescription benzodiazepine fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database

(by DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity

unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription benzodiazepine medication from January 2015 through June 2018. ‘All’ denotes all records of

prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are

registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

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Dentist Podiatrist Doctor Nurse

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25 | P a g e

Opioids

Notably, opioids are the only drug category that is prescribed by healthcare provider or prescriber (with the

exception of optometrists, who are within PDMP but do not have any prescription records to 12-29 year olds in

Maryland). Dentists provided equally as many opioid prescriptions as doctors to Maryland youth (12-17 years

old) from all opioid prescriptions combined from January 2015 through June 2018. Prescription opioid

medications dispensed to young adults (18-29 years old) has shown a sharp decrease from the beginning of

2015 to mid-June 2018 (Figure 10B)

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Opioid Prescription Drug Fills Dispensed to Youth and Young Adults Over Time

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Practitioner

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All Opioid Prescription Fills by Healthcare Provider

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Figure 10. Prescription opioid fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by DEA

degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity unavailable

from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription opioid medication from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were

dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents.

‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

A

B

26 | P a g e

Stimulants

Stimulant medications are most readily prescribed to Maryland youth (12-17 years old) by doctors (Figure

11A). Interestingly, the rate of prescriptions to youth from January 2015 to June 2018 has demonstrated a

pattern of more prescriptions filled in the first six months of the year, followed by a drop in the second half of

the year suggesting a seasonal influence. The rate of prescription stimulants to young adults (18-24) has

remained stable over the same time period, while young adults in their mid to late twenties are demonstrating a

gradual increase in dispensed stimulants (Figure 11B).

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Stimulant Prescription Drug Fills Dispensed to

Youth and Young Adults Over Time

12 to 17 18 to 24 25 to 29Figure 11. Prescription stimulant fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by

DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity

unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription stimulant medication from January 2015 through June 2018. ‘All’ denotes all records of prescription

fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered

MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

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27 | P a g e

Other

Other prescription medication fills comprise a small proportion of all dispensed medications to youth and young

adults in Maryland, however they are largely dispensed to young adults (18-29 years old) by doctors (Figure

12A).

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Other Prescription Drug Fills Dispensed to Youth and Young Adults Over Time

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Figure 12. Prescription other fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by

DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity

unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription other medication from January 2015 through June 2018. ‘All’ denotes all records of prescription

fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are

registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.

A

B

28 | P a g e

Spotlight on Doctors

Proportionally, doctors prescribe more stimulants than any medication with the other drug categories (Figure

13A). From January 2015 to June 2018, doctors’ prescribing rates for benzodiazepines and other medications

remain unchanged across all age groups. Doctors’ prescribing patterns for stimulants may be based on a

seasonal influence in Maryland youth, as they consistently prescribe more stimulant medications during the first

half of the year. Notably, rates of doctors’ prescription opioids have decreased by approximately 30% since the

beginning of January 2015 to June 2018 in young adults (18-29; Figure 13B).

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0.40

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0.70

0.80

0.90

1.00


PR

OP

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Proportion of Prescription Drugs Prescribed by Maryland Doctors

to Youth and Young Adults

12 to 17 18 to 24 25 to 29

Figure 13. Maryland doctors’ prescribing patterns and rates; (A) Proportion of prescription drugs prescribed to youth (12-17 years old) and young adults (18-24; 25-29 years old); (B) All patterns of

dispensed medications fills by drug category across January 2015 to June 2018. All registered healthcare providers within the PDMP database (by DEA degree: MD or DO).

0

20000

40000

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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018

Benzos Opioids Stimulants Other

# O

F P

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RIP

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ILL

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All Dispensed Medication Fills Prescribed To Maryland Youth and Young Adults by

Doctors Over Time

12 to 17 18 to 24 25 to 29

A

B

29 | P a g e

Spotlight on Dentists

Proportionally, of all medications that dentists have prescribed from January 2015 to June 2018, just over 90%

of prescriptions are opioids; consistent across all age groups. Over time, rates of opioid prescriptions have

decreased in young adults (18-29 years old), but prescribing patterns for youth may be based on a seasonal

influence as rates of opioids are higher in the second half of the year than the first.

0

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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018

Benzos Opioids Stimulants & Other

# O

F P

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ILL

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All Dispensed Medication Fills Prescribed to Maryland Youth and Young Adults

by Dentists Over Time

12 to 17 18 to 24 25 to 29

0.000

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Benzo Opioid Stimulant & Other

PR

OP

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S

Proportion of Prescription Drugs Prescribed by Maryland Dentists

to Youth and Young Adults

12 to 17 18 to 24 25 to 29

Figure 14. Maryland dentists’ prescribing patterns and rates; (A) Proportion of prescription drugs prescribed to youth (12-17 years old) and young adults (18-24; 25-29 years old); (B) All

patterns of dispensed medications fills by drug category across January 2015 to June 2018. All registered healthcare providers within the PDMP database (by DEA degree: DDS or DMD).

A

B

30 | P a g e

3.3 PRESCRIBING PATTERNS ACROSS JURISDICTIONS

The tables that follow show each Maryland jurisdiction for each age group and drug category in comparison to

the State’s average for the same age group and drug category within January to June 2018. Bars in red represent

jurisdictions above the State average. Bars in green represent jurisdictions below the State average.

Kent County has the highest proportion of benzodiazepines dispensed to youth (12-17 years old; Figure 15A),

while opioids were largely dispensed in Charles, Prince George’s, and St. Mary’s relative to the state average

(Figure 15B).

0

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PR

OP

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F O

PIO

ID F

ILL

S

Proportion of Opioid Fills Dispensed to Youth (12-17 years old) within

Jurisdictions relative to the Maryland State Average during Jan-Jun 2018

0

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PR

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F B

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Proportion of Benzodiazepine Fills Dispensed to Youth (12-17 years old) within


Figure 15. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.0374); and (B)

opioid medications (state average for 12-17 year olds in Jan-Jun 2018: 0.0904) dispensed to Maryland youth (12-17 years old) within each of Maryland’s jurisdiction from January to June

2018. Red bars denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.

A

B

31 | P a g e

Allegany County has the highest proportion of stimulant medications dispensed to youth (12-17 years old;

Figure 16A), while St. Mary’s has the highest proportion of other fills (Figure 16B) relative to the state

average.

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PR

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LS

Proportion of Other Fills Dispensed to Youth (12-17 years old) within


* * *

0.65

0.7

0.75

0.8

0.85

0.9

0.95

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ega

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ther

PR

OP

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F S

TIM

UL

AN

T F

ILL

S

Proportion of Stimulants Fills Dispensed to Youth (12-17 years old) within


Figure 16. Relative to the state of Maryland’s average, the proportion of (A) stimulant prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.843); and (B) other

medications (state average for 12-17 year olds in Jan-June 2018: 0.0271) dispensed to Maryland youth within each of Maryland’s jurisdiction from January to June 2018. Red bars denote a

jurisdiction that is above the state average, and green bars denote jurisdictions that are below. * denotes drug categories with a fill quantity unavailable from data, or specifically unavailable for

an age group.

A

B

32 | P a g e

Allegany has the highest proportion of benzodiazepine medications dispensed to young adults (18-24

years old; Figure 17A), while Baltimore City, Charles, and Garrett Counties have the highest proportion of

opioid medications (Figure 17B) relative to the state average.

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PR

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Proportion of Opioid Fills Dispensed to Young Adults (18-24 years old) within


0.05

0.1

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PR

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PIN

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S

Proportion of Benzodiazepine Fills Dispensed to Young Adults (18-24 years old)

within Jurisdictions relative to the Maryland State Average during Jan-Jun 2018

Figure 17. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.1194); and (B)

opioid medications (state average for 18-24 year olds in Jan-June 2018: 0.3337) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red

bars denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.

B

A

33 | P a g e

Howard, Montgomery, and Queen Anne’s Counties have the highest proportion of stimulant medications

dispensed to young adults (18-24 years old; Figure 18A), while Caroline and Carroll Counties have the highest

proportion of other prescriptions dispensed (Figure 18B) relative to the state average.

0.3

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Proportion of Stimulant Fills Dispensed to Young Adults (18-24 years old) within



medications (state average for 18-24 year olds in Jan-June 2018: 0.048419); dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars

denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.

A

B

0.03

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Proportion of Other Fills Dispensed to Young Adults (18-24 years old) within


*

34 | P a g e

Allegany County has the highest proportion of benzodiazepine prescriptions dispensed to young adults (25-29

years old; Figure 19A), while Garrett County has the highest proportion of opioid prescriptions dispensed

(Figure 19B) relative to the state average.

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Proportion of Opioid Fills Dispensed to Young Adults (25-29 years old) within


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Proportion of Benzodiazepine Fills Dispensed to Young Adults (25-29 years old)

within Jurisdictions relative to the Maryland State Average during Jan-Jun 2018

Figure 19. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 25-29 year olds in Jan-June 2018: 0.154493); and (B) opioid

medications (state average for 25-29 year olds in Jan-June 2018: 0.45485) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars denote a

jurisdiction that is above the state average, and green bars denote jurisdictions that are below.

B

A

35 | P a g e

Howard, Montgomery, and Queen Anne’s Counties have the highest proportion of stimulant prescriptions

dispensed to young adults (25-29 years old; Figure 20A), while Wicomico County has the highest proportion of

other prescriptions dispensed (Figure 20B) relative to the state average.

0.035

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0.15

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Proportion of Stimulant Fills Dispensed to Young Adults (25-29 years old) within



medications (state average for 25-29 year olds in Jan-June 2018: 0.054126) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars

denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.

A

B

36 | P a g e

The figures that follow show the proportion of each drug category within each jurisdiction from January 2015 – June 2018. The proportion of

benzodiazepine prescriptions filled in Queen Anne’s County in 2015 was almost 50% of all the fills over time (Figure 21). This fill pattern is

different from all other jurisdictions.

0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00

Allegany

Anne Arundel

Baltimore City

Baltimore County

Calvert

Caroline

Carroll

Cecil

Charles

Dorchester

Frederick

Garrett

Harford

Howard

Kent

Montgomery

Prince George's

Queen Anne's

St. Mary's

Somerset

Talbot

Washington

Wicomico

Worcester

Unknown/Other

PROPORTION OF BENZODIAZEPINE FILLS

MA

RY

LA

ND

JU

RIS

DIC

TIO

N

Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12 - 17 years old)

Jan-Jun 2015 Jul-Dec 2015 Jan-Jun 2016 Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Jan-Jun 2018

Figure 21. Benzodiazepines prescription fills dispensed to youth (12-17 years old) within each of Maryland’s 24 jurisdictions, proportional to six month intervals beginning with January 2015 through June 2018.

37 | P a g e

The proportion of opioid fills within Garrett County in 2015 was about 40% of all the fills over time (Figure 22). Over time, fills become

proportionally similar to the other jurisdictions.

0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00

Allegany

Anne Arundel

Baltimore City

Baltimore County

Calvert

Caroline

Carroll

Cecil

Charles

Dorchester

Frederick

Garrett

Harford

Howard

Kent

Montgomery

Prince George's

Queen Anne's

St. Mary's

Somerset

Talbot

Washington

Wicomico

Worcester

Unknown/Other

PROPORTION OF BENZODIAZEPINE FILLS

MA

RY

LA

ND

JU

RIS

DIC

TIO

N

Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12 - 17 years old)

Jan-Jun 2015 Jul-Dec 2015 Jan-Jun 2016 Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Jan

an investigation of schedule ii-v prescription drug dispensing rates & patterns … · 2020. 1....

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