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OR PDMP Program Details 2014
1. Oregon PDMP in 2014
Lisa Millet, IVPP Section Manager
Oregon Health Authority, Public Health Division
Opioid Prescribers Group
March 19, 2014
2. Objectives
• Provide a brief overview of Oregon’s prescription
opioid overdose epidemic
• Review Oregon’s PDMP history
• Provide an overview of system use to date and
barriers to adoption
• Review amended PDMP legislation and related
system changes
• Discuss how the PDMP can be used to assess
treatment and coordinate care
3. Unintentional or undetermined prescription opioid
overdose death rate per 100,000 by year and sex and
annual count by year, Oregon, 2000-2012
4. Average unintentional or undetermined prescription opioid
overdose death rate per 100,000 by age group and sex and
annual count by age group, Oregon, 2008-2012
5. Unintentional prescription opioid overdose
hospitalization rate per 100,000 by year and sex and
annual count by year, Oregon, 2000-2012
6. Average unintentional prescription opioid overdose
hospitalization rate per 100,00 by age group and sex and
annual count by age group, Oregon, 2010-2012
7. Who is most at risk?
A CDC policy impact report cites the following
indicators for people at highest risk for
prescription painkiller overdose:
• Take high doses of prescription painkillers
• Have low incomes
• Live in rural areas
• Have a history of mental illness
• Have a history of substance misuse are at highest risk
for overdosing
Source: Policy Impact: Prescription Painkiller Overdoses: http:
//www.cdc.gov/homeandrecreationalsafety/rxbrief/
8. Opioid overdose prevention
efforts in Oregon
• PDMP as a healthcare tool
• Opioid prescribing guidelines
• Public education on dangers of opioids
• Drug take back
• Access to treatment and recovery support
• Naloxone and buprenorphine
• Surveillance
• Evaluation
10. Primary diagnosis for unintentional prescription
opioid and heroin overdose hospitalization rate by
year, Oregon, 2000-2012
11. Increase in overdose death & hospitalization rates
per 100,000 for selected drugs, OR, 2000 to 2011
Drug Deaths Hospitalizations
2000 2011 2000 2011
Heroin
0.8 3.1 3.8 0.6 1.8 2.8
Prescription opioid drugs
1.0 4.6 4.8 2.0 10.0 5.1
Methadone
0.5 2.1 4.2 0.3 2.4 7.6
Benzodiazepines
0 0.9 30.3 1.3 3.9 3.0
Antiepileptic, sedative-hypnotic,
antidepressant
0.8 2.8 3.6 5.6 13.1 2.4
Methamphetamines and other
psychostimulants
0.5 1.4 3.1 0.8 2.0 2.5
Alcohol
0.4 3.0 6.8 0.7 1.2 1.6
12. Comparison of overdose hospitalizations
across ICD-9 codes for select drugs, Oregon,
2012
Primary diagnosis
(unintentional)
Multiple diagnoses 1-
10 (unintentional)
Induced dependency
or abuse impacting
health and daily life
activities across
diagnoses 1-10
Other specified and
unspecified drugs 831 1101 5995
Opioid and/or
pharmaceutical opioids 584 884 4501
Heroin 101 117
Methadone 97 131
Benzodiazepine 518 914
13. About Oregon’s PDMP
• Operated and maintained by the Oregon Health
Authority (OHA)
• Established in statute in 2009:
ORS 431.962 - 431.978 & 431.992
• Statute amended in 2013 legislative session
• Data are protected health information
• System is Web-based and access is limited
• Pharmacies began uploading Schedules II-IV controlled
substances on June 1, 2011
• Online system went live on September 1, 2011 and is
accessible 24/7
• System use is voluntary
14. Oregon PDMP collects pharmacy data
Patient information
• First and last names, middle initial
• Date of birth
• Address
• Patient sex*
Drug Information
• Drug code number
• Date drug was prescribed and date dispensed
• Quantity of drug dispensed
• Days supplied and prescription number*
• Refills authorized and refill number*
Pharmacy and practitioner information
• Dispensing pharmacy
• Prescriber
*Began collecting these data on January 1, 2014
15. PDMP Data: Select controlled substances
dispensed to residents, Oregon, 2012
Controlled Substance
Prescription
Recipient Count
in 12 months
Number of
prescriptions
dispensed in 12
months
Number of
prescriptions
dispensed per
prescription
recipient in 12
months
Number of
people receiving
prescription, per
1,000 residents
Number of
prescriptions
dispensed per 1,000
residents
Opioids1
908,162 3,495,888 3.8 233.8 900.1
Hydrocodone 676,105 1,947,074 2.9 174.1 501.3
Oxycodone 334,805 1,122,642 3.4 86.2 289.1
Morphine 40,004 234,233 5.9 10.3 60.3
Hydromorphone 22,998 68,274 3.0 5.9 17.6
Methadone2
16,259 123,665 7.6 4.2 31.8
Fentanyl 14,941 88,331 5.9 3.8 22.7
Benzodiazepines3
413,754 1,833,426 4.4 106.5 472.1
Lorazepam 132,705 416,302 3.1 34.2 107.2
Zolpidem 123,824 530,485 4.3 31.9 136.6
Alprazolam 99,024 373,609 3.8 25.5 96.2
Diazepam 70,421 184,657 2.6 18.1 47.5
Clonazepam 63,783 328,373 5.1 16.4 84.6
Temazepam 15,836 69,202 4.4 4.1 17.8
Opioid-Benzo Combo4
182,763 1,111,838 6.1 47.1 286.3
1
Opioids include: Hydrocodone, Oxycodone, Morphine, Methadone, Fentanyl, and Hydromorphone.
2
Does not include methadone used to treat addiction.
3
Benzodiazepines include: Zolpidem, Lorazepam, Alprazolam, Clonazepam, Diazepam, and Temazepam.
4
Opioids include all listed above. Benzodiazepines include all listed above except Zolpidem which represents a chemically
16. Comparing overdose death rates per 100,000 by drug using
NCHS population estimates and PDMP recipients, Oregon 2012
17. Distribution of Schedule II – IV controlled
substances prescriptions among prescribers,
Oregon, as of 12/31/13
Percent of prescribers Percent of CS prescriptions
Oregon Health Authority. 2013 Annual Report to the Advisory Commission
18. Oregon Health Authority. 2013 Annual Report to the Advisory Commission
Rate per 10,000 residents using 4 or more
prescribers and 4 or more pharmacies, Oregon,
7/1/12 to 12/31/12
19. PDMP use and access data
June 2011 through December 2013
• Almost 17 million Rx records in the database
• Approximately 98 percent of pharmacies
required to upload data are reporting within
the required 7-day period
• More than 7,200 authenticated users with
active access accounts
• More than 940,000 patient record queries
conducted by providers and pharmacists
20. Top 12 Prescriptions, JUN 2011—DEC 2013
Drug Number of Rx % of all Rx
Hydrocodone 4,697,183 27.7%
Oxycodone 2,832,151 16.7%
Zolpidem 1,292,356 7.6%
Lorazepam 1,040,223 6.1%
Alprazolam 927,742 5.5%
Clonazepam 817,372 4.8%
Amphet ASP/AMPHET/D-
AMPHET
609,217 3.6%
Morphine 572,415 3.4%
Methylphenidate 555,423 3.3%
Diazepam 456,718 2.7%
Methadone 305,466 1.8%
21. Historically who has been able to
obtain PDMP information?
• Oregon-licensed healthcare providers & pharmacists
authorized by the OHA can get online access
• Patients may obtain a free copy of their record which
includes a list of system users who accessed their
PDMP information
• Regulatory boards may request information on a
licensee if they certify it is necessary for an active
investigation
• Law enforcement agencies may request information
on an individual pursuant to a valid court order based
on probable cause
22. Comparison of Oregon licensees who have PDMP
accounts through 12/31/13 and who prescribed in
2013 by discipline
Licensed Discipline Number who
prescribed at least
one controlled
substance Schedule
II-IV in 2013
Number with PDMP
accounts by December, 2013
(% of those who prescribed
any CS II-IV)
Estimated
total number
of licensees
Nurse Practitioners 1,887 945 (50.1) 2,600
Dentists 2,409 506 (21.0) 3,750
Osteopathic physicians 750 378 (50.4) 875
Medical Physicians (MD) 8,822 3,201 (36.3) 12,700
Naturopathic physicians 344 87 (25.3) 850
Physician Assistants 1,136 457 (40.2) 1,500
Optometrists 85 8 (9.4) 750
Totals 15,433 5,582 (36.2) 23,025
23. Number of PDMP queries by all disciplines,
Oregon, Jan. 2012 to Dec. 2013, N=903,225
24. Average monthly number of PDMP queries per
querying user by discipline, Oregon, Jan. – Dec. 2013
25. 2013 Legislative Changes
Senate Bill 470
• Permits the PDMP to collect additional data (patient sex,
days supplied, and refill data)
• Permits prescribers and pharmacists to authorize delegate
access to members of staff
• Permits prescribers to review prescriptions dispensed
under their own DEA number
• Allows the State Medical Examiner and designees to access
PDMP information for autopsies and death investigations
• Authorizes prescribers in neighboring states (WA, ID, and
CA) and who treat Oregonians to access the Oregon PDMP
• Allows public health authorities to use de-identified PDMP
data
26. How PDMPs can facilitate better
health and health care
• Support medically necessary uses of controlled
substances
• Help identify risks to patient safety
• Facilitate coordination of care among providers
• Facilitate pharmacology consultation
• Aid in the identification of potential drug misuse,
abuse, or diversion of prescription drugs
• Facilitate the intervention and treatment of persons
addicted to prescription drugs
• Educate individuals and communities about the
dangers of prescription drugs
• Inform public health initiatives through outlining use
and misuse trends
27. Reported barriers to
PDMP access and use 1, 2
• Difficulty registering – i.e. application
notarization
• Difficulty accessing and using the system
• Not comfortable using a computer or the
internet
• Time constraints
• Lack of access by support staff
• Not aware of the program
1
April 2012 provider and pharmacist survey conducted by Program Design and
Evaluation Services through a Bureau of Justice Assistance PDMP grant award
2
April 2013 provider survey conducted by Acumentra Health and Oregon Health and
Sciences University through a National Institutes of Health grant award.
28. Provider recommendations to increase the
usefulness of the PDMP in clinical practice*
• Delegate access for support staff
• Training on access or use of the PDMP
• Training on how to respond to PDMP information
• Training on non-confrontational communication of findings
to patients
• Linking multiple state systems
• Automatic system notification when a prescription pattern
suggests potential misuse or diversion
• Faster availability of data in the system
• Unique patient identifier to reduce mistaken identity or use
of aliases
• Better insurance coverage for mental health or addiction
referrals
* From an April 2013 provider survey conducted by Acumentra Health and Oregon
Health and Sciences University through a National Institutes of Health grant award.
29. System changes and new system user
interface for 2014
• Delegate access for office staff
• Audit of delegate access
• Prescriber audit of dispensation under their
DEA number
• Simplified query screen
• Easier-to-read Web output for patient queries
