the latest prescription trends for controlled prescription ...€¦ · the latest prescription...

The Latest Prescription Trends for Controlled Prescription Drugs

September 1, 2015

Christopher M. Jones PharmD, MPH

Senior Advisor Office of Public Health Strategy and Analysis

Office of the Commissioner

Food and Drug Administration

Overview

• Data source

• Opioid analgesics

• Benzodiazepines

• Stimulants

• Opioid use disorder medication assisted

treatments

• Conclusions 2

Data Source

• Data from IMS Health

– National Prescription Audit

– National Prescription Audit Extended Insights

3

OPIOID ANALGESICS

4

Opioid analgesic prescriptions dispensed from US retail pharmacies, Q42009-Q22015

ER/LA Opioid Analgesics All Opioid Analgesics

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

Nu

mb

er o

f D

isp

ense

d P

resc

rip

tio

ns

Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014 2014 2015 2015

Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015

5

Opioid analgesic prescriptions dispensed from US retail pharmacies for select opioids,

Q42009-Q22015 % of All Opioids

hydrocodone oxycodone tramadol morphine fentanyl Dispensed in Q2-2015

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

Nu

mb

er o

f P

resc

rip

tio

ns

Dis

pen

sed

40.8%

24.6%

17.8

3.7%

2.2%



6

Opioid analgesic prescriptions dispensed from US retail pharmacies by provider specialty, 2010-2014

2010 2011 2012 2013 2014

Nu

mb

er o

f P

resc

rip

tio

ns

Dis

pen

sed

120,000,000

100,000,000

80,000,000

60,000,000

40,000,000

20,000,000

0


7

Percentage of opioid analgesic prescriptions dispensed from US retail pharmacies by specialty,

2010 vs 2014 2010 2014

50 45 40 35 30 25 20 15 10

5 0

Per

cen

t


8

Opioid analgesic prescriptions dispensed from US retail pharmacies by gender,

August 2014-July 2015

Female 58.7%

Male 41.3%

Source: IMS Health National Prescription Audit Extended Insights Data Extracted 8/24/2015

9

Opioid analgesic prescriptions dispensed from US retail pharmacies by age group,


10

Ages 0-19 2.8% Ages 20-39

20.8%

Ages 40-59 41.8%

Age 60+ 34.6%


BENZODIAZEPINES

11

Benzodiazepine prescriptions dispensed from US retail pharmacies, Q42009-Q22015

Alprazolam Lorazepam Diazepam All Benzodiazepines

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

Nu

mb

er o

f d

isp

ense

d p

resc

rip

tio

ns



12

Benzodiazepine prescriptions dispensed from US retail pharmacies by provider specialty, 2010-2014

2010 2011 2012 2013 2014

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

Nu

mb

er o

f d

isp

en

sed

pre

scri

pti

on

s

Primary Care Physicians Nurse Practitioners/Physician Psychiatrist/Psychologists Other Assistants


13

Percentage of benzodiazepine prescriptions dispensed from US retail pharmacies by specialty,

2010 vs 2014 2010 2014

0

10

20

30

40

50

60

70

Per

cen

t


14

Primary Care Physicians Nurse Practitioners/Physician Psychiatrist/Psychologists Other Assistants

Benzodiazepine prescriptions dispensed from US retail pharmacies by gender,


Male

Female 66.9%

33.1%


15

Benzodiazepine prescriptions dispensed from US retail pharmacies by age group,


16

Ages 0-19 1.8% Ages 20-39

18.7%

Ages 40-59 41.4%

Age 60+ 38.2%


STIMULANTS

17

Stimulant* prescriptions dispensed from US retail pharmacies, Q42009-Q22015

Amph/Dextroamph Methylphenidate All Stimulants *

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

Nu

mb

er o

f d

isp

ense

d p

resc

rip

tio

ns


* includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline


18

Stimulant* prescriptions dispensed from US retail pharmacies by provider specialty,

2010-2014

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

20,000,000

Nu

mb

er o

f d

isp

ense

d p

resc

rip

tio

ns 2010 2011 2012 2013 2014

Primary Care Physicians Nurse Psychiatrist/Psychologists Pediatrics Other Practitioners/Physician

Assistants * includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline


19

Percentage of stimulant* prescriptions dispensed from US retail pharmacies by specialty,

2010 vs 2014 2010 2014

0

5

10

15

20

25

30

35

Per

cen

t

Primary Care Physicians Nurse Psychiatrist/Psychologists Pediatrics Other Practitioners/Physician

Assistants

* includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate, pemoline


20

Stimulant* prescriptions dispensed from US retail pharmacies by gender,


Female 44.8%

Male 55.2%

*includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate,

Pemoline, modafinil, armodafinil, caffeine,


21

Stimulant* prescriptions dispensed from US retail pharmacies by age group,

August 2014-July 2015 Age 60+

Ages 0-19 45.3%

Ages 20-39

Ages 40-59 18.2%

4.6%

31.9% *includes: amphetamine, amphetamine-dextroamphetamine, dextroamphetamine,, dexmethylphenidate, lisdexamfetamine, methamphetamine, methylphenidate,

Pemoline, modafinil, armodafinil, caffeine,


22

OPIOID USE DISORDER

MEDICATION ASSISTED

TREATMENTS 23

Buprenorphine* prescriptions dispensed from US retail pharmacies, Q42009-Q22015

All Buprenorphine Suboxone & generics Subutex & generics Zubsolv Bunavail

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Nu

mb

er o

f d

isp

ense

d p

resc

rip

tio

ns


24

*Does not include Butrans or Buprenex (or generics) Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015

Percentage of buprenorphine* prescriptions dispensed from US retail pharmacies by specialty,

2010 vs 2014 2010 2014

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Per

cen

t

Primary Care Physicians Addiction Medicine/Psychiatry/Psychology Other

*Does not include Butrans or Buprenex (or generics) Source: IMS Health National Prescription Audit, Data Extracted 8/24/2015

25

Naltrexone* prescriptions dispensed from US retail +pharmacies, Q42009-Q22015

Vivitrol All Naltrexone

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Nu

mb

er o

f d

isp

ense

d p

resc

rip

tio

ns


* Naltrexone is also approved for use in alcohol dependence. Thus, not all prescriptions were used for opioid dependence +The number of prescriptions dispensed for Vivitrol from specialty pharmacies is approximately 3-4x that from US retail pharmacies.


26

Percentage of naltrexone* prescriptions dispensed from US retail pharmacies+ by specialty,

2010 vs 2014 2010 2014

0

10

20

30

40

50

60

Per

cen

t

Primary Care Physicians Nurse Practitioners/Physician Addiction Other Assistants Medicine/Psychiatry/Psychology

* Naltrexone is also approved for use in alcohol dependence. Thus, not all prescriptions were used for opioid dependence +The number of prescriptions dispensed for Vivitrol from specialty pharmacies is approximately 3-4x that from US retail pharmacies.


27

Conclusions • The number of prescriptions dispensed for opioid

analgesics has declined in recent years

• The number of prescriptions dispensed for

benzodiazepines has been relatively consistent

• The number of prescriptions dispensed for stimulants has increased in recent years

• The number of prescriptions dispensed for both

naltrexone and buprenorphine has increased in

recent years

• There is variation in prescribing by provider specialty

and patient gender and age across the examined

drug classes 28

Questions?

[email protected]

The findings in this presentation do not represent the official position of

the US Food and Drug Administration, the Department of Health and

Human Services, or the U.S. Government

29

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