West Virginia Board Of Pharmacy Prescription Opioid Indicators Report .

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West Virginia Board of Pharmacy Prescription Opioid Indicators ReportUpshur County – 2019The West Virginia Violence and Injury Prevention Program (WV VIPP), incollaboration with the West Virginia Board of Pharmacy and the West VirginiaUniversity Injury Control Research Center (ICRC), under the direction of theCenters for Disease Control and Prevention (CDC), continue to work to addressprescription drug misuse, diversion, and overdose within the state of WestVirginia. Prescription drug overdose continues to be a major issue in WestVirginia. Preliminary data from the West Virginia Heath Statistics Center showsthat in 2018, over 900 people died in association with drug misuse (includingprescription and illicit drugs) with a rate of 52.2 per 100,000 population. This isnearly three times the national average. To help combat this epidemic, CDCprovided specific indicators to identify high-risk areas within the state to allowfor intervention and community education.Upshur CountyWest Virginia Board of Pharmacy April 20201

Indicator 1: Number and rate of opioid analgesics per 1,000 state residentsThis indicator includes all opioid prescriptions that are classified as either Schedule II, III, IV, or V. The figuresbelow show the total number of opioid prescriptions for Upshur County and the rate per 1,000 populationcompared to the state. Census data was used to obtain demographic information and population sized.Figure 1.Number of OpioidAnalgesics Dispensed,Upshur County, 0546862016915603Upshur 12,08210,69720182019Figure 2.Rate of OpioidAnalgesics per 1,000Population in UpshurCounty and WV,2014-20192019WVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator is important because it provides information about prescription opioid use for each county.These data will help determine areas where high prescribing/dispensing are occurring around the state andallow for education on responsible opioid prescribing. High rates of opioid dispensing mean large quantitiesof opioids that are out in the community. From 2014-2019, Upshur County had lower rates of opioids beingprescribed compared to the state and there was an overall decrease in the rate during this time.Upshur CountyWest Virginia Board of Pharmacy April 20202

Indicator 2: Percent of patients receiving more than an average dailydose of 90 morphine milligram equivalents (MME).This indicator shows the total average daily dose of MMEs that a patient is taking. It includes all opioidprescriptions that are classified as either Schedule II, III, IV, or V. MMEs are used as a measure to describe thepotency of an opioid. Calculating MMEs is important to determine which patients may be at risk for anoverdose. The figure below shows the percent of patients with greater than an average daily dose of 90MMEs in Upshur County compared to the state during 2014-2019.Figure 3.Percent of PatientsReceiving More than anAverage Daily Dose of 90MME, Upshur County andWV, 2014-2019962014875520152016666520172018Upshur County552019WVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator is important because it provides information for prescribers about how much morphineequivalent drug the patient is receiving. MMEs help determine the amount of morphine an opioid dose isequal to when prescribed, often used as a gauge of the abuse and overdose potential of the amount of opioidthat is being given at a particular time. It is also a useful tool to identify high-burden areas in the state, whichis important for public health surveillance at the county level. From 2014-2019, Upshur County’s percent ofpatients receiving more than an average daily dose of 90 MMEs was lower than the state and there was aslight decrease during this time.Upshur CountyWest Virginia Board of Pharmacy April 20203

Indicator 3: Rate of multiple provider episodes for prescription opioids (5 or moreprescribers and 5 or more pharmacies in a 6-month period) per 100,00 residents.This indicator shows the rate of patients who went to 5 or more prescribers and 5 or more pharmacies withina 6-month period, or multiple provider episode (MPE). The rate is calculated per 100,000 population. Itincludes all opioid prescriptions that are classified as either Schedule II, III, IV, or V.43313216920201420158820162017Upshur County430201802019Figure 4.Rate of Multiple ProviderEpisodes (MPE) forPrescription Opioids per100,000 Population,Upshur County and WV,2014-2019WVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator is important because provides valuable information on prescription filling behaviors. Patientswho receive prescriptions from more than five doctors and who fill at more than five pharmacies are at greaterrisk of drug overdose. This indicator helps determine patients who may have drug seeking habits (i.e., “doctorshopping”). During 2014-2019, Upshur County had lower rates of patients who qualified as having an MPEcompared to the state apart from 2015 where the rate was slightly higher. There was an overall decreaseduring this time.Upshur CountyWest Virginia Board of Pharmacy April 20204

Indicator 4: Percent of patients prescribed long-acting/extendedrelease opioids among opioid-naïve patientsThis indicator represents the percent of patients with no prescribed opioid prescriptions in the previous 45days* who were prescribed at least one long acting/extended release (LA/ER) opioid, among all patients withLA/ER opioid prescriptions. It includes all opioid prescriptions that are classified as either Schedule II, III, IV,or V.16Figure 5.Percent of PatientsPrescribed Long Acting/Extended ReleaseOpioids among OpioidNaive Patients, UpshurCounty, 2019Upshur CountyWVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator is important to understand because it provides information about individuals who are notaccustomed to opioid medications, which may potentially increase the risk of opioid dependence, misuse, oroverdose. CDC opioid prescribing guidelines recommend using immediate release (IR) opioids beforetaking LA/ER. From 2014-2017, Upshur County had a higher percentage of patients who were opioid-naïvecompared to the state but fell below the state average in 2018. There was an overall decrease during thistime.*Note that CDC changed the definition of “opioid-naïve” from 60 days to 45 days in 2017.Upshur CountyWest Virginia Board of Pharmacy April 20205

Indicator 5: Percent of patient prescription days with overlappingopioid prescriptionsThis indicator shows the percent of days in which more than one prescribed opioid prescription during thesame time-period were dispensed, among all prescription days. It includes all opioid prescriptions that areclassified as either Schedule II, III, IV, or V.131312111320149920152016102017Upshur County10109820182019Figure 6.Percent of PatientPrescribed DaysOverlap BetweenOpioid Analgesics,Upshur County andWV, 2014-2019WVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator represents the patients who may potentially be using their opioid prescriptions not asprescribed or may show areas where drug diversion is occurring. Using multiple opioid prescriptions duringthe same time-period increased the risk for drug dependency and overdose. It is important to understandthis because a considerable number of drug overdose deaths include more than one opioid. From 20142019, Upshur County had a lower percentage of prescription overlap compared to the state average andthere was a decrease during this time.Upshur CountyWest Virginia Board of Pharmacy April 20206

Indicator 6: Percent of patient prescriptions days with overlappingopioid and benzodiazepine prescriptions.This indicator represents the percent of patients who have an opioid and a benzodiazepine (i.e., Lorazepam,Diazepam) prescription on the same day among all opioid prescription days. It includes all opioidprescriptions that are classified as either Schedule II, III, IV, or V.33Figure 7.Percent of PatientPrescribed OpioidDays that Overlapwith BenzodiazepinePrescriptions, UpshurCounty and 0182019Upshur CountyWVSource: West Virginia Controlled Substance Monitoring ProgramWhat Does This Mean?This indicator is important because it shows areas in the state where patients are using both opioids andbenzodiazepine drugs at the same time. Taking an opioid with a benzodiazepine increases the risk for drugoverdose and death, as both classes of medication depress the central nervous system. From 2014-2019,Upshur County had a lower percent of days where there was an overlapping opioid and benzodiazepineprescription than the state average and there was an overall decrease during this time period.Upshur CountyWest Virginia Board of Pharmacy April 20207

County Rankings By IndicatorPatient RWETZELWIRTWOODWYOMINGIndicator 26Indicator 28Indicator 3Indicator 4Indicator 5Indicator 95544.53138.5332154*Each county is ranked from 1 to 55, where a rank of 1 is assigned to the county with the highest (worst) rate or percentageand a 55 to the county with the lowest (best) rate or percentage. Counties with a ".5" in the rank had the same rank as anothercounty and the average rank was returned.Upshur CountyWest Virginia Board of Pharmacy April 20208

Percent of UpshurCounty with an opioidprescriptionPercent of Upshur Countywith a controlledsubstance prescription13%19%Percent of Upshur Countywith a benzodiazepineprescription5%Source: West Virginia Controlled Substance Monitoring ProgramFor more information regarding this county profile or the West Virginia Controlled Substance Monitoring Program(CSMP), please see contact information below.Contact Information:Mike Goff, Board of Pharmacy Executive DirectorPhone: (304) 558-8411E-mail: Michael.L.Goff@wv.govNathan Wood, CSMP EpidemiologistPhone: (304) 414-0789E-mail: Nathan.G.Wood@wv.govTim Dotson, CSMP EpidemiologistPhone: (304) 414-0537E-mail: Timothy.S.Dotson@wv.govTo access other WV County Profile Reports, follow the link /default.aspxUpshur CountyWest Virginia Board of Pharmacy April 20209

Upshur County West Virginia Board of Pharmacy April 2020 8 . County Rankings By Indicator Patient County Indicator 1 Indicator 2 Indicator 3 Indicator 4 Indicator 5 Indicator 6 BARBOUR 34 26 38.5 42 24 32 BERKELEY 37 2 19 40.5 2 48 BOONE 2 48 2 36.5 51 3 BRAXTON 43 24 38.5 40.5 18 26

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