Vermont Department of Health - Alcohol & Drug Abuse Programs - Opioids and 1 more...less...

NEW Draft Performance Measures - temporary program

Total Opioid Pain Relievers Dispensed by Vermont Licensed Pharmacies

66.68MilQ1 2019

Story Behind the Curve

The United States is in the midst of an epidemic of prescription opioid overdoses. The amount of opioids prescribed and sold in the US quadrupled since 1999, but the overall amount of pain reported by Americans hasn’t changed. This epidemic is devastating American lives, families, and communities. 

Many Americans suffer from chronic pain and deserve safe and effective pain management. Prescription opioids can help manage some types of pain in the short term. However, there is limited information about the benefits of opioids long term, and there are serious risks of opioid use disorder and overdose.

Most individuals who become dependent on opioids begin through the use of prescription opioids.  Pooling data from 2002 to 2012, the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not (0.39 vs. 0.02 percent) (Muhuri et al., 2013). A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (Lankenau et al., 2012). This rate represents a shift from historical trends. Of people entering treatment for heroin addiction who began abusing opioids in the 1960s, more than 80 percent started with heroin. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug (Cicero et al., 2014). Examining national-level general population heroin data (including those in and not in treatment), nearly 80 percent of heroin users reported using prescription opioids prior to heroin (Jones, 2013; Muhuri et al., 2013).

Vermont is encouraging patients and prescribers to use opioids only when essential due to these risks, and instead use other means for controlling pain.  Morphine milligram equivalents (MMEs) are the amount of morphine an opioid dose is equal to when prescribed. Many research experts, federal agencies (e.g., CDC, BJA, SAMHSA) and the VPMS use MMEs prescribed to standardize the dose across different formulations of drugs in order to better understand the abuse and overdose potential of opioid analgesics. The total MME is a good indication of total amount of opioids dispensed in the state and reducing the amount of opioids dispensed and used is an important part of the statewide strategy to reduce opioid overdose and dependence. 

Partners
  • Patients
  • Prescribers
  • Pharmacists
  • Treatment Providers
  • Insurers
  • Community coalitions
  • Harm reduction agencies
  • Center for Disease Control
  • Substance Abuse and Mental Health Administration
What Works

Using alternatives to opioids to treat pain.

Limiting prescribing to the lowest levels to treat pain.

Coordinating care between prescribers.

Using tools for prescribing.

Changes in regulation.

Notes on Methodology

Data are from the Vermont’s prescription drug monitoring program, known as the Vermont Prescription Monitoring System (VPMS), a statewide electronic database of controlled substance prescriptions dispensed from Vermont-licensed pharmacies. VPMS is a clinical tool that exists to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse, and diversion of controlled substances.

The VPMS is a statewide electronic database of controlled substance prescriptions dispensed from Vermont-licensed pharmacies. It does not include all prescriptions.

  • Individuals can, and do, fill prescriptions at pharmacies that are not Vermont-licensed. For example, some residents fill prescriptions in New Hampshire. These prescriptions are not included in the VPMS data.
  • VPMS does not currently collect data on controlled substances dispensed from emergency rooms, veterinarian offices or opioid treatment programs (OTPs) that dispense methadone and buprenorphine for opioid addiction, such as those treated in a “hub’. It DOES contain data from office-based opioid treatment at a physician’s office, such as those treated in a “spoke”.
  • Data submitted to VPMS by pharmacies can contain errors. Each data upload from a pharmacy is screened for errors and sent back to the pharmacy to be corrected if errors are discovered. However, not all errors are found or corrected.
  • Finally, the VPMS data is for prescriptions dispensed. The VPMS does not contain information regarding when, or if, a prescription was picked up or how a prescribed medication is used.

Routine reporting on the VPMS is available on the website:  http://www.healthvermont.gov/a...

Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy