Oklahoma's Strategy against Prescription Drug Abuse

1. SPF-Rx Strategic Prevention Framework for Prescription Drugs

2. What is SPF-Rx? • New grant from SAMHSA available only to states, U.S. territories, Pacific jurisdictions, and tribal entities that received SPF-PFS funds • SAMHSA’s purpose: • Raise awareness about the dangers of sharing medications and work with pharmaceutical and medical communities on the risks of overprescribing • Raise community awareness and bring prescription drug abuse prevention activities to a variety of sectors (e.g., communities, prescribers, parents, schools). • Age groups: youth 12-17 and adults 18+ • Project period: Sept. 1, 2016-August 31, 2021 • Project award: $371,616 per year

3. Oklahoma’s State Level Approach • Continue to collaborate with state-level partners (e.g., OBNDD, OSDH) to strengthen prescription monitoring program (PMP) data collection sharing and processes • Continue to implement state-level activities in the Governor’s plan: Reducing Prescription Drug Abuse in Oklahoma • Collaborate with state and local partners to develop county-level PMP data profiles for all counties • Provide training and technical assistance (TA) to REOWs and CDWs regarding data (PMP and other types of data) use, interpretation, and dissemination • Evaluate at state and local levels

4. Oklahoma’s Community Level Approach • Small amount of funds to be added to existing PFS contracts based on county size and population • Activities: • Collaborate with coalitions, associations, tribes, other organizations to educate the medical community on opioid prescribing guidelines and the importance of using the PMP • Collaborate with above entities to promote prescribing and dispensing policies to discourage drug seeking behavior in hospital emergency depts./urgent care clinics, office-based settings, and pharmacies • Provide input on, and implement at least one component of, a community-based social marketing/public education plan • Participate in local evaluation activities

5. NMUPD Rx drug overdoses Quality of life

6. What is the PMP? • Prescription Monitoring Program (PMP); also called Prescription Drug Monitoring Program (PDMP) in other states • Oklahoma’s PMP is housed and administered by the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) • Database of Schedule II-V controlled substances entered into database by dispenser at the time of delivery to patient • Sample of variables collected: • Name of drug • Dosage • Number of units dispensed • Prescriber • Dispenser • Date prescribed • Date delivered • Patient gender • DOB • Address • Does not include patient race, why prescription was written, patient health information

7. PMP Timeline • 1990: Oklahoma PMP enacted into law • 2012: All dispensers of Schedule II, III, IV, and V controlled substances required to report within five minutes of delivery to customer • HB 1781 enacted in November 2013: Requires OBNDD to share raw data with ODMHSAS and OSDH • HB 1948 enacted in Nov. 15: Requires all health care providers to access the PMP repository, under certain conditions, to assess medical need and appropriate prescribing of opioid therapy • August 2016: PMP transitioned from OBNDD in-house system to one administered by an outside vendor • Current status: OBNDD has been working to obtain data from vendor, which can then be given to ODMHSAS and OSDH - process has taken much longer than anticipated

8. REOW Coordinator • Build(s) capacity on utilizing, analyzing, and reporting real-time data in meaningful ways • Develop tool(s) for collecting and organizing data • Takes lead on developing county profiles describing PMP data • Provide(s) recommendations on useful PMP-related indicators, training, and technical assistance on how to sustain REOWs/CDWs • Respond to requests for data-related technical assistance and analysis

9. Sample of Brandeis University Recommended Measures • Prescription rates by quarter and year, by drug class and sex • Prescription rates by quarter and year, by major opioid drug category • Prescription rates by quarter and year, by major stimulant drug category • Mean daily dosage per patient in morphine milligram equivalents (MMEs) by quarter and year, by major opioid drug category • Percentage of prescribed drugs overlapping with another prescription from the same drug class, by quarter and year • Multiple provider episode rates by quarter and year, by drug schedule and age group

10. How many drugs are monitored by PMP? Source: Prescription Drug Monitoring Program Training & Technical Assistance Center, Brandeis University

11. How often is PMP data collected? Source: Prescription Drug Monitoring Program Training & Technical Assistance Center, Brandeis University

12. Statistics • Prescribers (2011)1 • 15,212 • Dispensers(2011)1 • 922 • Prescriptions collected (2011)1 • 8,733,388 • Number of patient history reports (2011)1 • 770,545 • 7,660deaths due to prescription drug overdose (1999-2015)2 • Age-adjusted prescription drug overdose rate in Oklahoma (2015)2 • 13.4 per 100,000 • Age-adjusted average prescription drug overdose rate in Oklahoma (1999-2015)2 • 12.6 per 100,000 Source(s): Prescription Drug Monitoring Program Training & Technical Assistance Center, Brandeis University, 2011. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC Wonder Online Database, released 2016.

13. Sample PMP profile

14. Potential possibilities utilizing PMP data • Ascertaining overdose death rate by prescriptions from prescribers • Trends in doctor shopping by type of prescription drug (schedules II-V) • Mean daily dosage in MMEs by month, and/or year

15. Questions?