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TRANSCRIPT
i
Prescription Monitoring Program
Annual Report
2018
TABLE OF CONTENTS Table of Contents ........................................................................................................................................................ i List of Tables and Figures ........................................................................................................................................... ii Acknowledgments .................................................................................................................................................... iii Executive Summary ................................................................................................................................................... 1 Operational Findings ................................................................................................................................................. 2 Introduction ............................................................................................................................................................... 3 Operations ................................................................................................................................................................. 5 Prescription Data ....................................................................................................................................................... 7 Dispensed by County ................................................................................................................................................ 8 Prescriptions Reported by Class.............................................................................................................................. 13
Opioids ............................................................................................................................................................ 13 Partial Opioid Agonists .................................................................................................................................... 17 Stimulants ....................................................................................................................................................... 18 Sedatives ......................................................................................................................................................... 18 Benzodiazepines ............................................................................................................................................. 19 Muscle Relaxants ............................................................................................................................................ 19 Antitussives ..................................................................................................................................................... 20
Key Findings- Prescribers and Recipients (2018) .................................................................................................... 21 Database Account Access ........................................................................................................................................ 23 Database Utilization ................................................................................................................................................ 25 Delegate Accounts .................................................................................................................................................. 29 Other Permissible Use of PMP Data ....................................................................................................................... 30 Multiple Jurisdiction Data Exchange ........................................................................................................................ 32 Key to Abbreviations ................................................................................................................................................ 35 Bibliography ............................................................................................................................................................. 36 Appendix A .................................................................................................................................................................. I
ii
LIST OF TABLES AND FIGURES Table 1. Top Twenty Controlled Substance Prescriptions Reported as Dispensed (Generic), 2018 .......................... 7 Table 2. Controlled Substance Prescriptions Dispensed by Minnesota Recipient Residence Counties (1) ................. 9 Table 3. Prescription Count and Average of Federally Scheduled Prescriptions Dispensed per Population ........... 12 Table 4. Opioids Reported as Dispensed (2018, Top Twenty).................................................................................. 13 Table 5. Crude Rate of Opioids Dispensed per 1,000 Population by MN Recipient Residence County (1) ................ 15 Table 6. Partial Opiate Agonists Reported as Dispensed (2018) .............................................................................. 17 Table 7. Stimulants Reported as Dispensed (2018, Top Ten) ................................................................................... 18 Table 8. Sedatives Reported as Dispensed (2018, Top Five) .................................................................................... 18 Table 9. Benzodiazepines Reported as Dispensed (2018, Top Ten) ......................................................................... 19 Table 10. Muscle Relaxants Reported as Dispensed (2018 Top Three) ................................................................... 19 Table 11. Antitussives Reported as Dispensed (2018, Top Five) .............................................................................. 20 Table 12. Key Findings, Recipient ............................................................................................................................. 22 Table 13. Average Number of New Account Requests per Day ............................................................................... 23 Table 14. Jurisdictions Actively Exchanging PMP Data with MN Account Holders .................................................. 32 Table A1. Controlled Substance Prescriptions Dispensed by Minnesota Recipient Counties* ................................... I Table A2. Opioid Prescriptions Dispensed by Minnesota Recipient Residence Counties* ...................................... IV Table A3a. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County - 2015* ....................................................................................................................................................................... VI Table A3b. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County – 2016* ..................................................................................................................................................................... VIII Table A3c. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County – 2017* ......................................................................................................................................................................... X Table A4. US Census Bureau Annual Estimates of Resident Population* ................................................................ XII
Figure 1. Top Ten Minnesota Recipient Counties by Prescription Count ................................................................... 8 Figure 2. Common Pain Medications Dispensed Monthly (2018) ............................................................................ 14 Figure 3. Controlled Substances Prescribed by Prescriber Percentile Rank (2018) ................................................. 21 Figure 4. Multiple Prescriber and Dispenser Episodes by Recipient Count .............................................................. 22 Figure 5. Account Holders vs. Total Licensed Professionals by Health-Related Licensing Boards ........................... 24 Figure 6. Total Account Holders Requesting Patient Reports and Requests Performed (2010-2018) ..................... 25 Figure 7. Total Accounts, Usage, and Requests by Quarters ................................................................................... 26 Figure 8a. Direct Access Patient Report Requests by Role Type (2010-2018) ......................................................... 27 Figure 8b. Direct Access Patient Report Requests by Role Type (2010-2018) cont. ................................................ 27 Figure 9. System Accounts by Role Type .................................................................................................................. 28 Figure 10. Delegate Accounts and Patient Report Requests (2013-2018) ............................................................... 29 Figure 11. Delegate Accounts and Patient Report Requests by Quarter (2018) ...................................................... 29 Figure 12. Law Enforcement and Recipient Requests (2018) .................................................................................. 30 Figure 13. Law Enforcement and Recipient Requests Over Time ............................................................................ 31 Figure 14. Multiple Jurisdiction Patient Report Requests 2018 ............................................................................... 33 Figure 15. Requests for Patient Records by Permissible Account Holders through PMPi (2018) ............................ 34
iii
ACKNOWLEDGMENTS
Prescription Data Contact:
Dr. Katrina Howard, Pharmacist Consultant [email protected]
Program Contacts:
Barbara Carter, Program Manager [email protected]
Shannon Whitman, Program Administrator [email protected]
Jen Nelson, Program Coordinator [email protected]
Contact Information:
Minnesota Board of Pharmacy Prescription Monitoring Program
2829 University Ave SE, Suite 530
Minneapolis, MN 55414
Minnesota Board of Pharmacy
Phone: 651-201-2825
Website: http://mn.gov/health-licensing-boards/pharmacy/
Prescription Monitoring Program
Phone: 651-201-2836
Email: [email protected]
Website: http://pmp.pharmacy.state.mn.us/
Date of Publication: October 4, 2019
1
EXECUTIVE SUMMARY
2018 marked the 9th year of operations of the Minnesota Prescription Monitoring Program (PMP). In 2009, MN Stats. §152.126 required the Board of Pharmacy (Board) to develop and maintain a database of controlled substance prescriptions for promoting public health and welfare by detecting abuse, misuse, and diversion of controlled substance prescriptions. The intent of the PMP database is to assist in improving patient care and reducing the misuse of controlled substances.
In mid-2014, a change in MN Stats. §152.126 became effective which allowed the State of Minnesota to participate in interstate exchange of patient controlled substance reports with permissible account holders in other jurisdictions. During this reporting period, prescribers and pharmacists were able to submit a request for patient data in 38 different states and jurisdictions.
Effective July 1, 2017 MN law mandated certain licensed prescribers and pharmacists to register for and maintain a PMP system user account. Maintenance begins with account activation and includes annual account profile review and update. Failure to activate the account or update the profile may result in disciplinary action by the licensee’s applicable health licensing board.
In 2018 the number of new approved accounts has tapered as compared to 2017; however, the number of patient report requests has continued to grow. Annual survey results continue to show prescribers and pharmacists are changing their prescribing and dispensing habits in part because of viewing patient history reports in the PMP database.
Minnesota PMP staff continue to work with dispensers to improve the quality of the data being reported and ensure all PMP data is reported in a timely manner. Additionally, the previous MN PMP RxSentry© system was replaced with Appriss Health’s PMP AWARxE©, which is more robust and includes an enhanced reporting tool to provide prescribers and pharmacists with an interactive patient controlled substance history report. These improvements are designed to provide more information in a more meaningful way. The updated system is intended to encourage increased and more frequent use of the database while providing patient care.
2
Operational Findings
• Over 6.9 million prescriptions, for federally scheduled II-V controlled substances, were reported as dispensed to the PMP database in 2018. That number reflects a 5.9% decrease from 2017.
• Based on data contained in the upgraded system platform, 88% of the top 100 prescribers of controlled substances have requested and obtained access to the MN PMP reporting database.
• Between January 2018 and December 2018, there was a decrease in new MN PMP account applications received, with an average of 14.4 applications per day, down from 46.3 in 2017. This decrease was anticipated due to the response in 2017 when the law was changed to require registration.
• The overall number of approved accounts in 2018 was 25,798, a decrease of roughly 11.5%.
• Delegates increased their utilization of the MN PMP database by 45% in 2018, though the number of new delegate accounts increased by only 1.9%.
• At the end of 2018, there were 23,035 MN licensed prescribers and pharmacists approved for access to the system.
• The total number of patient searches conducted by permissible account holders, including health care providers and pharmacists, increased from 875,141 in 2015 to 1,576,488 in 2018, an increase of 1014%.
• During 2018, the average number of patient searches conducted by health care providers (excluding searches performed on their behalf by their delegates) showed minimal change for all but pharmacists, who showed a significant increase as compared to 2017.
• In 2018, patient-requested reports increased 18% from 2017. These reports were mailed directly to the patient or to a third-party at the patients’ written request.
• In 2018, the MN PMP staff continued to fulfill requests submitted by local, state, and federal law enforcement. PMP staff generated and released 726 reports (patient history, prescribing history, and/or dispensing history) based on a valid search warrant.
• 2018 was the fourth full year Minnesota officially participated in a system that enabled MN PMP account holders to request patient reports across state lines. MN PMP staff added a connection to permissible account holders in one additional state in 2018. Authorized account holders in Minnesota requested their patients’ PMP data more than 3.4M times from participating states’ PMP systems and more than 11.2M requests were received from authorized account holders in participating states and jurisdictions.
• 2018 was also the fourth full year the MN PMP staff identified multiple prescriber and dispenser episodes by patients and notified the health care providers involved with that patient’s care. The threshold for multiple prescriber/pharmacy episodes was refined in 2018 based on the decline in patients meeting the initial threshold.
3
INTRODUCTION
There is growing evidence that prescription drug monitoring programs (PDMP/PMP) play an important role in the fight against prescription drug abuse. PMPs have proven to be effective in reducing prescription drug abuse, misuse, and diversion, assisting in identifying inappropriate prescribing or dispensing, and aiding in drug investigations, amongst other efforts.
To begin addressing prescription drug abuse in the State, on May 25, 2007, the Governor signed into law MN Stats. §152.126, which required the Minnesota Board of Pharmacy (Board) to establish an electronic system for the reporting of controlled substance prescriptions that are dispensed to residents of the state. The Board subsequently implemented the Minnesota Prescription Monitoring Program (PMP). Collection of data from dispensers of controlled substances began on January 4, 2010 with authorized access to the data commencing on April 15, 2010. MN Stats. §152.126 also required the Board to appoint an advisory task force. This task force consists of at least one representative of the Department of Health and Department of Human Services; each health-related licensing board that licenses prescribers; professional associations representing the medical community, pharmacy community, nurses, and dentists; a consumer privacy or security advocate; a consumer or patient rights organization; and an association of medical examiners and coroners. The advisory task force advises the Board on the development and operation of the Minnesota Prescription Monitoring Program, including technical standards for reporting and proper analysis and interpretation of PMP data.
This annual report serves as an overview of the utilization of the database by prescribers, pharmacists and other permissible account holders, as well as controlled substance prescription dispensing activities in the state. The report intends to educate individuals regarding the controlled substance prescription dispensing landscape in Minnesota as well as PMP database utilization by prescribers, pharmacists and their delegates.
Prescription data assessed in this report consists of the timeframe 1/1/18 – 12/31/18. Like previous annual reports, the term “controlled substance” refers to those medications that are classified federally as schedule II-V controlled substances only, unless otherwise noted. In comparing prescription counts to previous years, there are several items to be aware of:
1. On December 4, 2018, the PMP database migrated from the MN PMP RxSentry© system to PMP AWARxE© system, which is operated by Appriss Health, Minnesota’s contracted vendor. As such, prescription data that had been reported to MN PMP RxSentry© was migrated to the new PMP AWARxE© system. The MN PMP RxSentry© system used a different address resolving software than Appriss Health’s Business Intelligence (BI) tools. A key difference in the BI tools is that counties are now assigned by zip code whereas this was not the case in MN PMP RxSentry©. Due to this change in assignment, county-level prescription counts are different when viewing aggregate MN PMP RxSentry© data and Appriss Health’s BI data, and the two data sets cannot be compared. Thus, PMP staff updated the tables in this report to include data from 2015-2017 using Appriss Health’s BI tools. Additionally, PMP staff compiled Appendix A to depict county-level prescription data from 2015-2017, again using Appriss’ BI tools.
4
Introduction (cont.)
2. With the migration to the PMP AWARxE© system, a superior consolidation algorithm was applied to patient matching. Consolidation is an important feature as it groups patient records into one profile or concludes the records cannot be consolidated. It is a fine balance between false positives and false negatives, and aggregate patient counts may not be representative of individual patients. Because the consolidation algorithm used in PMP AWARxE© differs from the consolidation algorithm used in RxSentry©, depictions of patient counts between the two datasets cannot be compared.
3. Prior to July 1, 2014, dispensers were only required to report Minnesota schedule II-IV controlled substances to the Minnesota PMP database. Effective July 1, 2014, dispensers were required to report schedule V controlled substances as well as butalbital and tramadol. Tramadol and schedule V controlled substances were included in the 2014 Annual Report based on the timeframe of 9/1/14-12/31/14, as the system underwent an update to allow for the reporting of the additional medications. In the 2015 Annual Report, these medications, as well as schedule II-IV controlled substances were included for the full calendar year (1/1/15 – 12/31/15).
4. In 2016, legislation passed to require dispensers to report gabapentin to the MN PMP. However, since gabapentin is not a federal controlled substance, it is not included for the purposes of this report.
Prescription data in the PMP database is as accurate as the records submitted by dispensers. There are various required fields and validation checks in place to aid pharmacies in clean data submission. Pharmacies may edit, remove, or submit prescription records at any time to accurately reflect dispensing histories. As a result, previous and future patient requests submitted may result in differing output of aggregate data. An example of why a pharmacy may submit a historical upload is if the pharmacy experienced technical issues and was later made aware that data was not being reported to the PMP database. An example of prescription records being removed from the database is if prescriptions were reported to the database, yet the patient never picked the medications up from the pharmacy. In this example, the pharmacy would void the prescriptions in the database to reflect their actual dispensing activity.
In the interest of patient privacy, when less than ten of a medication is dispensed, it is reported as “<10” throughout the report.
5
OPERATIONS
In 2018, the PMP staff completed its ninth year of operation. Currently, the Minnesota program is staffed by three full time staff; Program Manager, Program Administrator and Pharmacist Consultant. For a portion of 2018 the PMP had a part time Program Specialist. The Board receives an annual appropriation, for operation of the PMP database, from the state government special revenue fund. The health-related licensing boards apportion between the Board of Medical Practice, Board of Nursing, Board of Dentistry, Board of Podiatric Medicine, and the Board of Pharmacy an amount paid through fees by each respective board. Each board’s apportioned share is based on the number of prescribers and pharmacists licensed collectively by these boards. The Board is currently administering a 2016 Harold Rogers Prescription Drug Monitoring Program grant, from the U.S. Department of Justice/Office of Justice Programs/Bureau of Justice Assistance, to enhance the current electronic system, provide funding for participating in outreach/education events, and provide small sub-grants to healthcare entities wishing to integrate access to the PMP database reports into their electronic health systems.
Prescription data is submitted to the PMP database by dispensing prescribers and pharmacies. All entities dispensing controlled substances in or into the State of Minnesota are required to report data daily, and dispensers who do not dispense a controlled substance on any given day are required to submit a “zero report” each day. PMP staff and a contracted vendor audit the submission of data as well as the data itself to ensure compliance in reporting and data integrity. Noncompliant pharmacies are communicated with by various means and a lack of response to the request to comply are referred to the Board’s regulatory section for further consideration. At the end of 2018, the Board licensed over 2,100 pharmacies. Of them, over 1,600 were required to report data to the PMP database. Current law allows an exemption from reporting when;
1. The pharmacy is a licensed hospital pharmacy that distributes controlled substances for inpatient hospital care only;
2. The individuals resides in a health care facility as defined in section 151.58, subdivision 2, paragraph (b), when a drug is distributed through the use of an automated drug distribution system according to section 151.58;
3. The individuals receive a drug sample that was packaged by a manufacturer and provided to the dispenser for dispensing as a professional sample pursuant to Code of Federal Regulations, title 21, part 203, subpart D;
4. The pharmacy or facility never dispenses controlled substances in or into the State of Minnesota.
In addition, federal regulation (CFR Title 42: Part 2) prevents federally funded opioid treatment programs (OTPs) from releasing certain patient data. As such, controlled substances dispensed from OTPs for medication-assisted treatment are not reported to the MN PMP database.
To stress the importance of accurate data in the PMP database, the PMP launched an initiative in the fall of 2015 to better address the quality of prescription data reported to the PMP. All Minnesota licensed pharmacies and uploaders (those who submit data on behalf of the pharmacy) received communication reminding them of the requirement to submit accurate data. Included in the communication was the notice that all dispensers must correct prescription errors inadvertently submitted to the PMP
6
Operations (cont.)
within seven days of the initial submission. The notice informed dispensers and uploaders that PMP staff would be auditing for error resolution and that failure to correct errors may result in notification to the Board’s regulatory section for further consideration. Some examples of errors the PMP may receive include invalid national drug code (NDC) numbers, missing patient first or last name, and invalid patient date of birth. Uploaders and/or pharmacies receive system-generated notices when errors occur in their submissions. The data integrity initiative was implemented to ensure pharmacies and uploaders are responding accordingly to these system-generated error notices. Data integrity and compliance in reporting are ongoing initiatives by MN PMP staff.
7
PRESCRIPTION DATA
In 2018, 6,985,041 federally scheduled II-V controlled substance prescriptions were reported to the PMP database as dispensed. These prescriptions resulted in 374,973,596 total units of controlled substances dispensed. Total units refer to the summation of all tablets, capsules, milliliters, grams, etc. reported as dispensed. Table 1 lists the top twenty controlled substance medications reported in 2018 by prescription count. A comparison of prescription counts and quantities from 2015-2017 are also included. Hydrocodone/acetaminophen, previously the number one federal controlled substance reported to the MN PMP database, was surpassed by dextroamphetamine/amphetamine in 2018, as it pertains to prescription count. The number of hydrocodone/acetaminophen prescriptions reported decreased by 15.7% from 2017 to 2018, while the number of dextroamphetamine/amphetamine prescriptions increased 6%.
Table 1. Top Twenty Controlled Substance Prescriptions Reported as Dispensed (Generic), 2018
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change
from '17 to
'18
2015 Quantity
Dispensed
2016 Quantity
Dispensed
2017 Quantity
Dispensed
2018 Quantity
Dispensed
% Change
from '17 to
'18 DEXTROAMPHETAMINE/
AMPHETAMINE 707,820 743,478 793,503 840,861 6.0% 32,868,001 34,145,751 35,487,541 36,980,659 4.2%
HYDROCODONE/ ACETAMINOPHEN 1,235,511 1,083,645 941,526 793,542 -15.7% 66,161,288 57,653,136 48,914,751 39,899,880 -18.4%
OXYCODONE HCL 670,909 667,397 644,777 624,023 -3.2% 49,293,088 47,921,053 44,390,431 38,684,687 -12.9%
TRAMADOL HCL 660,830 621,429 571,762 520,448 -9.0% 53,569,091 48,773,815 43,261,036 37,033,357 -14.4%
LORAZEPAM 563,430 543,146 520,877 494,782 -5.0% 26,186,033 24,672,179 22,950,880 21,000,132 -8.5%
METHYLPHENIDATE HCL 406,533 408,175 412,915 415,519 0.6% 20,609,987 20,325,764 20,060,634 19,589,147 -2.4%
ZOLPIDEM TARTRATE 522,569 478,685 444,673 414,568 -6.8% 17,632,532 16,180,474 14,812,186 13,929,882 -6.0%
CLONAZEPAM 436,201 421,018 401,631 379,157 -5.6% 26,626,153 25,161,088 23,603,806 21,820,302 -7.6% OXYCODONE
HCL/ACETAMINOPHEN 621,305 543,330 462,137 374,178 -19.0% 35,025,058 30,905,948 26,430,476 21,489,154 -18.7%
ALPRAZOLAM 367,454 356,298 334,016 315,011 -5.7% 20,102,844 19,202,429 17,448,681 16,040,110 -8.1% LISDEXAMFETAMINE
DIMESYLATE 139,177 160,238 162,435 159,220 -2.0% 4,429,599 5,061,593 5,111,202 5,010,162 -2.0%
MORPHINE SULFATE 191,603 186,121 175,660 155,514 -11.5% 11,254,067 10,747,544 9,459,779 8,074,398 -14.6%
PREGABALIN 121,279 138,075 145,467 151,611 4.2% 10,125,721 11,407,916 11,949,045 12,421,305 4.0%
DIAZEPAM 181,672 174,939 161,334 151,145 -6.3% 7,893,007 7,401,917 6,581,729 5,959,046 -9.5% CODEINE
PHOSPHATE/GUAIFENESIN 163,520 165,859 163,763 127,316 -22.3% 27,914,448 28,338,322 27,876,952 21,420,894 -23.2%
ACETAMINOPHEN WITH CODEINE 183,276 160,251 139,125 118,303 -15.0% 8,496,205 7,412,164 6,302,606 5,133,446 -18.6%
BUPRENORPHINE HCL/ NALOXONE HCL 56,434 66,275 81,924 103,484 26.3% 2,519,223 2,726,753 3,284,673 3,957,692 20.5%
HYDROMORPHONE HCL 96,594 94,048 95,986 91,479 -4.7% 7,110,948 6,688,125 6,151,268 5,414,629 -12.0%
PHENTERMINE HCL 66,890 72,826 79,901 85,121 6.5% 2,569,320 2,841,638 3,117,118 3,325,574 6.7%
FENTANYL 96,852 86,799 72,866 59,365 -18.5% 965,475 860,377 711,217 567,528 -20.2%
TOTAL 8,126,214 7,798,905 7,422,137 6,985,041 -5.9% 474,302,500 449,821,296 416,572,867 374,973,596 -10.0%
8
Dispensed by County
The database was queried by Minnesota County based on the address the recipient provided to the dispenser. Notably, data in the database is as reliable and accurate as the reporting dispenser’s records. Hennepin County, with the largest population, had the greatest volume of reported prescriptions in 2018. A correlation was noted between the population of the county and the quantity of prescriptions dispensed for the top seven counties. According to population estimates collected by the U.S. Census Bureau, the top ten counties in Minnesota, as of July 1, 2018, by population were: Hennepin (1,259,428); Ramsey (550,210); Dakota (425,423); Anoka (353,813); Washington (259,201); St. Louis (199,754); Stearns (159,256); Olmsted (156,277); Scott (147,381); and Wright (136,349). (1) Figure 1 shows the top ten recipient residence counties based on the number of prescriptions reported as dispensed.
Figure 1. Top Ten Minnesota Recipient Counties by Prescription Count
Table 2 shows the total number of controlled substance prescriptions reported as dispensed per recipient residence county in 2018, as well as the county’s corresponding population, as of July 1, 2018, according to population estimates collected by the U.S. Census Bureau. When assessing the crude rate, the county with the highest rate of prescriptions dispensed was Mille Lacs County with 2,203.4 prescriptions per 1,000 population. The county with the lowest rate of prescriptions dispensed was Houston County with 676.3 prescriptions per 1,000 population. The state crude rate was 1,206.7 prescriptions per 1,000 population (prescriptions reported as dispensed to recipients residing in all Minnesota Counties divided by the state population). The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions in 2018. Prescription counts and rates from 2015-2017 can be found in Appendix A.
1,442,720
607,964517,747
415,683323,552 297,302
176,815 157,625 157,492 140,530
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400,000
600,000
800,000
1,000,000
1,200,000
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Top Ten Recipient Residence Counties by Prescription Count
9
Dispensed by County (cont.)
Table 2. Controlled Substance Prescriptions Dispensed by Minnesota Recipient Residence Counties (1)
Geography 2018 Population 2018 Rx Count Rate per 1,000
population STATEWIDE 5,611,179 6,771,152 1,206.7
AITKIN 15,902 25,653 1,613.2 ANOKA 353,813 415,683 1,174.9 BECKER 34,371 43,698 1,271.4
BELTRAMI 46,847 61,154 1,305.4 BENTON 40,545 40,828 1,007.0
BIG STONE 4,989 8,233 1,650.2 BLUE EARTH 67,427 79,324 1,176.4
BROWN 25,111 31,467 1,253.1 CARLTON 35,837 54,141 1,510.8 CARVER 103,551 114,509 1,105.8
CASS 29,519 43,501 1,473.7 CHIPPEWA 11,924 13,766 1,154.5 CHISAGO 55,922 84,689 1,514.4
CLAY 63,955 78,412 1,226.0 CLEARWATER 8,810 14,451 1,640.3
COOK 5,393 5,473 1,014.8 COTTONWOOD 11,277 16,682 1,479.3
CROW WING 64,889 96,783 1,491.5 DAKOTA 425,423 517,747 1,217.0 DODGE 20,822 16,385 786.9
DOUGLAS 37,964 53,128 1,399.4 FARIBAULT 13,758 19,976 1,452.0 FILLMORE 21,058 20,481 972.6 FREEBORN 30,444 32,025 1,051.9 GOODHUE 46,403 61,209 1,319.1
GRANT 6,021 9,320 1,547.9 HENNEPIN 1,259,428 1,442,720 1,145.5 HOUSTON 18,578 12,565 676.3 HUBBARD 21,332 24,562 1,151.4
ISANTI 39,966 58,888 1,473.5 ITASCA 45,108 74,250 1,646.0
JACKSON 9,911 11,804 1,191.0
10
Geography 2018 Population 2018 Rx Count Rate per 1,000
population KANABEC 16,207 25,204 1,555.1
KANDIYOHI 42,855 47,655 1,112.0 KITTSON 4,248 5,951 1,400.9
KOOCHICHING 12,440 22,756 1,829.3 LAC QUI PARLE 6,658 9,420 1,414.8
LAKE 10,658 14,606 1,370.4 LAKE OF THE WOODS 3,758 4,986 1,326.8
LE SUEUR 28,494 26,837 941.8 LINCOLN 5,673 6,945 1,224.2
LYON 25,629 29,752 1,160.9 MAHNOMEN 5,519 10,645 1,928.8 MARSHALL 9,390 11,732 1,249.4
MARTIN 19,785 28,751 1,453.2 MCLEOD 35,873 49,221 1,372.1 MEEKER 23,141 26,718 1,154.6
MILLE LACS 26,139 57,594 2,203.4 MORRISON 33,169 44,954 1,355.3
MOWER 40,011 40,022 1,000.3 MURRAY 8,276 9,977 1,205.5 NICOLLET 34,220 37,369 1,092.0 NOBLES 21,924 19,266 878.8
NORMAN 6,475 8,360 1,291.1 OLMSTED 156,277 140,530 899.2
OTTER TAIL 58,812 76,363 1,298.4 PENNINGTON 14,178 20,829 1,469.1
PINE 29,483 40,423 1,371.1 PIPESTONE 9,047 15,894 1,756.8
POLK 31,529 49,460 1,568.7 POPE 11,097 15,490 1,395.9
RAMSEY 550,210 607,964 1,105.0 RED LAKE 3,999 5,793 1,448.6
REDWOOD 15,249 17,762 1,164.8 RENVILLE 14,612 20,554 1,406.7
RICE 66,523 77,034 1,158.0 ROCK 9,414 12,911 1,371.5
ROSEAU 15,150 21,177 1,397.8 SAINT LOUIS 199,754 297,302 1,488.3
SCOTT 147,381 157,492 1,068.6 SHERBURNE 96,036 139,608 1,453.7
11
Geography 2018 Population 2018 Rx Count Rate per 1,000
population SIBLEY 15,028 15,956 1,061.8
STEARNS 159,256 176,815 1,110.3 STEELE 36,803 49,577 1,347.1
STEVENS 9,753 9,591 983.4 SWIFT 9,345 12,143 1,299.4 TODD 24,582 28,532 1,160.7
TRAVERSE 3,308 5,187 1,568.0 WABASHA 21,645 27,168 1,255.2 WADENA 13,773 22,727 1,650.1 WASECA 18,691 22,392 1,198.0
WASHINGTON 259,201 323,552 1,248.3 WATONWAN 10,980 12,795 1,165.3
WILKIN 6,254 8,016 1,281.7 WINONA 50,825 46,320 911.4 WRIGHT 136,349 157,625 1,156.0
YELLOW MEDICINE 9,795 13,942 1,423.4
12
Table 3 shows the number of controlled substance prescriptions dispensed to Minnesota recipients by federal schedule, as well as the average number of prescriptions per Minnesota resident, if every resident in the State of Minnesota were to receive one prescription. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions.
Table 3. Prescription Count and Average of Federally Scheduled Prescriptions Dispensed per Population
Schedule
2015 RX Count to
MN Recipient
2016 RX Count to
MN Recipient
2017 RX Count to
MN Recipient
2018 Rx Count to
MN Recipient
% Change from 2017
to 2018
2015 RX per MN
Population*
2016 RX per MN
Population*
2017 RX per MN
Population*
2018 Rx per MN
Population*
II 4,175,975 3,979,145 3,769,747 3,530,644 -6.3% 0.76 0.72 0.68 0.63
III 362,155 350,644 353,906 364,983 3.1% 0.07 0.06 0.06 0.07
IV 2,998,574 2,863,538 2,701,854 2,547,523 -5.7% 0.55 0.52 0.49 0.45
V 332,237 353,238 358,713 328,002 -8.6% 0.06 0.06 0.06 0.06
Total 7,868,941 7,546,565 7,184,220 6,771,152 -5.7% 1.44 1.37 1.29 1.21
*Prescription count per MN Population is based on U.S. Census Bureau Population estimates, not on the number of recipients to receive controlled substances.
13
Prescriptions Reported by Class
Opioids In Minnesota, over 2.8 million opioid prescriptions were reported as dispensed in 2018 with hydrocodone/acetaminophen, oxycodone, and tramadol reported as the leading three. Table 4 shows the top twenty opiate agonists, as classified by the American Society of Health-System Pharmacists, AHFS® Pharmacologic-Therapeutic Classification© (2), reported by prescription count in 2018, as well as the number of prescriptions reported in 2015, 2016, and 2017. There was roughly an 11.8% reduction in opioid prescriptions dispensed from 2017 to 2018.
Table 4. Opioids Reported as Dispensed (2018, Top Twenty)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to '18
HYDROCODONE/ACETAMINOPHEN 1,235,511 1,083,646 941,526 793,538 -15.7%
OXYCODONE HCL 670,909 667,397 644,777 624,022 -3.2%
TRAMADOL HCL 660,830 621,430 571,762 520,448 -9.0%
OXYCODONE HCL/ACETAMINOPHEN 621,305 543,330 462,137 374,178 -19.0%
MORPHINE SULFATE 191,603 186,121 175,660 155,514 -11.5%
ACETAMINOPHEN WITH CODEINE 183,276 160,251 139,125 118,303 -15.0%
HYDROMORPHONE HCL 96,594 94,048 95,986 91,479 -4.7%
FENTANYL 96,852 86,799 72,866 59,365 -18.5%
METHADONE HCL 53,025 50,288 46,284 42,245 -8.7%
TRAMADOL HCL/ACETAMINOPHEN 9,871 8,181 6,340 4,813 -24.1%
BUTALBIT/ACETAMIN/CAFF/CODEINE 4,511 4,058 3,428 3,313 -3.4%
CODEINE SULFATE 3,974 4,104 3,446 3,301 -4.2%
CODEINE/BUTALBITAL/ASA/CAFFEIN 4,739 4,069 3,371 2,876 -14.7%
HYDROCODONE/IBUPROFEN 6,545 4,886 3,508 2,602 -25.8%
TAPENTADOL HCL 2,709 2,848 2,595 2,185 -15.8%
OXYCODONE MYRISTATE* n/a 164 707 1,452 105.4%
HYDROMORPHONE HCL/PF 878 801 1,116 988 -11.5%
HYDROCODONE BITARTRATE 1,012 1,163 1,046 967 -7.6%
OXYMORPHONE HCL 2,178 2,032 1,545 819 -47.0%
OPIUM/BELLADONNA ALKALOIDS 992 1,012 832 634 -23.8%
TOTAL 3,850,323 3,528,948 3,180,131 2,804,918 -11.8%
*XTAMPZA ER® is an extended-release formulation of oxycodone which was approved by the U.S. Food and Drug Administration (FDA) in 2016.
14
Figure 2 illustrates common pain medications reported as dispensed each month in 2018. Hydrocodone/acetaminophen was largely the number one opioid dispensed each month.
Figure 2. Common Pain Medications Dispensed Monthly (2018)
*Classified as opiate agonists by AHFS® Pharmacologic-Therapeutic Classification©
Table 5 shows the crude rate of opioid prescriptions, by prescription type, per 1,000 population. For every 1,000 Minnesota residents, regardless of age or whether they had any prescriptions filled, there were 482.0 opioid prescriptions reported. The crude rate is based on prescriptions reported per recipient residence county and the county’s population, per U.S. Census Bureau population estimates. The rate is shown for the full calendar year and is portrayed by county and statewide. The prescription types included in Table 5 consist of a subset of opiate agonists as categorized by AHFS© classification. Opioid prescription rates from 2015-2017 can be found in Appendix A. Furthermore, a new table is included in Appendix A (Table 2) which shows the number of opioid prescriptions reported as dispensed in 2015-2018 per Minnesota recipient residence county.
71,828
63,440
69,53665,666
68,80566,290 65,723
69,514
59,629
66,44463,608 63,055
52,49547,559
52,90249,727
53,460 51,655 51,21854,677
48,406
54,770 53,118 54,035
45,14340,271
44,295 42,51745,292 43,225 43,670 45,480
40,65745,430
42,713 41,755
35,36631,370 33,544 31,305 32,256 30,935 30,408 31,470
28,07430,678 29,371 29,401
14,053 12,272 13,614 12,724 13,353 12,945 13,036 13,403 11,821 13,239 12,631 12,423
0
20,000
40,000
60,000
80,000
Jan Feb March April May June July Aug Sept Oct Nov Dec
Num
ber o
f Pre
scrip
tions
Disp
ense
d
Common Pain Medications Dispensed, Monthly*
Hydrocodone/APAP Oxycodone HCl Tramadol HClOxycodone HCl/APAP Morphine Sulfate APAP/CodeineHydromorphone HCl Fentanyl Methadone HCl
15
Table 5. Crude Rate of Opioids Dispensed per 1,000 Population by MN Recipient Residence County (1)
COUNTY All Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
STATEWIDE 482.0 137.5 171.0 90.1 22.2 27.0 10.4 15.8 AITKIN 909.3 283.9 346.1 135.5 24.5 60.9 25.5 21.3
ANOKA 487.1 133.0 203.2 73.6 19.7 26.0 6.9 15.4
BECKER 511.7 210.6 117.9 92.5 24.2 37.8 10.4 8.8
BELTRAMI 535.2 189.7 89.2 179.4 27.1 27.4 8.2 7.9
BENTON 433.5 135.8 136.3 86.5 21.3 33.1 6.9 8.1
BIG STONE 706.8 244.9 114.3 197.8 60.1 41.3 31.7 6.2
BLUE EARTH 416.2 102.6 128.1 115.1 18.3 22.0 10.6 14.8
BROWN 485.9 154.7 145.3 101.9 19.1 27.1 19.8 8.6
CARLTON 721.4 287.3 153.6 160.4 30.5 42.0 13.1 18.8
CARVER 383.4 133.8 120.2 62.8 18.8 21.9 6.8 14.2
CASS 648.9 246.0 154.4 136.0 34.2 38.1 17.0 13.8
CHIPPEWA 507.5 149.9 134.4 120.8 28.5 35.1 26.4 7.4
CHISAGO 697.0 190.9 279.4 109.0 26.0 37.1 17.4 24.0
CLAY 372.5 125.0 91.5 90.1 15.0 21.9 11.2 10.8
CLEARWATER 701.6 232.1 155.1 218.4 40.2 21.1 21.5 9.5
COOK 517.5 206.9 146.7 96.2 20.4 20.4 14.3 4.8
COTTONWOOD 650.9 177.5 104.2 219.1 28.8 30.5 71.7 6.9
CROW WING 623.4 224.2 204.3 97.5 24.1 37.9 15.4 12.6
DAKOTA 450.2 118.8 180.3 69.2 22.4 23.8 8.6 18.2
DODGE 304.6 51.8 119.5 80.6 12.9 12.6 7.8 18.4
DOUGLAS 589.1 198.1 159.8 140.9 27.3 35.8 15.0 6.9
FARIBAULT 669.7 183.2 185.3 197.8 19.5 58.7 12.5 9.9
FILLMORE 448.6 91.0 135.2 155.1 15.4 20.6 13.2 13.3
FREEBORN 458.4 110.9 121.9 156.0 12.5 29.9 8.6 14.2
GOODHUE 591.9 127.9 213.5 141.5 25.8 38.5 16.2 22.2
GRANT 623.2 192.5 199.3 147.5 30.6 28.6 13.8 10.0
HENNEPIN 413.7 104.8 174.7 59.9 20.3 22.6 6.2 18.3
HOUSTON 291.3 100.3 56.4 90.5 6.8 14.5 14.8 4.7
HUBBARD 483.8 168.5 119.6 105.1 25.3 30.1 12.3 15.8
ISANTI 689.2 182.7 303.7 79.0 27.9 43.6 16.4 17.5
ITASCA 728.1 231.8 226.2 148.4 37.6 32.0 9.9 28.1
JACKSON 422.1 147.2 59.0 166.3 16.5 18.1 11.0 3.3
KANABEC 836.3 226.6 384.0 87.6 21.0 62.9 18.0 22.2
KANDIYOHI 457.4 142.6 104.0 118.3 33.2 35.8 12.5 7.4
KITTSON 589.9 175.8 115.3 164.1 37.9 33.9 54.1 6.4
KOOCHICHING 749.8 255.9 180.2 185.9 45.7 44.2 15.3 11.8
LAC QUI PARLE 647.9 224.4 124.5 174.4 20.7 43.6 44.8 7.2
16
COUNTY All Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
LAKE 666.6 261.6 167.9 120.6 28.3 37.9 19.0 15.8
LAKE OF THE WOODS 736.0 237.1 140.2 232.3 38.1 22.6 53.8 2.4
LE SUEUR 403.7 104.4 137.3 104.8 15.7 14.4 10.7 12.5
LINCOLN 537.8 157.8 86.4 193.2 24.3 36.7 28.2 9.5
LYON 444.5 161.8 75.1 120.5 20.9 26.5 24.7 6.8
MAHNOMEN 684.0 257.3 162.5 139.7 42.4 33.9 15.0 19.6
MARSHALL 517.8 154.4 116.2 144.5 33.8 22.3 28.5 6.6
MARTIN 605.6 188.1 153.5 173.0 20.9 32.6 18.9 12.8
MCLEOD 593.6 187.4 173.0 122.6 31.7 40.9 13.2 11.3
MEEKER 539.4 167.8 145.2 126.6 18.4 40.5 18.2 12.2
MILLE LACS 1064.8 321.0 417.2 155.3 46.6 62.8 14.5 26.9
MORRISON 634.4 230.3 177.5 138.8 28.7 38.2 10.0 5.6
MOWER 379.1 92.3 121.9 107.4 9.5 23.0 11.0 10.1
MURRAY 493.0 136.4 70.3 193.3 18.6 35.4 33.1 4.5
NICOLLET 371.4 94.5 106.6 111.4 17.7 15.5 8.7 12.2
NOBLES 333.2 127.3 46.8 105.3 16.9 19.8 12.9 2.4
NORMAN 417.0 146.6 78.8 104.6 23.8 27.2 15.8 12.2
OLMSTED 325.8 57.3 115.4 96.9 10.1 15.0 7.1 21.7
OTTER TAIL 555.1 171.4 145.3 142.3 26.4 34.0 19.5 10.3
PENNINGTON 588.0 190.4 126.0 156.9 41.8 35.7 18.7 6.4
PINE 745.8 230.3 276.4 114.7 21.9 55.0 16.2 19.4
PIPESTONE 760.6 277.2 169.4 189.6 36.7 38.9 33.5 8.3
POLK 605.3 197.7 149.0 140.9 37.0 34.3 32.4 6.2
POPE 635.3 199.6 167.2 140.5 23.3 45.8 42.0 9.0
RAMSEY 455.1 105.2 194.5 70.4 24.2 24.7 7.9 18.0
RED LAKE 603.4 186.0 138.3 176.3 35.0 37.0 11.8 5.5
REDWOOD 477.7 151.0 115.9 125.1 18.7 21.0 32.1 7.2
RENVILLE 613.7 234.7 150.6 126.7 47.6 25.9 14.6 8.3
RICE 495.4 134.8 178.0 105.2 16.0 34.6 8.6 10.3
ROCK 640.4 221.8 120.7 194.5 25.7 35.3 29.6 1.2
ROSEAU 619.1 182.6 159.9 158.2 43.4 32.5 26.1 3.6
SAINT LOUIS 609.6 234.6 149.8 120.9 20.7 31.2 12.8 24.5
SCOTT 406.6 117.3 155.3 63.6 20.0 21.8 7.3 14.7
SHERBURNE 597.5 180.8 231.0 98.5 24.2 33.0 8.7 12.9
SIBLEY 492.7 173.4 138.7 94.8 23.9 23.4 14.3 13.2
STEARNS 464.2 155.4 129.3 105.2 23.5 27.7 12.3 5.7
STEELE 468.8 122.4 147.6 143.6 15.0 22.8 7.7 8.2
STEVENS 412.2 149.9 120.0 85.4 24.3 14.8 10.9 5.6
SWIFT 536.3 198.6 123.5 117.4 25.9 33.9 14.8 18.3
TODD 605.1 229.6 157.1 105.2 34.9 43.2 18.6 5.0
17
COUNTY All Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
TRAVERSE 648.1 281.4 126.1 136.0 45.6 18.7 32.0 4.2
WABASHA 567.0 111.9 168.5 190.7 24.0 26.8 19.9 22.4
WADENA 780.7 272.7 205.6 151.9 48.3 44.7 38.0 13.6
WASECA 461.0 118.7 146.0 133.2 17.7 21.5 9.6 12.3
WASHINGTON 490.9 125.9 201.6 74.4 24.1 26.3 8.9 19.5
WATONWAN 532.0 148.8 163.0 141.6 17.5 24.5 21.8 9.2
WILKIN 543.3 178.0 113.2 138.0 38.5 44.8 20.1 9.0
WINONA 416.8 118.4 117.7 112.8 12.9 25.0 14.2 11.1
WRIGHT 466.0 143.8 175.4 70.6 18.3 28.5 9.1 11.8
YELLOW MEDICINE 675.0 201.7 112.1 210.1 42.7 45.3 38.9 10.6
Partial Opioid Agonists Partial opiate agonists are commonly used to treat pain or opioid dependence. The most frequent partial opiate agonist reported as dispensed in 2018 was buprenorphine/naloxone (i.e. Suboxone®, Bunavail®, Zubsolv®). Table 6 shows the number of partial opiate agonists reported as dispensed, by prescription count, in 2018 as well as the number of prescriptions reported in 2015, 2016, and 2017. Note, federal regulation (CFR Title 42: Part 2) prevents federally funded opioid treatment programs (OTPs) from releasing certain patient data. As such, controlled substances dispensed from OTPs for medication-assisted treatment will not appear in the MN PMP database.
Table 6. Partial Opiate Agonists Reported as Dispensed (2018)
Drug 2015 RX Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to '18
BUPRENORPHINE HCL/NALOXONE HCL 56,434 66,275 81,924 103,484 26.3%
BUPRENORPHINE HCL 9,301 10,960 14,139 18,546 31.2% BUPRENORPHINE 5,252 4,354 3,586 4,253 18.6%
BUTORPHANOL TARTRATE 2,038 1,966 1,831 1,649 -9.9% PENTAZOCINE HCL/NALOXONE
HCL 309 207 178 139 -21.9%
TOTAL 73,334 83,762 101,658 128,071 26.0%
18
Stimulants The stimulants shown below, as categorized by the American Society of Health-System Pharmacists’ AHFS© classifications, consist of anorexigenic agents and respiratory and central nervous system stimulants. (2) In 2018, the leading controlled substance stimulants reported were dextroamphetamine/amphetamine (i.e. Adderall®, Adderall XR®), methylphenidate HCl (i.e. Concerta®, Ritalin®, Metadate®, etc.) and lisdexamfetamine (i.e. Vyvanse®). The top ten stimulants reported as dispensed are shown in Table 7 as well as a comparison of prescriptions reported in 2015, 2016, and 2017.
Table 7. Stimulants Reported as Dispensed (2018, Top Ten)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17
to '18
DEXTROAMPHETAMINE/AMPHETAMINE 707,820 743,478 793,503 840,861 6.0% METHYLPHENIDATE HCL 406,533 408,175 412,915 415,519 0.6%
LISDEXAMFETAMINE DIMESYLATE 139,177 160,238 162,435 159,220 -2.0% PHENTERMINE HCL 66,890 72,826 79,901 85,121 6.5%
DEXMETHYLPHENIDATE HCL 29,720 31,745 33,130 35,386 6.8% MODAFINIL 25,218 26,585 28,422 30,891 8.7%
DEXTROAMPHETAMINE SULFATE 28,510 28,037 28,020 27,888 -0.5% ARMODAFINIL 15,811 14,173 13,036 12,820 -1.7%
METHYLPHENIDATE 6,933 4,258 2,977 3,369 13.2% PHENTERMINE/TOPIRAMATE 3,003 2,701 2,968 3,010 1.4%
TOTAL 1,434,442 1,496,669 1,561,592 1,618,219 3.6%
Sedatives The medications in the group of sedatives below consist of anxiolytics, sedatives, hypnotics, and miscellaneous as classified by AHFS pharmacologic-therapeutic classification. (2) Of the controlled substances, zolpidem tartrate (i.e. Ambien®, Ambien CR®, etc.) was the leading sedative reported as dispensed. Table 8 provides an overview of the top five sedatives reported as dispensed, by prescription count, from 2015 to 2018.
Table 8. Sedatives Reported as Dispensed (2018, Top Five)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to '18
ZOLPIDEM TARTRATE 522,569 478,685 444,673 414,568 -6.8% ESZOPICLONE 47,825 49,014 49,953 52,031 4.2%
ZALEPLON 19,517 19,344 18,662 18,288 -2.0% SUVOREXANT 2,922 5,716 6,242 7,205 15.4%
MEPROBAMATE 461 380 301 285 -5.3% TOTAL 593,429 553,246 519,888 492,453 -5.3%
19
Benzodiazepines Benzodiazepines are medications that can have anticonvulsant, anxiolytic, hypnotic, muscle relaxant, and sedative properties. Over 1.4 million benzodiazepines were reported as dispensed in 2018. The leading medications consist of lorazepam, clonazepam, and alprazolam. Table 9 shows the top ten benzodiazepines reported as dispensed, by prescription count in 2018, as well as the number of prescriptions reported in 2015, 2016, and 2017. There was roughly a 5.7% reduction in benzodiazepines reported from 2017 to 2018.
Table 9. Benzodiazepines Reported as Dispensed (2018, Top Ten)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to '18
LORAZEPAM 563,430 543,146 520,877 494,782 -5.0% CLONAZEPAM 436,201 421,018 401,631 379,157 -5.6% ALPRAZOLAM 367,454 356,298 334,016 315,011 -5.7%
DIAZEPAM 181,672 174,939 161,334 151,145 -6.3% TEMAZEPAM 70,858 66,878 61,109 54,899 -10.2% TRIAZOLAM 10,793 10,278 9,032 8,145 -9.8% CLOBAZAM 4,558 5,590 6,392 7,016 9.8%
CLORAZEPATE DIPOTASSIUM 3,877 3,471 3,184 2,867 -10.0%
CHLORDIAZEPOXIDE HCL 2,706 2,718 2,392 2,107 -11.9% OXAZEPAM 1,922 1,706 1,569 1,373 -12.5%
TOTAL 1,647,819 1,590,456 1,506,066 1,420,118 -5.7%
Muscle Relaxants Of the centrally acting skeletal muscle relaxants, as categorized by AHFS© classification, carisoprodol is the only medication that is a controlled substance. The number of carisoprodol-containing prescriptions that were reported to the MN PMP in 2018 are listed in Table 10 below as well as their corresponding counts in 2015, 2016, and 2017.
Table 10. Muscle Relaxants Reported as Dispensed (2018 Top Three)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to '18
CARISOPRODOL 26,305 22,466 18,390 15,688 -14.7% CARISOPRODOL/ASPIRIN/
CODEINE 20 13 12 10 -16.7%
CARISOPRODOL/ASPIRIN* <10 <10 0 0 n/a TOTAL 26,333 22,484 18,402 15,698 -14.7% *No prescriptions for carisoprodol/aspirin were reported as dispensed in 2017 and 2018.
20
Antitussives Of the antitussives (or cough suppressants) categorized by AHFS© classification, hydrocodone and codeine are the only medications scheduled as controlled substances. Table 11 shows the top five antitussives reported as dispensed, by prescription count, in the last four years.
Table 11. Antitussives Reported as Dispensed (2018, Top Five)
Drug 2015 Rx Count
2016 Rx Count
2017 Rx Count
2018 Rx Count
% Change from '17 to
'18 CODEINE PHOSPHATE/GUAIFENESIN 163,520 165,859 163,763 127,316 -22.3%
PROMETHAZINE HCL/CODEINE 11,951 10,062 8,384 5,923 -29.4% HYDROCODONE/CHLORPHEN P-STIREX 3,130 2,432 1,870 1,333 -28.7%
HYDROCODONE BIT/HOMATROP ME-BR 1,246 1,245 1,312 1,320 0.6% PROMETHAZINE/PHENYLEPH/CODEINE 253 145 128 83 -35.2%
TOTAL 180,232 179,845 175,524 136,008 -22.5%
21
Key Findings- Prescribers and Recipients (2018)
Data from the PMP database was analyzed to identify the key findings noted below:
• The top 500 prescribers prescribed 22.6% of all controlled substance prescriptions reported as dispensed and 26.2% of the total quantity reported as dispensed (units reported).
• Of the top 100 prescribers of controlled substances reported, 88% have requested and obtained access to the MN PMP.
• Figure 3 shows the percentage of schedule II-V controlled substance prescriptions written by prescribers by percentile ranking. This is based on unique and valid prescriber identifiers reported by dispensers. As such, if a prescriber has more than one DEA number, they may inadvertently be counted as more than one prescriber in the figure below. Of note, the top 1% of prescribers contributed to 22.01% of all schedule II-V controlled substances reported to the MN PMP.
Figure 3. Controlled Substances Prescribed by Prescriber Percentile Rank (2018)
• Table 12 portrays the number of individuals who received controlled substance prescriptions from 10 or more prescribers AND 10 or more pharmacies in each quarter throughout 2018, as well as the largest number of prescribers identified as having prescribed a controlled substance prescription for those recipients.
0%
20%
40%
60%
80%
1st - 10th >10th -20th >20th -
30th >30th -40th >40th -
50th >50th -100th
Top 1%
74.04%
15.79% 5.91%2.39%
0.98% 0.90%
Top 1%
% o
f Con
trol
led
Subs
tanc
es P
resc
ribed
Prescriber Percentile Rank
Percentage of Federal Schedule II-V Controlled Substances Prescribed by Prescriber Percentile Rank, 2018
22
Table 12. Key Findings, Recipient
Timeframe Number of Recipients
who met Threshold (10/10/90)
Highest Number of Prescribers Identified
1/1/18-3/31/18 1 16 4/1/18 - 6/30/18 1 10 7/1/18 - 9/30/18 0 n/a
10/1/18 - 12/31/18 1 13
• Figure 4 shows multiple prescriber and dispenser episodes from 2015 – 2018. The thresholds incorporated consist of 5/5/90 (5 prescribers or more plus 5 dispensers or more in 90 days) as well as 10/10/90 (10 prescribers or more plus 10 dispensers or more in 90 days). A few noteworthy items occurred which may contribute to trends seen in Figure 4. See footnotes beneath Figure 4. This assessment includes all prescriptions reported to the database (i.e. butalbital and gabapentin).
Figure 4. Multiple Prescriber and Dispenser Episodes by Recipient Count
Note, 2015-2017 data was updated in Figure 4 due to the change in consolidation algorithm which occurred when
the PMP database migrated from the RxSentry© system to the AWARxE© system. *In Q1 2015, PMP staff began sending unsolicited notices to prescribers and dispensers regarding individuals with high-risk patient behavior, thereby alerting them to view the PMP and to discuss any concerns they may have with
their patient. *In Q3 2016, the law changed requiring dispensers to report gabapentin to the PMP.
906949 978
842 832
674 705 695626
517 495425 400 367
327 310
8
1514 14
5
85 6
4
2 2 1 1 1 0 10
5
10
15
20
0
200
400
600
800
1000
1200
Q1* Q2 Q3 Q4 Q1 Q2 Q3* Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2015 2016 2017 2018
Num
ber o
f Rec
ipie
nts
Num
ber o
f Rec
ipie
nts
Multiple Prescriber and Dispenser Episodes by Recipient Count
5|5|90 10|10|90
23
DATABASE ACCOUNT ACCESS
The following sections cover PMP system account holders and their use of the PMP database. During the 2016 legislative session, MN Stats. §152.126 was amended to require prescribers and pharmacists practicing within Minnesota to register for a PMP account. By July 1, 2017, every prescriber licensed by a MN health-licensing board practicing within this state who is authorized to prescribe controlled substances, for humans, and who holds a current registration issued by the federal Drug Enforcement Administration, and every pharmacist licensed by the Board and practicing within the state, must register for and maintain a user account with the MN PMP. While viewing this data, it is important to remember that it is unlikely that 100% of prescribers and pharmacists licensed in MN would meet the above qualifications and therefore be required to obtain access to the MN PMP. At the end of 2018 estimates show that 42% of prescribing health care licensees and 61% of licensed pharmacists have requested and been approved for access to the PMP database. This does not include those licensed but not practicing in MN or whose practice does not warrant or allow for access to the PMP.
Since the program began in 2010, there has been a steady increase in the number of authorized system account holders accessing the PMP database. 2017 showed an expected peak in registered new accounts due to the changed in legislation. Table 13 shows the average number of requests for new accounts the PMP has received daily since 2010.
Table 13. Average Number of New Account Requests per Day
Year New Account Requests (Average)
2010 12.2 per day*
2011 8.2 per day
2012 10.4 per day
2013 13.2 per day
2014 15.8 per day
2015 17.7 per day
2016 21.5 per day
2017 46.3 per day
2018 14.4 per day *Accounts requested per day in 2010 are reflective beginning April 1, 2010.
Access to the database was not available prior to this date.
24
Prescribers and Pharmacists can request an account through the PMP online registration system. After verifying the individual has an active license to dispense or prescribe controlled substances and in the case of prescribers, has a Drug Enforcement Agency (DEA) registration number, the applicant may be granted access to the MN PMP. The Boards of Medical Practice, Pharmacy, Nursing, and Dentistry have successfully integrated automatic registration into their online license renewal system. The green bar in Figure 5 shows registered accounts in the database arranged by the board that licenses the individual. The dark blue bar shows the number of individuals that are licensed by that board. Note: The number of prescribers includes all prescribers licensed by the various boards regardless of where they practice or if they have a DEA registration to prescribe controlled substances. There are licensees within these licensing boards that do not actively prescribe or treat patients (administrative positions, research, education, etc.). There are also individuals included in the total licensed professionals column that are licensed in MN but may practice in another state, are retired, or not practicing. Licensed professionals included under Dentistry are DMD and DDS, under
Pharmacy are RPh, and under Medical Practice are MD, DO, PA’s and Residents. The column representing total licensed professionals by the Board of Nursing represents only APRNs who are eligible to register with the DEA to prescribe controlled substances.
Figure 5. Account Holders vs. Total Licensed Professionals by Health-Related Licensing
Boards
0
10,000
20,000
30,000
9,421
4,237
251
27,226
8,683
3,2311,710
177
12,328
5,280
Registered Accounts vs.Total Licensed Professionals by Board,
2018
# Licensees # Accounts
25
Database Utilization
Just as the number of account holders has grown over time, so has the utilization of the database. Figure 6 shows the total number of requests for patient history reports performed during the past eight years of operation. It also depicts the increase in the number of account holders utilizing the database over time. 2018 has shown a stable number of accounts and a steep increase in utilization of the database.
Figure 6. Total Account Holders Requesting Patient Reports and Requests Performed (2010-2018)
2,087
3,383
5,390
7,477
8,854
10,027
11,600
14,632 14,352
79,479176,645
309,007
562,214
786,734875,141
1,168,1861,244,173
1,576,488
0
200,000
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600,000
800,000
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1,200,000
1,400,000
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1,800,000
0
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4,000
6,000
8,000
10,000
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2010 2011 2012 2013 2014 2015 2016 2017 2018
Requ
ests
Acco
unt H
olde
rs R
eque
stin
g Re
port
s
Total Patient Report Requests
Total # of Account Holders Requesting Reports Total # of Requests
26
Figure 7 represents the quarterly utilization throughout 2018. It provides the number of registered account holders, the number of account holders that requested patient reports during the timeframe, as well as the number of patient report requests performed during each quarter.
Figure 7. Total Accounts, Usage, and Requests by Quarters
Figures 8a and 8b illustrate the number of patient reports requested by each PMP system role type throughout time. Each role type has shown increase in usage of the database over the past eight years with the most common being pharmacists, medical doctors, doctors of osteopathy, physician assistants, and residents. It is worth noting that a registered account holder (prescriber or pharmacist) who holds a Supervising Account may not appear to be requesting a report when their delegate is requesting a report on their behalf. See Key to Abbreviations for descriptions of acronyms.
9,778 10,127 10,258 15,839
24,72224,262 24,638
25,858347,683
379,092 385,439375,442
320,000
330,000
340,000
350,000
360,000
370,000
380,000
390,000
0
5,000
10,000
15,000
20,000
25,000
30,000
Q1 (Jan - Mar) Q2 (Apr - Jun) Q3 (Jul - Sep) Q4 (Oct - Dec)
Requ
ests
Acco
unts
Total Accounts and Patient Report Requests
Total # of Account Holders that Requested Reports
Total Registered Accounts
Total # of Report Requests by All Account Holders
27
Figure 8a. Direct Access Patient Report Requests by Role Type (2010-2018)
Figure 8b. Direct Access Patient Report Requests by Role Type (2010-2018) cont.
6934
296
54,7
59
1575
1
16,6
83
935
121,
498
33,3
91
26,5
94
3,12
3
209,
329
63,5
50
37,5
19
6,70
7
238,
262
219,
227
51,8
50
7,37
0
288,
823
318,
881
50,9
06
7,58
8
265,
734
310,
218
77,1
18
10,7
81
269,
557
352,
604
100,
734
11,3
47
326,
374
372,
835
88,0
30
8,55
3
301,
394
492,
903
0
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200,000
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400,000
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APRNs DDS/DMD MD/DO/PA/Residents RPh
Direct Access Patient Report Requests by Role Type
2010 2011 2012 2013 2014 2015 2016 2017 2018
17 0 0
1,66
1
102
0 0
3,99
0
226
0
276
4,76
6
646
0
490
2,43
0
955
12
691
3,20
4
607
0
1,02
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2,81
9
502
6
1,31
2
3,31
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511
11
396
3,50
3
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2,000
3,000
4,000
5,000
6,000
DPM OD MEC MRRP
Direct Access Patient Report Requests by Role Type
2010 2011 2012 2013 2014 2015 2016 2017 2018
28
At the end of 2018, there were 25,798 registered account holders. This is an 11.5% decrease from 2017. On December 4, 2018 the Minnesota PMP migrated to a new software solution. Registered accounts were migrated to the new system if they had been accessed in the previous 12-month period, or if they were newer than 6 months regardless of whether they had been accessed. A series of communications were sent to account holders in preparation for the migration date to ensure the greatest percentage of those registered for and utilizing the system experienced a seamless transition. The decrease in registered accounts is attributed to those that did not respond to communications, did not access their previous PMP accounts, or did not have current contact information within their account. The role type of the active registered account holders is shown in Figure 9 with the highest percentage of registered accounts belonging to MD/DO/PAs and RPhs.
Figure 9. System Accounts by Role Type
RPH, 21.0%
APRN, 12.7%
DDS/DMD, 6.6%
Delegates, 10.1%
DPM, <1%
MEC, <1%
MD/DO/PA, 47.5%
RRP, <1%OD, <1%
Vet, <1%
System Accounts by Role Type
29
Delegate Accounts
MN statutes allow for prescribers and pharmacists (Supervising Account Holders) to delegate the task of accessing the PMP database to an agent or employee under their direction. Delegates may apply for an individual account which once approved by their Supervising Account Holder, will be allowed access to request patient data on their behalf.
The number of delegate accounts has increased by 404% since 2013. Figure 10 shows the number of individuals that registered for a delegate account from 2013 to 2018, as well as the number of patient report requests performed and how many delegates performed those requests. Along with the increase in delegate accounts, the utilization of the PMP has increased dramatically from 2017 to 2018. Delegates can increase workflow efficiency in the clinical environment by preparing a patient report for their supervising provider upon request.
Figure 10. Delegate Accounts and Patient Report Requests (2013-2018)
Figure 11 shows the increase in use by quarter in 2018.
Figure 11. Delegate Accounts and Patient Report Requests by Quarter (2018)
451 742
1,155
1,6631,768
2,426
517
1,446
2,357
3,548
2,560 2,610
56,564 115,139
234,681303,548
410,798
596,275
0
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2013 2014 2015 2016 2017 2018
Requ
ests
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unts
Delegate Activity
Active Account Holders Registered Accounts Report Requests
1,5391,634
1,6771,807
136,490147,708
148,460
163,617
120,000
140,000
160,000
180,000
1,500
1,600
1,700
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1,900
Q1 Q2 Q3 Q4
Patie
nt R
eque
sts
Acco
unts
Delegate Activity by Quarter
Account Holders Making Requests
30
Other Permissible Use of PMP Data
In addition to prescribers, pharmacists, and their delegates, the law allows others to obtain patient history reports data from the PMP staff. By submitting a valid search warrant, law enforcement officials can receive a report that contains any of the following data:
• a recipient’s controlled substance prescription history, • the history of all reported controlled substance prescriptions associated with a prescriber based on their
Federal Drug Enforcement Administration (DEA) registration or • the history of controlled substance prescriptions reported as dispensed by a dispenser.
In all cases, the MN Board of Pharmacy staff assigned the duties of administering the PMP, access the database and the resulting report is sent to the requestor. In 2018, law enforcement officials presented the MN PMP staff with 726 search warrants, a 12% decrease from the search warrants received in 2017.
The recipients of the controlled substance prescriptions reported to the PMP are also permitted to obtain information regarding their own prescription history. A request for release of the data, which has been signed in the presence of a notary public and sent to the PMP office, is required. As with requests made by law enforcement officials, the PMP staff access the database and the resulting report is sent to the requestor. A provision was put in place that will also allow the recipient to give consent for release of the report to a third party. Legal counsel, probation officials, MN Health Licensing Boards, and others have used this provision. In 2018, the PMP staff processed 311 requests from recipients or their designee, an 18% increase in requests from 2017.
Figure 12 shows the number of law enforcement and recipient requests received throughout 2018.
Figure 12. Law Enforcement and Recipient Requests (2018)
53
76
57
7075
6167
52
66
51 5345
26 2530 32
1723 26 29
24 2328 28
0
20
40
60
80
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
Law Enforcement and Recipient Requests
Law Enforcement Recipient
31
Figure 13 shows the initial increase and then stability in volume of requests received from law enforcement and individuals in the period between 2012 and 2018.
Figure 13. Law Enforcement and Recipient Requests Over Time
2012
2013
2014
2015
2016
2017
2018
0
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LawEnforcement
Recipient
182
9
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usts
Requests for Data Over Time
32
MULTIPLE JURISDICTION DATA EXCHANGE
The MN PMP has been participating in a multijurisdictional data exchange system since July 2014. MN Stats. §152.126, Subd. 6(g) permits the Board to participate in a system, provided that permissible account holders in other jurisdictions may access MN patient history reports only as allowed under MN law. The Board chose to utilize the National Association of Boards of Pharmacy (NABP) PMP InterConnect© hub solution to facilitate the sharing of prescription monitoring program patient history reports across state lines to authorized account holders. It allows participating PMPs across the United States additional information to provide a more effective means of combating drug diversion and drug abuse nationwide. It should be noted that the “hub” retains no PMP data. The system acts as a pass-through for transferring a patient history report to the requesting jurisdiction’s authorized PMP account holder. Each participating PMP controls who, from collaborating jurisdiction, can access reports based on their own laws and regulations.
At the end of 2018, PMPs in 50 jurisdictions, including MN, were participating in the PMP InterConnect© data exchange hub, with MN actively connected to authorized account holders within 38 of those jurisdictions. Table 14 shows the jurisdictions with which MN is actively connected to. Only approved MN prescribers, pharmacists, and their delegates holding active MN PMP accounts have access to patient history reports from participating jurisdictions.
Table 14. Jurisdictions Actively Exchanging PMP Data with MN Account Holders
Alabama* Iowa* Nevada* South Carolina* Alaska* Kansas* New Jersey* South Dakota*
Arizona* Kentucky New Mexico Tennessee Arkansas Louisiana* New York Texas* Colorado Maine* North Carolina Virginia*
Connecticut* Maryland North Dakota Washington DC* Delaware Massachusetts Ohio* West Virginia
Idaho Michigan* Oklahoma Wisconsin Illinois* Mississippi* Pennsylvania* Indiana Montana Rhode Island
*Select role types may not be permitted by this jurisdiction to access their patient reports.
Authorized MN PMP account holders made 1,660,927 data requests to other participating jurisdictions in 2018. During this same time, other participating jurisdiction’s authorized PMP account holders made 6,018,407 requests for MN PMP controlled substance history reports. Figure 14 is a breakdown of report requests, by month.
33
Figure 14. Multiple Jurisdiction Patient Report Requests 2018
Figure 15 reflects the volume of reports requested by MN account holders to PMP databases in other jurisdictions, compared to the volume of MN patient reports requested by other jurisdiction’s PMP account holders. States that border MN are requesting reports frequently. This information exchange is important for reviewing data on individuals who receive prescriptions dispensed across borders. These numbers rise as more jurisdictions enact legislation enabling connection to data sharing hubs and MN establishes connections with additional jurisdictions. Note: The Minnesota staff enabled connection with North Carolina in February 2018.
143,414130,097
145,252 149,220 145,030 145,711 145,849163,533
136,102
171,678150,547
79,480
16,144 14,922 17,817 19,295 18,005 17,002 18,049 18,835 15,977 18,760 16,425 17,752
0
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Jan Feb March Apr May June July Aug Sept Oct Nov Dec
Multi Jurisdiction Queries
MN Disclosures to Another Jurisdiction MN Interjurisdiction Requests
34
Figure 15. Requests for Patient Records by Permissible Account Holders through PMPi (2018)
36,15635,917
37,295
36,406
35,710
35,341
36,069
35,278
36,062
37,016
35,387
106,672
35,384
35,848
35,879
35,808
35,574
35,081
16,306
36,66236,315
35,071
34,97535,757
35,846
0
129,596
35,825
35,838
35,709
35,674
35,799
104,77235,00935,434
35,894
35,650
157,912
606470,258
77,906
55,257
64,018
33,94161,338
10,50835,445
3,34924,574
54,775
31,057206,319
210,184
56,263
260,290
98,082
138,857
6,242
297,434
229,688
19,227116,712
69,386
145,685
79,264611,134
741,306
22,987
41,139
73,686288,994
309,992
92,505
225
78,627
0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000
Alabama
Alaska
Arizona
Arkansas
Colorado
Connecticut
Delaware
District of…
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Mississippi
Montana
Nevada
New Jersey
New Mexico
New York
North Carolina*
North Dakota
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Virginia
West Virginia
Wisconsin
Number of Records Exchanged with MN via PMP InterConnect
# Reports State Requested from MN PMPDatabase
# Reports MN Account Holders Requestedfrom Other State
1,295,689
35
KEY TO ABBREVIATIONS
APAP: Acetaminophen, the generic of Tylenol® APRN: Advanced Practice Registered Nurse DDS: Doctor of Dental Surgery DO: Doctor of Osteopathy DMD: Doctor of Medicine in Dentistry DPM: Doctor of Podiatric Medicine MD: Medical Doctor MEC: Medical Examiner/Coroner MRRP: Minnesota Restricted Recipient Program OD: Doctor of Optometry PA: Physician Assistant RPh: Pharmacist Rx: Prescription VET: Veterinarian
36
BIBLIOGRAPHY
BIBLIOGRAPHY 1. US Census Bureau, Population Division, Annual Estimation of the Resident Population. April 1, 2010 - July 1, 2018.
2. McEvoy, G., Snow, E., Miller, J. et al, [ed.]. AHFS Drug Information 2018, Bethesda : American Society of Health-System Pharmacists(R), 2018.
APPENDIX A
As mentioned in the Introduction of the Annual Report, the MN PMP database was migrated from the MN PMP RxSentry© system to Appriss Health’s PMP AWARxE© system on 12/4/2018. As such, to enable account holders to view complete data in the new database format, prescription data that had been reported to the RxSentry© database was migrated to the new AWARxE© database. RxSentry© used different address resolving software than Appriss Health’s Business Intelligence (BI) tools. A key difference in Appriss’ BI tools is that counties are assigned by zip code whereas this was not the case in RxSentry©. Due to this change in assignment, county-level prescription counts are different when viewing aggregate RxSentry© data and Appriss’ BI data, and the two data sets cannot be compared. The PMP staff have updated the tables in the annual report to include data from 2015-2017 using Appriss’ BI tools. Additionally, PMP staff compiled Appendix A to depict county-level prescription data from 2015-2017, again using Appriss’ BI tools.
Table A1. Controlled Substance Prescriptions Dispensed by Minnesota Recipient Counties*
Prescription Count Rate per 1,000 population Geography 2015 2016 2017 2015 2016 2017 STATEWIDE 7,868,941 7,546,565 7,184,220 1,435.3 1,366.3 1,290.2
AITKIN 34,011 32,164 29,120 2,145.1 2,041.3 1,842.0 ANOKA 491,666 472,696 443,359 1,428.2 1,363.6 1,264.9 BECKER 53,250 49,947 46,654 1,592.3 1,481.3 1,369.2
BELTRAMI 73,550 69,956 64,678 1,612.8 1,520.3 1,391.4 BENTON 45,634 44,197 41,591 1,157.9 1,114.1 1,036.5
BIG STONE 8,887 8,440 8,599 1,780.2 1,687.3 1,716.0 BLUE EARTH 89,889 87,855 83,367 1,369.0 1,324.3 1,246.4
BROWN 36,135 35,336 34,171 1,431.8 1,398.8 1,357.5 CARLTON 63,632 59,450 56,701 1,797.2 1,672.1 1,595.7 CARVER 124,185 121,151 117,317 1,259.0 1,206.9 1,148.5
CASS 54,200 51,097 46,628 1,889.4 1,761.1 1,589.4 CHIPPEWA 15,903 15,899 14,691 1,316.8 1,320.6 1,228.5 CHISAGO 93,470 92,781 89,079 1,727.3 1,699.7 1,613.3
CLAY 93,640 89,173 84,445 1,506.8 1,415.8 1,326.0 CLEARWATER 18,032 17,421 16,127 2,050.0 1,972.9 1,824.9
COOK 7,484 6,730 6,013 1,431.5 1,267.7 1,116.8 COTTONWOOD 17,113 17,097 16,951 1,497.7 1,502.9 1,503.1
CROW WING 115,173 107,996 101,265 1,821.5 1,694.3 1,574.5 DAKOTA 589,091 568,981 547,361 1,422.1 1,362.1 1,297.6 DODGE 20,350 18,847 17,792 996.7 916.9 858.0
DOUGLAS 66,343 65,345 61,551 1,803.7 1,759.1 1,638.9 FARIBAULT 23,275 23,234 21,720 1,664.8 1,675.2 1,578.0 FILLMORE 25,948 24,307 22,836 1,251.9 1,162.9 1,088.4 FREEBORN 42,583 37,636 35,325 1,396.3 1,237.7 1,156.8 GOODHUE 73,119 69,425 66,343 1,587.0 1,501.0 1,431.8
GRANT 11,399 10,843 10,355 1,941.9 1,827.6 1,743.9 HENNEPIN 1,652,384 1,585,713 1,521,666 1,351.6 1,283.1 1,219.0 HOUSTON 13,873 13,821 14,145 742.6 739.3 758.0 HUBBARD 29,151 27,700 26,637 1,412.0 1,338.2 1,268.4
ISANTI 66,512 65,951 62,713 1,737.6 1,700.8 1,584.3 ITASCA 87,783 82,000 78,391 1,939.5 1,815.6 1,735.8
JACKSON 10,420 10,936 10,966 1,032.2 1,097.2 1,097.9
II
Prescription Count Rate per 1,000 population Geography 2015 2016 2017 2015 2016 2017 KANABEC 30,776 29,660 27,332 1,937.5 1,865.1 1,702.5
KANDIYOHI 55,254 54,219 51,988 1,297.3 1,271.7 1,217.1 KITTSON 7,039 7,025 6,506 1,598.0 1,627.7 1,527.6
KOOCHICHING 27,435 26,709 24,592 2,143.7 2,118.2 1,963.3 LAC QUI PARLE 10,168 10,323 9,775 1,479.6 1,532.3 1,460.0
LAKE 17,579 16,327 15,306 1,666.7 1,551.4 1,455.5 LAKE OF THE
WOODS 5,535 5,183 5,211 1,429.5 1,367.5 1,394.8
LE SUEUR 31,352 30,449 28,159 1,130.4 1,098.4 1,000.3 LINCOLN 7,537 7,236 7,369 1,319.7 1,268.6 1,296.9
LYON 31,114 31,308 30,929 1,204.2 1,204.2 1,191.7 MAHNOMEN 13,847 13,416 11,628 2,546.8 2,443.7 2,084.2 MARSHALL 13,551 13,484 12,658 1,440.1 1,438.9 1,351.1
MARTIN 33,477 32,787 31,596 1,671.0 1,647.4 1,591.1 MCLEOD 54,469 52,960 51,559 1,520.5 1,480.7 1,436.9 MEEKER 29,761 29,622 28,531 1,291.9 1,285.0 1,238.3
MILLE LACS 69,388 65,949 61,487 2,722.8 2,577.8 2,376.1 MORRISON 53,712 51,555 47,510 1,639.4 1,566.7 1,435.3
MOWER 58,280 53,586 48,337 1,478.4 1,357.7 1,217.6 MURRAY 10,873 10,952 10,904 1,295.3 1,318.2 1,305.4 NICOLLET 41,969 41,338 40,147 1,251.6 1,225.5 1,178.8 NOBLES 21,748 21,949 20,651 997.8 999.4 946.9
NORMAN 11,853 11,122 10,182 1,790.2 1,703.5 1,546.2 OLMSTED 164,260 154,890 147,863 1,085.4 1,011.4 956.9
OTTER TAIL 87,474 84,543 81,300 1,520.1 1,461.0 1,395.7 PENNINGTON 24,740 24,766 23,694 1,738.1 1,743.2 1,669.6
PINE 51,426 47,228 43,239 1,770.7 1,636.6 1,481.6 PIPESTONE 16,145 16,458 16,481 1,742.2 1,790.3 1,811.9
POLK 55,134 54,474 52,350 1,749.7 1,717.4 1,651.2 POPE 17,166 16,890 16,296 1,570.5 1,540.6 1,483.5
RAMSEY 714,968 683,706 652,747 1,331.7 1,261.6 1,196.6 RED LAKE 6,509 6,157 6,139 1,614.3 1,543.1 1,526.4
REDWOOD 21,013 20,092 19,264 1,362.5 1,321.0 1,263.8 RENVILLE 22,900 22,484 21,842 1,548.1 1,539.6 1,489.2
RICE 93,017 87,435 82,166 1,424.3 1,328.3 1,241.7 ROCK 12,800 13,591 13,011 1,356.4 1,448.5 1,376.4
ROSEAU 22,820 22,383 22,309 1,461.0 1,439.1 1,457.1 ST. LOUIS 356,696 327,969 308,843 1,781.0 1,640.5 1,545.8
SCOTT 176,095 171,652 166,858 1,245.7 1,197.5 1,146.0 SHERBURNE 157,444 150,707 144,637 1,722.3 1,615.9 1,529.8
SIBLEY 18,992 18,208 16,548 1,275.7 1,229.0 1,110.3 STEARNS 201,442 193,918 183,098 1,292.2 1,235.2 1,159.0 STEELE 58,610 57,512 54,376 1,600.9 1,568.7 1,476.6
STEVENS 13,016 11,600 10,793 1,319.5 1,185.6 1,115.9 SWIFT 14,065 13,624 13,068 1,499.6 1,442.2 1,390.8 TODD 36,660 33,770 30,335 1,506.2 1,384.6 1,236.5
TRAVERSE 6,405 6,365 5,846 1,901.2 1,915.4 1,767.8 WABASHA 33,799 31,203 29,306 1,580.9 1,456.4 1,357.4 WADENA 28,592 26,639 25,372 2,091.9 1,965.8 1,859.3
III
Prescription Count Rate per 1,000 population
Geography 2015 2016 2017 2015 2016 2017 WASECA 26,823 25,320 24,159 1,417.5 1,348.3 1,290.1
WASHINGTON 362,590 351,939 339,091 1,447.5 1,393.0 1,326.1 WATONWAN 14,780 14,435 13,904 1,343.4 1,314.4 1,273.7
WILKIN 10,476 9,602 8,915 1,648.5 1,518.8 1,410.2 WINONA 64,635 57,123 50,421 1,272.1 1,123.6 994.4 WRIGHT 177,515 172,932 163,988 1,355.3 1,306.7 1,221.5 YELLOW
MEDICINE 15,132 15,666 15,047 1,538.4 1,584.8 1,528.4
*Rates were calculated using US Census Bureau population estimates. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions. See Table 4 for population estimates utilized.
IV
Table A2. Opioid Prescriptions Dispensed by Minnesota Recipient Residence Counties*
Prescription Count Rate Per 1,000 Population Geography 2015 2016 2017 2018 2015 2016 2017 2018 STATEWIDE 3,714,365 3,400,302 3,062,960 2,704,445 677.5 615.6 550.1 482.0
AITKIN 20,650 19,158 16,812 14,459 1,302.4 1,215.80 1,063.40 909.3 ANOKA 239,199 220,391 195,527 172,349 694.8 635.7 557.8 487.1 BECKER 25,706 22,989 19,836 17,588 768.7 681.8 582.1 511.7
BELTRAMI 38,175 34,338 28,862 25,073 837.1 746.2 620.9 535.2 BENTON 22,575 21,080 18,587 17,575 572.8 531.4 463.2 433.5
BIG STONE 4,171 3,902 3,889 3,526 835.5 780.1 776.1 706.8 BLUE EARTH 37,335 35,151 31,480 28,062 568.6 529.8 470.6 416.2
BROWN 16,809 15,894 14,349 12,202 666.0 629.2 570 485.9 CARLTON 34,754 31,636 28,576 25,853 981.6 889.8 804.2 721.4 CARVER 51,979 48,129 43,526 39,704 527.0 479.5 426.1 383.4
CASS 29,439 26,456 22,289 19,154 1,026.2 911.8 759.8 648.9 CHIPPEWA 8,254 8,029 6,932 6,051 683.4 666.9 579.7 507.5 CHISAGO 49,518 46,890 42,870 38,980 915.1 859 776.4 697.0
CLAY 38,047 33,409 28,785 23,822 612.2 530.4 452 372.5 CLEARWATER 9,279 8,675 7,269 6,181 1,054.9 982.4 822.6 701.6
COOK 4,399 3,718 3,145 2,791 841.4 700.3 584.1 517.5 COTTONWOOD 8,738 8,442 8,049 7,340 764.7 742.1 713.8 650.9
CROW WING 56,663 49,479 44,782 40,455 896.1 776.3 696.3 623.4 DAKOTA 257,350 236,023 216,132 191,514 621.3 565 512.4 450.2 DODGE 9,295 8,108 7,104 6,343 455.3 394.5 342.6 304.6
DOUGLAS 32,750 30,624 28,094 22,364 890.4 824.4 748.1 589.1 FARIBAULT 12,102 11,831 10,578 9,214 865.6 853.1 768.5 669.7 FILLMORE 13,379 12,246 11,244 9,447 645.5 585.9 535.9 448.6 FREEBORN 20,707 17,344 16,029 13,956 679.0 570.4 524.9 458.4 GOODHUE 38,257 34,270 31,362 27,464 830.4 740.9 676.9 591.9
GRANT 5,272 4,946 4,452 3,752 898.1 833.6 749.7 623.2 HENNEPIN 728,555 662,001 594,333 521,074 595.9 535.7 476.1 413.7 HOUSTON 6,627 6,501 6,463 5,412 354.7 347.8 346.3 291.3 HUBBARD 14,411 13,323 11,876 10,320 698.0 643.6 565.5 483.8
ISANTI 36,018 34,459 30,960 27,546 941.0 888.6 782.2 689.2 ITASCA 46,096 39,986 36,326 32,844 1,018.4 885.4 804.4 728.1
JACKSON 4,412 4,373 4,052 4,183 437.0 438.7 405.7 422.1 KANABEC 18,423 17,285 15,399 13,554 1,159.8 1,086.90 959.2 836.3
KANDIYOHI 25,796 24,276 22,771 19,602 605.7 569.4 533.1 457.4 KITTSON 3,312 3,279 2,821 2,506 751.9 759.7 662.4 589.9
KOOCHICHING 13,487 12,332 10,715 9,327 1,053.8 978 855.4 749.8 LAC QUI PARLE 4,959 5,145 4,751 4,314 721.6 763.7 709.6 647.9
LAKE 9,605 8,743 7,915 7,105 910.7 830.8 752.7 666.6 LAKE OF THE
WOODS 3,336 3,009 2,857 2,766 861.6 793.9 764.7 736.0
LE SUEUR 15,652 14,428 12,746 11,503 564.3 520.5 452.8 403.7 LINCOLN 3,435 3,236 3,333 3,051 601.5 567.3 586.6 537.8
LYON 13,628 13,424 12,258 11,392 527.5 516.3 472.3 444.5 MAHNOMEN 6,817 5,756 4,452 3,775 1,253.8 1,048.50 798 684.0 MARSHALL 6,519 6,103 5,420 4,862 692.8 651.3 578.5 517.8
MARTIN 16,439 15,171 14,131 11,982 820.6 762.3 711.6 605.6 MCLEOD 27,361 25,684 23,911 21,293 763.8 718.1 666.4 593.6
V
Prescription Count Rate Per 1,000 Population Geography 2015 2016 2017 2018 2015 2016 2017 2018
MEEKER 16,143 15,609 14,156 12,482 700.8 677.1 614.4 539.4 MILLE LACS 38,826 35,943 31,812 27,833 1,523.5 1,405.00 1,229.40 1,064.8 MORRISON 28,399 26,161 23,406 21,044 866.8 795 707.1 634.4
MOWER 28,024 24,117 20,525 15,167 710.9 611 517 379.1 MURRAY 5,135 4,915 4,707 4,080 611.7 591.6 563.5 493.0 NICOLLET 17,348 16,266 14,693 12,708 517.4 482.2 431.4 371.4 NOBLES 9,637 9,777 8,546 7,305 442.2 445.2 391.8 333.2
NORMAN 5,382 4,581 3,717 2,700 812.9 701.6 564.5 417.0 OLMSTED 71,410 64,499 57,942 50,920 471.9 421.2 375 325.8
OTTER TAIL 44,474 41,368 37,548 32,647 772.9 714.9 644.6 555.1 PENNINGTON 11,906 11,516 10,595 8,337 836.4 810.6 746.6 588.0
PINE 30,972 27,767 24,378 21,989 1,066.5 962.2 835.3 745.8 PIPESTONE 7,199 7,214 7,084 6,881 776.8 784.7 778.8 760.6
POLK 26,319 23,925 21,477 19,083 835.3 754.3 677.4 605.3 POPE 9,052 8,700 7,842 7,050 828.2 793.6 713.9 635.3
RAMSEY 345,951 317,360 287,271 250,394 644.4 585.6 526.6 455.1 RED LAKE 3,194 2,858 2,782 2,413 792.2 716.3 691.7 603.4
REDWOOD 10,788 9,719 8,549 7,285 699.5 639 560.8 477.7 RENVILLE 11,034 10,795 10,060 8,967 745.9 739.2 685.9 613.7
RICE 45,608 40,961 36,591 32,957 698.4 622.3 553 495.4 ROCK 6,296 6,533 6,208 6,029 667.2 696.3 656.7 640.4
ROSEAU 11,266 10,622 10,302 9,379 721.3 682.9 672.8 619.1 ST. LOUIS 172,224 149,909 134,453 121,778 859.9 749.8 672.9 609.6
SCOTT 79,286 73,457 68,269 59,922 560.9 512.5 468.9 406.6 SHERBURNE 77,306 70,511 63,929 57,378 845.7 756 676.2 597.5
SIBLEY 10,246 9,294 8,037 7,405 688.3 627.3 539.3 492.7 STEARNS 96,856 89,738 80,682 73,929 621.3 571.6 510.7 464.2 STEELE 25,447 23,797 20,516 17,252 695.1 649.1 557.1 468.8
STEVENS 5,822 5,169 4,559 4,020 590.2 528.3 471.4 412.2 SWIFT 6,869 6,458 5,883 5,012 732.4 683.6 626.1 536.3 TODD 20,607 18,725 16,203 14,874 846.6 767.8 660.5 605.1
TRAVERSE 2,938 2,749 2,583 2,144 872.1 827.3 781.1 648.1 WABASHA 16,385 14,651 13,637 12,272 766.4 683.8 631.6 567.0 WADENA 15,261 13,370 12,196 10,753 1,116.5 986.6 893.7 780.7 WASECA 12,116 10,904 9,779 8,616 640.3 580.6 522.2 461.0
WASHINGTON 162,486 152,806 141,311 127,235 648.7 604.8 552.7 490.9 WATONWAN 7,654 7,096 6,566 5,841 695.7 646.1 601.5 532.0
WILKIN 5,227 4,490 3,905 3,398 822.5 710.2 617.7 543.3 WINONA 30,811 27,231 23,664 21,183 606.4 535.6 466.7 416.8 WRIGHT 84,974 78,908 70,959 63,541 648.8 596.2 528.5 466.0 YELLOW
MEDICINE 7,797 8,161 7,588 6,612 792.7 825.6 770.7 675.0
*Rates were calculated using US Census Bureau population estimates. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions. See Table 4 for population estimates utilized.
VI
Table A3a. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County - 2015*
COUNTY All
Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
STATEWIDE 677.5 219.6 226.8 117.8 34.8 33.7 17.2 17.0 AITKIN 1,302.4 429.5 460.7 202.6 53.2 68.6 44.8 25.5 ANOKA 694.8 211.9 279.5 101.7 30.6 30.5 11.2 18.1 BECKER 768.7 319.5 174.4 128.2 44.1 41.4 28.0 17.8
BELTRAMI 837.1 318.9 121.2 243.7 58.0 42.2 19.7 22.0 BENTON 572.8 202.0 166.7 108.7 34.1 34.9 12.7 8.0
BIG STONE 835.5 301.9 118.6 230.4 73.3 43.3 44.7 9.4 BLUE EARTH 568.6 165.7 165.4 144.7 25.5 33.0 19.4 9.7
BROWN 666.0 233.5 185.0 137.6 32.2 30.8 23.5 11.6 CARLTON 981.6 421.2 198.5 190.8 45.1 53.9 25.7 20.1 CARVER 527.0 204.7 161.2 71.9 28.9 26.9 14.2 12.8
CASS 1,026.2 396.5 223.9 210.2 63.5 58.4 33.7 23.8 CHIPPEWA 683.4 250.9 149.7 145.5 36.0 30.6 55.3 10.8 CHISAGO 915.1 309.3 333.1 121.9 37.8 47.6 22.0 27.1
CLAY 612.2 239.5 137.8 124.4 28.8 28.5 27.8 17.7 CLEARWATER 1,054.9 403.4 166.9 295.4 65.7 44.1 44.0 21.3
COOK 841.4 346.4 204.7 138.9 39.6 50.3 29.6 14.7 COTTONWOOD 764.7 266.6 127.9 216.2 37.4 34.0 72.5 5.6
CROW WING 896.1 335.5 266.7 152.7 43.2 44.3 24.8 16.8 DAKOTA 621.3 192.1 233.5 91.7 34.2 28.4 11.7 18.1 DODGE 455.3 95.5 164.6 125.1 19.2 21.7 11.9 16.1
DOUGLAS 890.4 334.9 220.9 184.4 58.5 41.4 28.6 13.7 FARIBAULT 865.6 255.6 227.5 255.1 30.3 63.8 19.2 7.8 FILLMORE 645.5 146.0 177.2 219.8 32.5 25.9 20.3 19.0 FREEBORN 679.0 206.0 176.8 198.5 21.0 34.7 22.0 16.8 GOODHUE 830.4 225.6 279.7 179.4 39.4 48.6 28.2 20.6
GRANT 898.1 321.0 258.8 179.0 52.6 41.7 29.5 7.5 HENNEPIN 595.9 177.0 242.1 76.9 32.4 29.2 10.1 19.4 HOUSTON 354.7 141.8 58.2 97.2 9.3 13.7 25.9 5.6 HUBBARD 698.0 243.1 167.8 140.2 39.6 37.9 33.2 20.4
ISANTI 941.0 283.1 393.3 114.4 37.4 54.8 19.8 19.4 ITASCA 1,018.4 367.1 287.7 183.7 52.7 51.3 26.9 29.3
JACKSON 437.0 167.5 54.1 149.3 26.2 22.3 11.0 6.0 KANABEC 1,159.8 349.7 473.2 140.1 38.0 80.8 32.4 26.6
KANDIYOHI 605.7 218.7 131.9 136.6 49.9 31.1 21.4 9.3 KITTSON 751.9 214.8 136.0 195.2 42.7 69.5 80.6 2.7
KOOCHICHING 1,053.8 396.5 227.5 226.8 51.4 65.6 42.0 23.1 LAC QUI PARLE 721.6 270.5 127.9 163.7 39.0 40.0 66.5 6.3
LAKE 910.7 383.4 196.2 140.8 43.1 55.8 49.9 19.9 LAKE OF THE
WOODS 861.6 297.5 178.2 251.5 30.2 24.5 63.3 9.8
LE SUEUR 564.3 167.8 184.1 127.5 23.7 24.0 22.6 10.0 LINCOLN 601.5 190.2 102.3 186.3 44.5 25.7 42.9 6.3
LYON 527.5 215.0 74.8 139.2 29.9 23.0 23.6 11.4
VII
COUNTY All
Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
MAHNOMEN 1,253.8 545.7 295.0 215.2 68.6 51.5 29.6 17.7 MARSHALL 692.8 221.3 161.8 168.9 52.5 37.9 32.9 3.8
MARTIN 820.6 302.1 192.3 210.5 30.2 44.3 33.0 4.1 MCLEOD 763.8 269.2 217.5 134.4 48.1 40.2 26.7 17.7 MEEKER 700.8 224.3 190.1 158.1 25.8 48.4 33.8 14.8
MILLE LACS 1,523.5 478.4 591.3 206.6 67.1 83.4 30.3 40.1 MORRISON 866.8 316.5 228.0 197.2 42.2 43.9 20.1 8.0
MOWER 710.9 183.3 227.1 198.9 24.8 34.4 17.9 16.9 MURRAY 611.7 218.1 83.0 207.8 27.2 32.3 37.9 3.0 NICOLLET 517.4 155.0 148.4 132.7 27.5 27.7 14.2 6.8 NOBLES 442.2 183.8 68.2 123.9 28.9 17.7 15.9 1.5
NORMAN 812.9 316.1 130.6 186.7 46.2 43.6 53.5 15.7 OLMSTED 471.9 97.4 165.1 140.7 19.1 17.4 11.1 17.9
OTTER TAIL 772.9 260.8 191.9 182.0 39.2 41.2 38.3 12.3 PENNINGTON 836.4 301.2 148.9 211.2 69.0 53.2 35.3 6.2
PINE 1,066.5 364.8 376.6 151.3 34.5 71.1 26.0 27.8 PIPESTONE 776.8 322.1 155.7 179.9 35.5 45.3 29.6 5.8
POLK 835.3 295.0 200.5 189.1 54.0 36.4 43.3 5.5 POPE 828.2 310.0 190.9 151.1 37.0 53.6 64.8 16.8
RAMSEY 644.4 177.4 258.0 95.8 38.0 31.5 12.7 17.5 RED LAKE 792.2 285.5 143.6 211.8 70.4 32.7 30.3 3.7
REDWOOD 699.5 220.1 169.2 168.2 37.3 29.1 55.0 12.9 RENVILLE 745.9 302.7 163.7 131.8 61.9 33.9 38.6 10.1
RICE 698.4 230.8 233.4 132.6 29.2 37.6 17.1 9.9 ROCK 667.2 253.9 127.9 152.9 32.5 37.7 45.7 2.9
ROSEAU 721.3 269.0 168.0 137.5 52.8 44.0 28.1 4.5 SAINT LOUIS 859.9 362.6 189.0 166.7 34.5 43.3 19.9 22.0
SCOTT 560.9 185.3 205.3 78.7 28.9 26.7 9.1 18.8 SHERBURNE 845.7 282.0 316.4 125.1 37.2 39.0 17.7 17.5
SIBLEY 688.3 261.6 188.7 106.0 40.6 41.4 24.7 10.2 STEARNS 621.3 219.9 167.0 130.2 35.5 35.8 17.2 7.9 STEELE 695.1 222.4 185.2 212.8 26.5 21.4 13.6 9.7
STEVENS 590.2 216.7 145.8 119.1 51.6 24.2 24.0 5.3 SWIFT 732.4 299.1 140.5 146.2 45.3 26.2 44.5 26.5 TODD 846.6 347.4 177.9 165.8 44.4 44.5 41.1 7.6
TRAVERSE 872.1 396.3 153.2 151.1 52.2 32.4 50.2 6.5 WABASHA 766.4 181.8 213.8 263.2 35.7 26.9 19.7 17.4 WADENA 1,116.5 420.5 261.9 211.7 67.9 56.8 55.3 31.8 WASECA 640.3 196.7 183.9 171.1 28.1 29.3 20.3 10.6
WASHINGTON 648.7 201.9 244.8 88.1 35.0 31.5 14.4 18.9 WATONWAN 695.7 227.0 182.4 170.4 25.5 43.8 31.3 8.8
WILKIN 822.5 333.0 168.5 174.5 53.5 52.1 24.4 12.3 WINONA 606.4 192.0 155.6 155.5 22.3 33.5 28.3 11.7 WRIGHT 648.8 220.5 230.4 98.3 28.9 34.5 13.8 12.2 YELLOW
MEDICINE 792.7 272.1 136.1 210.0 48.7 46.0 50.3 18.3
*Rates were calculated using US Census Bureau population estimates. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions. See Table 4 for population estimates utilized.
VIII
Table A3b. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County – 2016*
COUNTY All
Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
STATEWIDE 615.6 190.9 210.5 109.6 30.3 32.5 15.3 16.4 AITKIN 1,215.8 381.8 435.6 184.4 44.4 75.1 46.3 30.4 ANOKA 635.7 185.3 258.8 95.6 28.0 29.4 9.5 17.9 BECKER 681.8 281.3 158.3 117.6 37.7 37.5 21.4 15.1
BELTRAMI 746.2 285.5 117.5 223.6 48.6 32.8 15.6 13.0 BENTON 531.4 177.1 151.5 104.6 32.7 39.1 11.3 8.5
BIG STONE 780.1 296.9 101.0 202.7 77.0 46.0 36.4 7.6 BLUE EARTH 529.8 147.2 156.7 139.9 22.5 30.2 16.6 10.9
BROWN 629.2 214.9 174.5 133.0 27.8 29.5 24.9 11.6 CARLTON 889.8 376.2 190.6 180.1 37.4 49.4 21.1 14.7 CARVER 479.5 176.8 151.4 71.6 24.9 24.7 11.4 12.9
CASS 911.8 358.8 203.8 182.7 48.5 56.2 28.5 18.5 CHIPPEWA 666.9 231.2 149.2 150.3 29.5 30.6 55.9 16.0 CHISAGO 859.0 271.6 319.3 125.4 34.4 44.9 21.2 25.6
CLAY 530.4 202.1 117.2 117.3 24.8 27.9 21.5 12.2 CLEARWATER 982.4 360.6 178.1 284.7 45.0 34.0 44.5 22.8
COOK 700.3 271.4 193.6 120.9 29.4 40.1 20.9 15.8 COTTONWOOD 742.1 241.9 122.8 232.3 36.4 34.4 66.0 4.4
CROW WING 776.3 286.6 236.9 131.9 34.3 42.0 19.7 15.2 DAKOTA 565.0 166.3 217.3 83.6 29.4 28.5 11.3 17.6 DODGE 394.5 80.8 148.0 104.6 14.9 18.4 10.3 15.4
DOUGLAS 824.4 298.5 205.7 188.0 50.3 38.4 24.3 11.9 FARIBAULT 853.1 250.5 219.9 256.0 26.2 64.2 20.6 10.8 FILLMORE 585.9 138.7 161.9 187.7 25.5 30.7 18.5 18.4 FREEBORN 570.4 160.9 143.0 178.7 16.3 31.1 19.1 18.0 GOODHUE 740.9 175.9 269.3 159.4 34.2 48.7 24.1 22.5
GRANT 833.6 283.8 240.9 189.1 41.1 33.7 22.1 19.7 HENNEPIN 535.7 149.6 222.3 71.3 28.3 27.8 9.3 19.0 HOUSTON 347.8 130.3 61.5 100.5 8.3 12.5 23.8 6.7 HUBBARD 643.6 225.4 169.4 120.6 35.5 36.5 26.2 17.2
ISANTI 888.6 254.2 381.8 103.1 35.6 54.1 21.7 18.5 ITASCA 885.4 308.1 255.2 173.5 43.4 45.5 18.6 22.8
JACKSON 438.7 165.3 64.6 142.2 27.5 18.2 14.5 5.7 KANABEC 1,086.9 302.8 468.5 133.6 31.6 85.1 24.1 26.3
KANDIYOHI 569.4 192.8 128.5 136.3 43.3 34.1 18.3 8.6 KITTSON 759.7 238.6 143.9 173.1 48.4 59.8 83.2 4.9
KOOCHICHING 978.0 344.0 229.3 220.3 44.3 64.6 35.1 25.4 LAC QUI PARLE 763.7 270.4 140.0 188.1 36.5 53.0 61.2 6.7
LAKE 830.8 338.7 189.6 134.4 39.4 53.3 40.5 15.0 LAKE OF THE
WOODS 793.9 293.4 164.6 212.4 34.0 23.7 54.6 5.3
LE SUEUR 520.5 141.3 171.0 129.6 19.6 24.5 16.6 11.8 LINCOLN 567.3 170.9 96.8 204.9 31.4 18.9 34.2 6.0
LYON 516.3 205.1 84.2 135.9 30.7 21.2 21.7 7.9 MAHNOMEN 1,048.5 449.2 250.6 186.3 57.7 41.7 23.9 22.8 MARSHALL 651.3 207.4 149.8 157.6 47.2 33.1 34.8 8.1
IX
COUNTY All
Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
MARTIN 762.3 270.1 179.8 193.9 29.6 44.2 30.9 9.0 MCLEOD 718.1 244.3 207.6 133.3 43.8 42.8 23.6 12.8 MEEKER 677.1 216.4 176.4 158.9 25.0 48.2 33.9 11.1
MILLE LACS 1,405.0 432.9 546.0 201.1 56.3 79.8 24.0 35.1 MORRISON 795.0 297.2 212.5 173.2 34.7 42.8 18.0 6.8
MOWER 611.0 147.3 195.7 173.3 21.1 36.6 15.0 15.1 MURRAY 591.6 201.1 81.5 198.5 26.0 37.7 42.9 2.4 NICOLLET 482.2 136.2 139.3 137.6 22.4 22.1 12.3 6.7 NOBLES 445.2 177.5 61.4 135.0 23.7 24.4 18.6 2.0
NORMAN 701.6 254.9 130.5 178.1 35.2 46.1 38.1 6.1 OLMSTED 421.2 83.7 148.5 125.8 14.4 17.0 9.5 19.6
OTTER TAIL 714.9 232.9 180.0 171.9 35.3 40.6 33.4 13.7 PENNINGTON 810.6 283.5 154.5 201.4 65.3 61.3 24.5 7.8
PINE 962.2 320.5 346.6 139.7 27.7 69.0 21.6 23.4 PIPESTONE 784.7 306.2 154.9 207.1 33.4 43.2 29.0 4.6
POLK 754.3 262.1 173.1 172.4 51.3 37.7 42.4 4.9 POPE 793.6 287.9 194.8 139.8 30.9 56.3 59.7 15.9
RAMSEY 585.6 152.6 236.9 87.4 33.3 31.2 11.8 19.1 RED LAKE 716.3 262.9 141.4 173.4 48.4 41.6 29.8 4.5
REDWOOD 639.0 205.0 151.9 161.6 27.2 29.7 47.0 7.7 RENVILLE 739.2 306.1 161.0 127.8 55.7 31.6 37.5 12.1
RICE 622.3 191.4 215.3 123.6 22.8 38.8 13.4 8.5 ROCK 696.3 261.6 137.3 170.6 30.1 43.2 40.2 1.6
ROSEAU 682.9 218.9 164.2 158.5 56.4 39.3 26.1 5.1 SAINT LOUIS 749.8 311.5 171.1 146.4 29.1 38.2 16.7 18.4
SCOTT 512.5 162.8 191.2 72.5 25.3 25.9 8.6 18.2 SHERBURNE 756.0 245.8 285.3 115.8 31.7 34.8 16.6 15.1
SIBLEY 627.3 219.2 180.2 112.9 31.2 39.9 20.1 9.9 STEARNS 571.6 194.6 155.0 124.9 32.7 34.7 16.3 7.0 STEELE 649.1 189.4 189.4 202.2 22.0 23.1 11.3 10.0
STEVENS 528.3 182.3 143.3 118.9 35.9 16.7 15.6 10.7 SWIFT 683.6 253.5 131.9 139.4 50.9 29.5 43.1 28.9 TODD 767.8 311.0 172.8 145.0 43.6 42.2 30.6 8.2
TRAVERSE 827.3 381.3 144.4 143.8 57.2 25.6 41.2 8.1 WABASHA 683.8 155.5 200.0 231.2 31.6 25.8 17.2 15.4 WADENA 986.6 362.6 243.1 190.0 60.5 44.4 50.5 24.7 WASECA 580.6 166.6 178.3 160.9 23.4 22.7 19.9 7.8
WASHINGTON 604.8 175.1 235.3 83.9 31.9 31.9 13.2 19.3 WATONWAN 646.1 195.5 182.8 169.6 21.9 39.0 25.1 6.1
WILKIN 710.2 279.5 131.0 161.0 50.6 50.0 25.3 7.6 WINONA 535.6 168.6 142.3 136.7 17.9 30.4 21.2 11.8 WRIGHT 596.2 193.3 220.0 89.8 24.6 35.3 13.1 11.8 YELLOW
MEDICINE 825.6 262.2 137.4 237.5 48.7 42.8 73.7 9.6
*Rates were calculated using US Census Bureau population estimates. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions. See Table 4 for population estimates utilized.
X
Table A3c. Crude Rate of Specific Opioids Dispensed per 1,000 Population by MN Recipient Residence County – 2017*
COUNTY All Opioid Rate
Hydrocodone Rate
Oxycodone Rate
Tramadol Rate
Codeine Rate
Morphine Rate
Fentanyl Rate
Hydromor-phone Rate
STATEWIDE 550.1 164.4 190.9 99.8 26.1 30.5 12.8 16.6 AITKIN 1,063.4 330.6 395.0 158.9 35.9 69.0 31.8 27.3 ANOKA 557.8 156.7 228.5 84.2 23.9 29.3 8.6 16.7 BECKER 582.1 246.6 131.6 103.4 29.8 36.2 14.3 11.2
BELTRAMI 620.9 235.1 97.1 195.6 35.1 30.8 11.1 7.8 BENTON 463.2 152.9 136.3 93.7 24.4 35.2 9.3 6.2
BIG STONE 776.1 286.6 122.7 199.4 61.7 41.1 49.3 6.0 BLUE EARTH 470.6 125.3 140.8 127.8 19.6 24.0 12.8 15.1
BROWN 570.0 187.9 160.0 117.6 26.2 31.0 22.1 10.9 CARLTON 804.2 337.6 169.3 170.7 32.0 44.2 17.2 17.0 CARVER 426.1 150.4 134.4 67.6 22.1 24.2 9.0 13.5
CASS 759.8 291.0 180.5 151.8 38.1 49.7 20.9 13.9 CHIPPEWA 579.7 184.1 136.7 141.7 30.2 32.1 35.6 11.9 CHISAGO 776.4 236.4 288.0 120.6 29.5 41.4 20.3 26.6
CLAY 452.0 160.6 108.4 105.8 19.7 24.7 14.7 11.1 CLEARWATER 822.6 285.8 167.0 254.4 39.6 24.3 32.3 12.6
COOK 584.1 224.2 164.0 103.5 27.9 30.3 17.6 8.7 COTTONWOOD 713.8 219.4 113.8 229.6 36.6 31.7 68.5 6.2
CROW WING 696.3 248.2 228.7 110.5 28.7 41.6 16.8 13.7 DAKOTA 512.4 143.3 200.2 76.2 26.0 27.8 10.4 18.0 DODGE 342.6 65.7 129.0 92.9 11.1 17.5 8.3 16.6
DOUGLAS 748.1 252.0 203.1 182.2 38.1 35.6 21.5 9.0 FARIBAULT 768.5 216.9 201.0 232.3 26.6 62.5 16.0 8.9 FILLMORE 535.9 126.2 144.7 170.1 21.2 30.7 17.4 20.5 FREEBORN 524.9 129.8 139.0 176.2 14.2 32.7 16.6 12.2 GOODHUE 676.9 158.7 241.4 150.9 27.6 46.1 19.8 26.3
GRANT 749.7 236.3 234.3 177.2 31.7 34.9 19.5 15.2 HENNEPIN 476.1 126.7 199.0 65.5 23.9 26.2 7.8 19.1 HOUSTON 346.3 121.9 56.1 109.7 8.1 15.8 24.0 6.6 HUBBARD 565.5 199.1 147.6 112.2 30.8 34.0 19.3 11.5
ISANTI 782.2 216.6 335.7 91.4 30.7 50.6 19.0 18.9 ITASCA 804.4 275.0 238.7 159.3 42.5 36.2 14.0 23.2
JACKSON 405.7 159.2 53.4 141.8 22.6 14.5 8.9 4.5 KANABEC 959.2 259.9 432.7 107.9 25.0 75.0 17.6 25.3
KANDIYOHI 533.1 172.9 118.6 136.0 43.2 34.0 14.6 8.3 KITTSON 662.4 201.5 120.7 161.1 40.9 52.8 70.7 7.0
KOOCHICHING 855.4 300.8 205.6 202.6 47.6 45.3 24.5 16.3 LAC QUI PARLE 709.6 265.0 120.4 176.1 28.5 43.8 60.0 11.5
LAKE 752.7 306.4 168.2 131.0 35.9 44.4 30.8 18.1 LAKE OF THE
WOODS 764.7 260.4 143.5 231.8 40.4 21.4 56.7 3.5
LE SUEUR 452.8 122.9 149.0 109.9 21.2 20.6 11.4 14.5 LINCOLN 586.6 166.8 96.8 216.5 26.9 27.8 40.0 8.4
LYON 472.3 175.2 80.2 124.0 24.3 26.5 27.7 6.6 MAHNOMEN 798.0 329.4 166.5 157.4 54.7 34.1 23.7 22.4 MARSHALL 578.5 183.7 132.2 150.6 35.5 29.5 27.5 6.0
MARTIN 711.6 236.7 184.4 186.1 29.3 38.9 23.4 10.6 MCLEOD 666.4 214.8 195.3 127.6 38.9 46.3 19.3 12.6 MEEKER 614.4 199.2 165.5 144.6 18.9 44.5 22.1 12.5
MILLE LACS 1,229.4 376.2 482.6 173.9 52.7 66.9 18.3 33.2 MORRISON 707.1 263.0 195.6 150.3 30.9 41.2 12.7 6.0
XI
COUNTY All Opioid
Rate Hydrocodone
Rate Oxycodone
Rate Tramadol
Rate Codeine
Rate Morphine
Rate Fentanyl
Rate
Hydromor-phone Rate
MOWER 517.0 124.2 168.9 143.4 15.0 31.7 12.9 14.0 MURRAY 563.5 182.1 83.7 192.1 23.3 39.1 35.6 4.9 NICOLLET 431.4 119.1 124.1 121.4 21.4 16.9 11.6 11.3 NOBLES 391.8 154.2 54.5 116.7 23.6 22.7 16.6 1.9
NORMAN 564.5 188.6 111.2 135.3 29.6 41.3 31.6 17.0 OLMSTED 375.0 71.8 131.4 110.1 11.5 16.4 7.7 23.2
OTTER TAIL 644.6 205.4 169.9 159.5 30.7 37.0 25.1 11.2 PENNINGTON 746.6 263.8 150.2 181.8 56.3 50.6 23.3 9.2
PINE 835.3 275.5 301.5 123.4 26.6 60.6 16.0 19.0 PIPESTONE 778.8 300.8 165.1 190.2 32.3 44.9 32.2 6.2
POLK 677.4 234.9 157.2 156.5 42.5 33.1 37.8 5.4 POPE 713.9 234.3 184.1 148.8 27.2 49.4 50.1 11.6
RAMSEY 526.6 129.9 217.3 79.6 27.7 29.8 10.2 20.1 RED LAKE 691.7 256.1 150.4 168.6 38.0 39.5 22.4 7.5
REDWOOD 560.8 187.8 128.1 135.3 24.2 27.8 42.4 8.1 RENVILLE 685.9 272.0 156.1 130.6 55.2 33.6 24.6 9.6
RICE 553.0 160.5 192.3 113.2 20.0 39.4 9.6 10.3 ROCK 656.7 233.7 130.4 176.7 24.2 43.6 34.9 0.5
ROSEAU 672.8 200.5 165.0 170.8 52.9 36.4 26.0 7.3 SAINT LOUIS 672.9 271.4 158.6 132.9 24.6 33.0 15.0 21.5
SCOTT 468.9 142.2 177.0 68.8 23.0 24.3 8.4 17.9 SHERBURNE 676.2 211.7 256.5 105.8 28.1 36.0 12.6 15.8
SIBLEY 539.3 190.8 143.9 109.5 29.9 29.0 16.2 9.4 STEARNS 510.7 172.4 140.9 113.6 27.9 31.2 12.6 6.4
STEELE 557.1 160.5 163.5 169.3 17.2 25.7 9.6 9.8 STEVENS 471.4 176.8 132.5 103.3 23.0 14.9 13.1 5.3
SWIFT 626.1 234.5 149.7 124.9 31.6 29.8 27.6 21.9 TODD 660.5 265.3 159.8 117.4 38.4 38.2 23.9 5.0
TRAVERSE 781.1 341.1 147.0 150.6 64.4 24.8 32.4 9.4 WABASHA 631.6 136.1 189.5 210.6 26.0 26.3 20.7 16.5 WADENA 893.7 314.4 223.6 175.1 64.8 46.6 45.1 18.0 WASECA 522.2 142.8 159.3 151.4 21.0 21.3 13.0 13.0
WASHINGTON 552.7 152.4 217.5 80.0 28.0 30.1 11.2 21.1 WATONWAN 601.5 178.8 186.9 156.9 24.5 27.7 15.6 8.8
WILKIN 617.7 220.5 119.1 149.3 41.0 48.4 23.7 11.9 WINONA 466.7 146.6 125.2 119.7 15.6 26.4 16.5 10.9 WRIGHT 528.5 168.4 197.0 78.9 21.2 32.0 10.2 12.7 YELLOW
MEDICINE 770.7 247.2 134.4 219.8 41.4 45.6 54.7 12.9
*Rates were calculated using US Census Bureau population estimates. The rates portrayed are regardless of age or whether Minnesota residents filled controlled substance prescriptions. See Table 4 for population estimates utilized.
XII
Table A4. US Census Bureau Annual Estimates of Resident Population* Population Estimate (as of July 1)
Geography 2015 2016 2017 2018
STATEWIDE - Minnesota 5,482,503 5,523,409 5,568,155 5,611,179
Aitkin County, Minnesota 15,855 15,757 15,809 15,902
Anoka County, Minnesota 344,246 346,665 350,521 353,813
Becker County, Minnesota 33,442 33,719 34,075 34,371
Beltrami County, Minnesota 45,604 46,016 46,484 46,847
Benton County, Minnesota 39,412 39,670 40,127 40,545
Big Stone County, Minnesota 4,992 5,002 5,011 4,989
Blue Earth County, Minnesota 65,658 66,343 66,887 67,427
Brown County, Minnesota 25,237 25,262 25,172 25,111
Carlton County, Minnesota 35,407 35,554 35,534 35,837
Carver County, Minnesota 98,635 100,380 102,150 103,551
Cass County, Minnesota 28,687 29,015 29,336 29,519
Chippewa County, Minnesota 12,077 12,039 11,958 11,924
Chisago County, Minnesota 54,113 54,588 55,214 55,922
Clay County, Minnesota 62,146 62,983 63,682 63,955
Clearwater County, Minnesota 8,796 8,830 8,837 8,810
Cook County, Minnesota 5,228 5,309 5,384 5,393
Cottonwood County, Minnesota 11,426 11,376 11,277 11,277
Crow Wing County, Minnesota 63,231 63,739 64,315 64,889
Dakota County, Minnesota 414,240 417,732 421,821 425,423
Dodge County, Minnesota 20,417 20,555 20,737 20,822
Douglas County, Minnesota 36,782 37,147 37,556 37,964
Faribault County, Minnesota 13,981 13,869 13,764 13,758
Fillmore County, Minnesota 20,727 20,902 20,982 21,058
Freeborn County, Minnesota 30,496 30,409 30,537 30,444
Goodhue County, Minnesota 46,073 46,252 46,334 46,403
Grant County, Minnesota 5,870 5,933 5,938 6,021
Hennepin County, Minnesota 1,222,578 1,235,875 1,248,246 1,259,428
Houston County, Minnesota 18,681 18,694 18,662 18,578
Hubbard County, Minnesota 20,645 20,700 21,001 21,332
Isanti County, Minnesota 38,277 38,777 39,583 39,966
Itasca County, Minnesota 45,261 45,164 45,161 45,108
Jackson County, Minnesota 10,095 9,967 9,988 9,911
Kanabec County, Minnesota 15,884 15,903 16,054 16,207
Kandiyohi County, Minnesota 42,590 42,636 42,715 42,855
Kittson County, Minnesota 4,405 4,316 4,259 4,248
Koochiching County, Minnesota 12,798 12,609 12,526 12,440
Lac qui Parle County, Minnesota 6,872 6,737 6,695 6,658
Lake County, Minnesota 10,547 10,524 10,516 10,658
XIII
Population Estimate (as of July 1)
Geography 2015 2016 2017 2018
Lake of the Woods County, Minnesota 3,872 3,790 3,736 3,758
Le Sueur County, Minnesota 27,736 27,720 28,151 28,494
Lincoln County, Minnesota 5,711 5,704 5,682 5,673
Lyon County, Minnesota 25,837 26,000 25,953 25,629
Mahnomen County, Minnesota 5,437 5,490 5,579 5,519
Marshall County, Minnesota 9,410 9,371 9,369 9,390
Martin County, Minnesota 20,034 19,902 19,858 19,785
McLeod County, Minnesota 35,824 35,767 35,883 35,873
Meeker County, Minnesota 23,036 23,052 23,041 23,141
Mille Lacs County, Minnesota 25,484 25,583 25,877 26,139
Morrison County, Minnesota 32,763 32,907 33,100 33,169
Mower County, Minnesota 39,420 39,469 39,699 40,011
Murray County, Minnesota 8,394 8,308 8,353 8,276
Nicollet County, Minnesota 33,532 33,732 34,058 34,220
Nobles County, Minnesota 21,795 21,963 21,810 21,924
Norman County, Minnesota 6,621 6,529 6,585 6,475
Olmsted County, Minnesota 151,335 153,137 154,519 156,277
Otter Tail County, Minnesota 57,544 57,865 58,251 58,812
Pennington County, Minnesota 14,234 14,207 14,191 14,178
Pine County, Minnesota 29,042 28,857 29,184 29,483
Pipestone County, Minnesota 9,267 9,193 9,096 9,047
Polk County, Minnesota 31,510 31,718 31,705 31,529
Pope County, Minnesota 10,930 10,963 10,985 11,097
Ramsey County, Minnesota 536,879 541,944 545,518 550,210
Red Lake County, Minnesota 4,032 3,990 4,022 3,999
Redwood County, Minnesota 15,422 15,210 15,243 15,249
Renville County, Minnesota 14,792 14,604 14,667 14,612
Rice County, Minnesota 65,307 65,825 66,173 66,523
Rock County, Minnesota 9,437 9,383 9,453 9,414
Roseau County, Minnesota 15,619 15,554 15,311 15,150
St. Louis County, Minnesota 200,276 199,925 199,798 199,754
Scott County, Minnesota 141,361 143,340 145,595 147,381
Sherburne County, Minnesota 91,416 93,266 94,547 96,036
Sibley County, Minnesota 14,887 14,815 14,904 15,028
Stearns County, Minnesota 155,890 156,996 157,979 159,256
Steele County, Minnesota 36,610 36,662 36,824 36,803
Stevens County, Minnesota 9,864 9,784 9,672 9,753
Swift County, Minnesota 9,379 9,447 9,396 9,345
Todd County, Minnesota 24,340 24,389 24,532 24,582
Traverse County, Minnesota 3,369 3,323 3,307 3,308
Wabasha County, Minnesota 21,380 21,425 21,590 21,645
XIV
Population Estimate (as of July 1)
Geography 2015 2016 2017 2018
Wadena County, Minnesota 13,668 13,551 13,646 13,773
Waseca County, Minnesota 18,923 18,779 18,726 18,691
Washington County, Minnesota 250,494 252,650 255,697 259,201
Watonwan County, Minnesota 11,002 10,982 10,916 10,980
Wilkin County, Minnesota 6,355 6,322 6,322 6,254
Winona County, Minnesota 50,808 50,840 50,704 50,825
Wright County, Minnesota 130,978 132,343 134,255 136,349
Yellow Medicine County, Minnesota 9,836 9,885 9,845 9,795
*Per U.S. Census Bureau, “the population and housing unit estimates are released on a flow basis throughout each year. Each new series of data (called vintages) incorporates the latest administrative record data, geographic boundaries, and methodology. Therefore, the entire time series of estimates beginning with the most recent decennial census is revised
annually and estimates from different vintages of data may not be consistent across geography and characteristics detail. When multiple vintages of data are available, the most recent vintage is the preferred data. The vintage year (e.g., V2018)
refers to the final year of the time series. The reference date for all estimates is July 1, unless otherwise specified.” (1)