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The Latest Prescription Trends for Controlled Prescription Drugs
September 1, 2015
Christopher M. Jones PharmD, MPH
Senior Advisor Office of Public Health Strategy and Analysis
Office of the Commissioner
Food and Drug Administration
Overview
• Data source
• Opioid analgesics
• Benzodiazepines
• Stimulants
• Opioid use disorder medication assisted
treatments
• Conclusions 2
Data Source
• Data from IMS Health
– National Prescription Audit
– National Prescription Audit Extended Insights
3
OPIOID ANALGESICS
4
Opioid analgesic prescriptions dispensed from US retail pharmacies, Q42009-Q22015
ER/LA Opioid Analgesics All Opioid Analgesics
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
Nu
mb
er o
f D
isp
ense
d P
resc
rip
tio
ns
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
5
Opioid analgesic prescriptions dispensed from US retail pharmacies for select opioids,
Q42009-Q22015 % of All Opioids
hydrocodone oxycodone tramadol morphine fentanyl Dispensed in Q2-2015
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
Nu
mb
er o
f P
resc
rip
tio
ns
Dis
pen
sed
40.8%
24.6%
17.8
3.7%
2.2%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
6
Opioid analgesic prescriptions dispensed from US retail pharmacies by provider specialty, 2010-2014
2010 2011 2012 2013 2014
Nu
mb
er o
f P
resc
rip
tio
ns
Dis
pen
sed
120,000,000
100,000,000
80,000,000
60,000,000
40,000,000
20,000,000
0
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
7
Percentage of opioid analgesic prescriptions dispensed from US retail pharmacies by specialty,
2010 vs 2014 2010 2014
50 45 40 35 30 25 20 15 10
5 0
Per
cen
t
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
8
Opioid analgesic prescriptions dispensed from US retail pharmacies by gender,
August 2014-July 2015
Female 58.7%
Male 41.3%
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
9
Opioid analgesic prescriptions dispensed from US retail pharmacies by age group,
August 2014-July 2015
10
Ages 0-19 2.8% Ages 20-39
20.8%
Ages 40-59 41.8%
Age 60+ 34.6%
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
BENZODIAZEPINES
11
Benzodiazepine prescriptions dispensed from US retail pharmacies, Q42009-Q22015
Alprazolam Lorazepam Diazepam All Benzodiazepines
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Nu
mb
er o
f d
isp
ense
d p
resc
rip
tio
ns
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
12
Benzodiazepine prescriptions dispensed from US retail pharmacies by provider specialty, 2010-2014
2010 2011 2012 2013 2014
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
Nu
mb
er o
f d
isp
en
sed
pre
scri
pti
on
s
Primary Care Physicians Nurse Practitioners/Physician Psychiatrist/Psychologists Other Assistants
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
13
Percentage of benzodiazepine prescriptions dispensed from US retail pharmacies by specialty,
2010 vs 2014 2010 2014
0
10
20
30
40
50
60
70
Per
cen
t
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
14
Primary Care Physicians Nurse Practitioners/Physician Psychiatrist/Psychologists Other Assistants
Benzodiazepine prescriptions dispensed from US retail pharmacies by gender,
August 2014-July 2015
Male
Female 66.9%
33.1%
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
15
Benzodiazepine prescriptions dispensed from US retail pharmacies by age group,
August 2014-July 2015
16
Ages 0-19 1.8% Ages 20-39
18.7%
Ages 40-59 41.4%
Age 60+ 38.2%
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
STIMULANTS
17
Stimulant* prescriptions dispensed from US retail pharmacies, Q42009-Q22015
Amph/Dextroamph Methylphenidate All Stimulants *
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
Nu
mb
er o
f d
isp
ense
d p
resc
rip
tio
ns
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
* includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
18
Stimulant* prescriptions dispensed from US retail pharmacies by provider specialty,
2010-2014
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
20,000,000
Nu
mb
er o
f d
isp
ense
d p
resc
rip
tio
ns 2010 2011 2012 2013 2014
Primary Care Physicians Nurse Psychiatrist/Psychologists Pediatrics Other Practitioners/Physician
Assistants * includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
19
Percentage of stimulant* prescriptions dispensed from US retail pharmacies by specialty,
2010 vs 2014 2010 2014
0
5
10
15
20
25
30
35
Per
cen
t
Primary Care Physicians Nurse Psychiatrist/Psychologists Pediatrics Other Practitioners/Physician
Assistants
* includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
20
Stimulant* prescriptions dispensed from US retail pharmacies by gender,
August 2014-July 2015
Female 44.8%
Male 55.2%
*includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate,
Pemoline, modafinil, armodafinil, caffeine,
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
21
Stimulant* prescriptions dispensed from US retail pharmacies by age group,
August 2014-July 2015 Age 60+
Ages 0-19 45.3%
Ages 20-39
Ages 40-59 18.2%
4.6%
31.9% *includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate,
Pemoline, modafinil, armodafinil, caffeine,
Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015
22
OPIOID USE DISORDER
MEDICATION ASSISTED
TREATMENTS 23
Buprenorphine* prescriptions dispensed from US retail pharmacies, Q42009-Q22015
All Buprenorphine Suboxone & generics Subutex & generics Zubsolv Bunavail
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Nu
mb
er o
f d
isp
ense
d p
resc
rip
tio
ns
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
24
*Does not include Butrans or Buprenex (or generics) Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
Percentage of buprenorphine* prescriptions dispensed from US retail pharmacies by specialty,
2010 vs 2014 2010 2014
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Per
cen
t
Primary Care Physicians Addiction Medicine/Psychiatry/Psychology Other
*Does not include Butrans or Buprenex (or generics) Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
25
Naltrexone* prescriptions dispensed from US retail +pharmacies, Q42009-Q22015
Vivitrol All Naltrexone
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Nu
mb
er o
f d
isp
ense
d p
resc
rip
tio
ns
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015
* Naltrexone is also approved for use in alcohol dependence. Thus, not all prescriptions were used for opioid dependence +The number of prescriptions dispensed for Vivitrol from specialty pharmacies is approximately 3-4x that from US retail pharmacies.
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
26
Percentage of naltrexone* prescriptions dispensed from US retail pharmacies+ by specialty,
2010 vs 2014 2010 2014
0
10
20
30
40
50
60
Per
cen
t
Primary Care Physicians Nurse Practitioners/Physician Addiction Other Assistants Medicine/Psychiatry/Psychology
* Naltrexone is also approved for use in alcohol dependence. Thus, not all prescriptions were used for opioid dependence +The number of prescriptions dispensed for Vivitrol from specialty pharmacies is approximately 3-4x that from US retail pharmacies.
Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015
27
Conclusions • The number of prescriptions dispensed for opioid
analgesics has declined in recent years
• The number of prescriptions dispensed for
benzodiazepines has been relatively consistent
• The number of prescriptions dispensed for stimulants has increased in recent years
• The number of prescriptions dispensed for both
naltrexone and buprenorphine has increased in
recent years
• There is variation in prescribing by provider specialty
and patient gender and age across the examined
drug classes 28
Questions?
Christopher.M.Jones@fda.hhs.gov
The findings in this presentation do not represent the official position of
the US Food and Drug Administration, the Department of Health and
Human Services, or the U.S. Government
29
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