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BACKGROUND: Prescription drug misuse and abuse has been declared a public health priority in Marin County, California, where the accidental drug overdose death rate exceeds the state average. Prescribing practices are linked to overdose rates and other adverse health outcomes. Knowledge about local prescribing patterns was limited. Prescription Drug Monitoring Programs (PDMPs) are one tool used to understand the problem. California's PDMP, Controlled Substance Utilization Review and Evaluation System (CURES), was implemented in 2008. The purpose of this study was to use CURES data to describe controlled substance prescriptions in Marin County, California to inform local intervention.
METHODS: We analyzed CURES data from Marin County pharmacies from 2010 through 2013 to determine the number of controlled substance prescriptions by year, drug class, and drug product. Opioid prescriptions were stratified by patient age and sex. We calculated morphine milligram equivalents (MMEs) of opioids prescribed in Marin County per resident. We found the percent of patients who filled both opioid and benzodiazepine prescriptions within 30 days. We estimated the percent of prescriptions filled from high frequency opioid providers.
RESULTS: There were 1.62 million controlled substance prescriptions filled in Marin County pharmacies from 2010 to 2013. The annual number ranged from 396,518 prescriptions in 2010 to 416,777 in 2012. Opioids were the most commonly prescribed controlled substance class accounting for 45.6% (743,254) of the total. The most commonly prescribed controlled substance product was hydrocodone (397,511; 24.4%) followed by zolpidem (191,791; 11.8%). The greatest number of opioid prescriptions were prescribed for patients aged 45 to 64 (347,427; 46.7%) and female patients (433,390; 58.3%). MMEs prescribed per resident decreased from 749 MMEs in 2010 to 730 MMEs in 2013. Out of 165,486 patients who received opioids, 22.7% also received benzodiazepine within 30 days of an opioid prescription. In 2013, 15% of total opioid prescribers accounted for 88% of opioid prescriptions.
CONCLUSIONS: The use of PDMPs for population-level analyses can offer important insights into controlled substance prescriptions. Findings have been used to inform local efforts in identifying areas for intervention and to track local changes in prescribing patterns, including efforts to reduce total opioid prescriptions and co-prescription of opioids and benzodiazepines. Sharing study methods with other jurisdictions may improve local capacity in controlled substance epidemiology.