Presentation - Tufts Health Care Institute

Number of Prescribers ofMethadone by Rx3,0002,500FDA AlertNov 20062,0001,50040mg. dosesRestricted DistributionJan 20081,00050002006Q12006Q22006Q32006Q42007Q12007Q22007Q32007Q42008Q12008Q22008Q32008Q45 10 40 LiqSource: Ohio Automated Rx Reporting System

Number of MethadonePrescriptions Dispensed40,00035,00030,000FDA AlertNov 200625,00020,00015,00040mg. dosesRestricted DistributionJan 200810,0005,00002006Q12006Q22006Q32006Q42007Q12007Q22007Q32007Q42008Q12008Q22008Q32008Q4Series1 Series2 Series3 Series4Source: Ohio Automated Rx Reporting System

Doses of Methadone Dispensed6,000,0005,000,000FDA AlertNov 20064,000,000Doses3,000,0002,000,0001,000,00040mg. dosesRestricted DistributionJan 200802006 Q12006 Q22006 Q32006 Q42007 Q12007 Q22007 Q32007 Q42008 Q12008 Q22008 Q32008 Q45 10 40 LiqSource: Ohio Automated Rx Reporting System

Zip Code of Prescribers in Ohio PMP2007 DataWAORNVCAAKIDUTMTWYCONDSDNEKSAZ NM OKTXMNIAMOARWILA4.9IL INMI4.1OH40.4KYTNMS AL GAPA5.9WVVANYNCSCFL6.5VN T HCTMENJMDRIDEDCMA% of 85,000Prescribers> 0 – 0.9%1.0 – 1.9%2.0 – 4.0%4.0 – 10.0%> 10.0%HIZip code is based on DEA Registration data

# Rxs from Prescribers in OH PMP2007 DataWAORNVCAAKIDAZUTMTWYCONMNDSDNEKSTXOKMNIAMOARWILAMI1.4PA0.5NYIL IN OH0.4 95.4 WV VA0.7KYNCTNSCMS AL GAFLVN T HCTMENJMDRIDEDCMA% of 20 MPrescriptions> 0 – 0.09%.1 – 0.19%0.2– 0.4%0.4 – 2.0%>95.0%HILocation of prescriber is based on zip code onDEA Registration data.

Zip Code of Prescribers in KY PMP2007 DataWAORNVCAAKMT NDMNIDSD WINYWYMINE IAILCOINOH11.9 WUT7.7KS MOKY V VA28.9TN NC11.7AZ NM OK ARSCMS AL GATXLAFLHIPA5.3VN T HCTMENJMDRIDEDCMA% of 47,000Prescribers> 0 – 0.9%1.0 – 1.9%2.0 – 4.0%4.0 – 15.0%> 28.0%Zip code is based on DEA Registration dataSource: Kentucky All Schedule Prescription Electronic Reporting

# Rxs from Prescribers in KY PMP2007 DataWAORNVCAAKMT NDMN1.0IDSD WINYWYMINE IAIL IN OH2.0UT1.2 WCOKS MOKY V VA93%TN NC1.4AZ NM OK ARSCMS AL GATXLAFLPAVN T HCTMENJMDRIDEDCMA% of 9.9 MPrescriptions> 0 – 0.09%.1 – .19%.2 – .4%.4 – 2.0%> 93.0%Source: Kentucky All Schedule Prescription Electronic ReportingHILocation of prescriber is based onzip code on DEA Registration data.

Zip Code of Patients in KY PMP2007 DataWAORNVCAAKIDUTMTWYCONDSDNEKSAZ NM OKTXMNIAMOARWILAMIIL IN OH1.50.4 0.7KY0.894.5TN0.8WVMS AL GAPAVANYNCSCFL0.3VN T HCTMENJMDRIDEDCMA% of 1.6 MPatients> 0 – 0.1%0.1 – 0.2%0.2– 0.3%0.3 – 2.0%> 94.0%HIZip code is based on Rx dataSource: Kentucky All Schedule Prescription Electronic Reporting

WAORCA26.2NV21.2%AKZip Code of Prescribers in NV PMP2007 Data(NV had 54.5 M visitors in 2007)IDUT4.7MTWYCONDSDNEKSAZ NM OKHITX3.6MNIAMOARWILAMIIL IN OHKYTN2.92.2MS AL GAZip code is based on DEA Registration dataWVPAVANYNCSCFL3.8VN 2.1 T HCTMENJMDRIDEDCMA% of 36,000Prescribers> 0 – 0.9%1.0 – 1.9%2.0 – 4.0%4.0 – 10.0%> 20.0%

WAORCA1.7NVIDUT95.6% 1.5AK# Rxs from Prescribers in NV PMP2007 Data(NV had 54.5 M visitors in 2007)MTWYCONDSDNEKSAZ NM OKHITXMNIAMOARWILAMIIL IN OHKYTNWVMS AL GAPAVANYNCSCFLLocation of prescriber is based on zip code onDEA Registration data.VN T HCTMENJMDRIDEDCMA% of 3.9 MPrescriptions> 0 – 0.09%.1 – .19%.2 – .4%.4 – 2.0%> 95.0%

Zip Code of Patients in NV PMP 2007 Data(NV had 54.5 M visitors in 2007)WAORCA1.7NV96.8%AKIDUTMTWYCONDSDNEKSAZ NM OK1.3TXMNIAMOARWILAMIWIL IN OHKYTNVMS AL GAPAVASCNYNCFLVN T HCTMENJMDRIDEDCMA% of 3.4 MPrescriptions> 0 – 0.1%0.1 – 0.19%0.2 – 0.29%0.3 – 2.0%> 96.0%HIZip code is based on Rx data

WA2.0ORNVCA59.4%AKZip Code of Prescribers in CA PMP2007 DataIDUTMTWYCONDSDNEKSAZ NM OK2.4HITX3.2MNIAMOARWILAMIIL IN OHKYTNMS AL GAZip code is based on DEA Registration dataWVPAVANYNCSCFL2.8VN 2.1 T HCTMENJMDRIDEDCMA% of 198,000Prescribers> 0 – 0.9%1.0 – 2.9%3.0 – 3.9%4.0 – 6.0%>59.0%

# Rxs from Prescribers in CA PMP2007 DataWAORNVCA98.5%AKIDUTMTWYCONDSDNEKSAZ NM OKTXMNIAMOARWILAMIIL IN OHKYTNWVMS AL GAPAVANYNCSCFLVN T HCTMENJMDRIDEDCMA% of 34 MPrescriptions> 0 – 0.09%.1 – .19%.2 – .4%.4 – 2.0%> 98.0%HILocation of prescriber is based on zip code onDEA Registration data.

WAORCA4.519.6%NV5.2AKIDUTMTWYCONDSDNEKSAZ NM OK6.3Zip Code of Patients in CA PMP2007 DataHITX5.6MNIAMOARWILAZip code is based on Rx dataMIIL IN OHKYTNWVMS AL GAPAVANYNCSCFL4.8VN T HCTMENJMDRIDEDCMA% of 196,000Patients> 0 – 0.9%1.0 – 2.9%3.0– 3.9%4.0 –7.0%> 19.0%

Case Study #3 Using PMP data to Analyzegeographic trends of diversion• E.g. Physician recently arrested High volume of opioid prescriptions Unusual patient mix

OH Physician ArrestedJuly 28, 2008Patient BasePatient AddressKYOHWVINTNNCDRNumber of Patients2483104031191893Source: Ohio Automated Rx Reporting System

Location of Prescribers Before ArrestSource: Ohio Automated Rx Reporting System

Location of PatientsSource: Ohio Automated Rx Reporting System

Location of Prescribers After ArrestSource: Ohio Automated Rx Reporting System

Location of Prescribers(OH-KY Region) After ArrestSource: Ohio Automated Rx Reporting System

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