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An Investigation of Schedule II-V
Prescription Drug Dispensing Rates
& Patterns among Youth and Young
Adults in Maryland
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CONTRIBUTORS
This report was compiled by the following faculty and staff of the Behavioral Health Research
Team in the School of Pharmacy at the University of Maryland, Baltimore:
Fadia T. Shaya, PhD
Professor and Director / Lead Evaluator
Nicole Sealfon, MPH
Associate Director
Meg Robertson, MPH
Program Specialist
Shardai Jones, MPH
Research Specialist
Vanessa Michel
Research Specialist
Zach Leppert
PharmD Student
ACKNOWLEDGEMENTS
We thank the staff at the Maryland Department of Health (MDH) for their support and guidance
on this report.
We also thank the staff within Pharmaceutical Researching Computing for analytical support.
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EXECUTIVE SUMMARY
This is the study of Maryland Prescription Drug Motoring Program (PDMP) data. The purpose
of this assessment is to provide a snapshot of what is being prescribed for youth and young
adults (ages 12-29) in Maryland. Using the PDMP data, this report characterizes trends in
dispensing rates over time from January 2015 through June 2018. It identifies prescribing
patterns of the therapeutic classes of interest among healthcare providers to identify prescription
rates and trends with particular emphasis on opioids. This analysis is an essential first step in
evaluating the need for further education or interventions at the prescriber-level.
Interventions and education to prescribers of adolescents can decrease exposure and prevent
future misuse of prescription drugs. Youth and young adults prescribing patterns are important to
monitor and this is an important step in surveillance of prescription drug dispensing patterns.
Early exposure to prescription opioids in adolescence is significantly associated with non-
medical use of prescription opioid (NMUPO) use at age 351.
The specific aims of this assessment are to review Schedule II-V prescription drug dispensing
rates and patterns across therapeutic classes, and at both the state and jurisdiction level and with
particular emphasis on Maryland youth (12-17 year olds) and young adults (18-24; 25-29 year
olds) from January 2015 – June 2018. Additionally, the assessment will characterize the
prescribing patterns of healthcare providers across therapeutic classes for youth and young
adults.
The most current PDMP data from Chesapeake Regional Information System for our Patients
(CRISP) was used for this assessment (updated as of November 2018). Records from January
2015 through June 2018 in the state of Maryland were selected for analyses, broken up into six-
month intervals. The data was analyzed at the statewide, jurisdictional and provider level for
youth and young adults (ages 12-29) in Maryland.
The majority of prescription fills to youth recipients (12-17) and young adults (18-24) were
stimulant medications. The young adults in their late twenties (25-29) fill proportionately more
opioids than their younger counterparts do. Prescription opioids fills dispensed to young adults
(18-29) demonstrate the greatest decrease in fills from 2015 to mid-2018 out of all the
prescription drug classes. Doctors followed by dentists prescribed the greatest amount of fills
dispensed to Maryland youth and young adults. Proportionately, doctors prescribe more
stimulants than any medication in the other drug categories. Among dentists, just over 90% of
prescriptions prescribed for youth and young adults are opioids. There are proportion differences
of drugs dispensed to youth and young adults within the jurisdictions relative to the Maryland
proportion of the dispensed drug. Overall, this assessment provides a first step in data analysis to
begin the discussions with other key stakeholders for developing education and interventions for
providers, youth and young adults in Maryland.
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TABLE OF CONTENTS
EXECUTIVE SUMMARY 2
LIST OF TABLES 5
LIST OF FIGURES 6
1.0 INTRODUCTION 9
1.1. PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) 9
1.2 IMPORTANCE OF MONITORING PRESCRIBING PATTERNS IN YOUTH & YOUNG ADULTS 9
1.3 CURRENT ASSESSMENT 10
1.4 SPECIFIC AIMS 10
2.0 METHODOLOGY 11
2.1 PDMP DATA & TIMELINE 11
2.2 DRUG CATEGORIES BASED ON THERAPEUTIC CLASS 11
2.3 DEMOGRAPHICS 11
2.4 PRESCRIBER IDENTIFICATION 11
2.5 FILL-LEVEL ANALYSIS 12
2.5.1 STATE-WIDE 12
2.5.2 JURISDICTION-LEVEL 12
2.5.3 PRESCRIBER-LEVEL 12
2.6 PERSON-LEVEL ANALYSIS 13
2.6.1 STATE-WIDE 13
2.6.2 JURISDICTION-LEVEL 13
2.6.3 PRESCRIBER-LEVEL 13
3.0 DATA ANALYSIS 14
3.1 PRESCRIBING & DISPENSING RATES IN THE STATE OF MARYLAND 14
3.1.1 MARYLAND RECIPIENTS OF ALL AGES 14
3.1.2 MARYLAND YOUTH & YOUNG ADULTS 15
3.2 PRESCRIBING PATTERNS OF HEALTHCARE PROVIDERS 23
3.3 PRESCRIBING PATTERNS ACROSS JURISDICTIONS 30
4.0 DISCUSSION 45
4.1 KEY FINDINGS 45
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4.2 LIMITATIONS 46
REFERENCES 47
APPENDIX 1: DRUG CATEGORY ASSIGNMENT FROM GNN 48
APPENDIX 2: ALL PRESCRIBERS TABLE 49
APPENDIX 3: JURISDICTION FILLS DATA TABLES 52
APPENDIX 4: JURISDICTION DISPENSER FILLS DATA TABLES 65
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LIST OF TABLES
Table 1 - Total Schedule II-V Prescription Drug Fills to Youth & Young Adults in the State of Maryland
from January 2015 - June 2018
Table 2. Census data population estimates of 12-17, 18-24, and 25-29 year olds in the state of Maryland
in 2017
Appendix 1: Drug Category Assignment from GNN
Appendix 2: All Prescribers Table
Appendix 3: Jurisdiction Fills by Recipient Data Tables
Appendix 4: Prescription Fills by Jurisdiction where prescriptions were filled by registered dispensers
within each Jurisdiction
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LIST OF FIGURES
Figure 1A - Total Schedule II-V Prescription Drug Fills to Recipients (all ages) in the State of Maryland
Figure 1B - Total Recipients (all ages) of Schedule II-V Prescription Drugs in the State of Maryland
Figure 2 – Proportion of Schedule II-V Prescription Drugs Fills by Youth & Young Adults in the State of
Maryland
Figure 3A - Percentage of Youth and Young Adults who Filled Any Prescription Medication from their
Total Respective Populations in the State of Maryland in 2017
Figure 3B - Percentage of Youth and Young Adults who filled a prescription from their Total Respective
Populations in the State of Maryland in 2017
Figure 4A - Total Prescription Drug Fills to Youth Recipients (12-17 year olds)
Figure 4B – Total Prescription Drug Fills to Young Adult Recipients (18-24 year olds)
Figure 4C - Total Prescription Drug Fills to Young Adult Recipients (25-29 year olds)
Figure 5A - Youth Recipients of Prescription Drugs in Maryland (12-17 years old)
Figure 5B – Young Adult Recipients (ages 18-24) of Prescription Drugs
Figure 5C - Young Adult Recipients (ages 25-29) of Prescription Drugs
Figure 6 - Proportion of Prescription Fills by Drug Category in Youth & Young Adults
Figure 7 - Total Prescription Fills by Drug Category Dispensed to Youth & Young Adults
Figure 8 - Total Prescription Drug Fills Prescribed to Maryland Youth and Young Adults by Maryland
Healthcare Providers
Figure 9A – All Benzodiazepine Prescription Fills by Healthcare Provider
Figure 9B– Benzodiazepine Prescription Fills Dispensed to Youth and Young Adults Over Time
Figure 10A – All Opioid Prescription Fills by Healthcare Provider
Figure 10B– Opioid Prescription Fills Dispensed to Youth and Young Adults Over Time
Figure 11A – All Stimulant Prescription Fills by Healthcare Provider
Figure 11B– Stimulant Prescription Fills Dispensed to Youth and Young Adults Over Time
Figure 12A – All Other Prescription Fills by Healthcare Provider
Figure 12B– Other Prescription Fills Dispensed to Youth and Young Adults Over Time
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Figure 13A – Proportion of Prescription Drugs Prescribed by Doctors to Maryland Youth and Young
Adults
Figure 13B– All Dispensed Prescription Medication Fills Prescribed by Doctors to Youth and Young
Adults Over Time
Figure 14A – Proportion of Prescription Drugs Prescribed by Dentists to Maryland Youth and Young
Adults
Figure 14B– All Dispensed Prescription Medication Fills Prescribed by Dentists to Youth and Young
Adults Over Time
Figure 15A - Proportion of Benzodiazepine Fills Dispensed to Youth (12-17 year olds) within
Jurisdictions relative to the Maryland State Average for Youth
Figure 15B - Proportion of Opioid Fills Dispensed to Youth (12-17 year olds) within Jurisdictions
relative to the Maryland State Average for Youth
Figure 16A - Proportion of Stimulant Fills Dispensed to Youth (12-17 year olds) within Jurisdictions
relative to the Maryland State Average for Youth
Figure 16B - Proportion of Other Fills Dispensed to Youth (12-17 year olds) within Jurisdictions relative
to the Maryland State Average for Youth
Figure 17A - Proportion of Benzodiazepine Fills Dispensed to Young Adults (18-24 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 17B - Proportion of Opioid Fills Dispensed to Young Adults (18-24 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 18A - Proportion of Stimulant Fills Dispensed to Young Adults (18-24 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 18B - Proportion of Other Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions
relative to the Maryland State Average for Young Adults
Figure 19A - Proportion of Benzodiazepine Fills Dispensed to Young Adults (25-29 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 19B - Proportion of Opioid Fills Dispensed to Young Adults (18-24 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 20A - Proportion of Stimulants Fills Dispensed to Young Adults (18-24 year olds) within
Jurisdictions relative to the Maryland State Average for Young Adults
Figure 20B - Proportion of Other Fills Dispensed to Young Adults (18-24 year olds) within Jurisdictions
relative to the Maryland State Average for Young Adults
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Figure 21 – Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12-17 years
old) Across January 2015 – June 2018
Figure 22 – Proportion of Opioids within each Maryland Jurisdiction among Youth (12-17 years old)
Across January 2015 – June 2018
Figure 23 – Proportion of Stimulants within each Maryland Jurisdiction among Youth (12-17 years old)
Across January 2015 – June 2018
Figure 24 – Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (18-24 years
old) Across January 2015 – June 2018
Figure 25 – Proportion of Opioids within each Maryland Jurisdiction among Youth (18-24) years old)
Across January 2015 – June 2018
Figure 26 - Proportion of Stimulants within each Maryland Jurisdiction among Youth (18-24 years old)
Across January 2015 – June 2018
Figure 27 - Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (25-29 years
old) Across January 2015 – June 2018
Figure 28 - Proportion of Opioids within each Maryland Jurisdiction among Youth (25-29 years old)
Across January 2015 – June 2018
Figure 29 - Proportion of Stimulants within each Maryland Jurisdiction among Youth (25-29 years old)
Across January 2015 – June 2018
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1.0 INTRODUCTION
1.1. PRESCRIPTION DRUG MONITORING PROGRAM (PDMP)
The Maryland Prescription Drug Monitoring Program (PDMP) data contain records of all
controlled dangerous substances (CDS) prescription history for patients. Chesapeake Regional
Information System for our Patients (CRISP) is Maryland’s designated health information
exchange service which contracts with PDMP to allow healthcare providers to access PDMP
data from within CRISP. As of October 2016, Maryland law dictates that all prescribers and
pharmacists register with the PDMP.
Each patient is designated a unique “CRISP ID” which allows healthcare providers to track their
patients’ prescription and dispensing history in Maryland. Pharmacies are required to report a
record of dispensing patients’ prescriptions within CRISP, so the PDMP is kept updated. As of
July 2018, it was required by law that all prescribers refer to their patient’s PDMP records prior
to prescribing a new course of treatment with an opioid or benzodiazepine medication (with a
few exceptions for some clinical settings). Prescribers must also query their patient’s PDMP
record every 90 days as a follow-up if they recommend the patient continue the same course of
treatment.
The PDMP is a key component of Maryland’s strategy and prevention plan for reducing drug-
related overdoses by carefully monitoring and recording all schedule II-V controlled dangerous
substances prescribed and dispensed in Maryland. While the PDMP is particularly important for
monitoring opioid prescribing and dispensing history, it is also a valuable record of other
Controlled Dangerous Substances (CDS) such as benzodiazepines, stimulants, and other
therapeutic classes. These medications can be abused in combination with opioids medications.
Importantly, these data reflect a high level of reliability due to the State’s mandated standards of
CRISP usage among Maryland healthcare providers and pharmacists for every patient that is
provided a prescription for medication. The availability of these data present an important
opportunity to review dispensing rates of prescription medications and assess patterns in usage
across the state of Maryland.
1.2 IMPORTANCE OF MONITORING PRESCRIBING PATTERNS IN
YOUTH & YOUNG ADULTS
Early exposure to prescription opioids in adolescence is significantly associated with non-
medical use of prescription opioid (NMUPO) use at age 351. Additionally, high school aged
recipients of opioid prescriptions are 33% more likely to misuse opioids after high school2.
Interventions and education to prescribers of adolescents can decrease exposure and prevent
future misuse of prescription drugs. A substantial source of NMUPO among high school seniors
were from their own previous prescription leftovers3.
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1.3 CURRENT ASSESSMENT
The purpose of this assessment is to provide a snapshot of what is being prescribed for youth and
young adults (ages 12-29) in Maryland. This assessment is an important step in surveillance of
prescription drug dispensing patterns across the state of Maryland, within each jurisdiction, and
characterizing the rate of prescriptions from Maryland healthcare providers. This report
characterizes trends in dispensing rates prescription medications over time from January 2015
through June 2018. Importantly, this assessment identifies prescribing patterns of the therapeutic
classes of interest among healthcare providers to identify prescription rates and trends; with
particular emphasis on opioids. This analysis will be an essential first step in evaluating the need
for further education or intervention at the prescriber-level.
1.4 SPECIFIC AIMS
The specific aims of this assessment are to review Schedule II-V prescription drug dispensing
rates and patterns across therapeutic classes, and at both the state and jurisdiction level and with
particular emphasis on Maryland youth (12-17 year olds) and young adults (18-24; 25-29 year
olds) from January 2015 – June 2018.
Aim 1 Characterize the prescribing patterns of schedule II-V prescription drugs state-wide in
Maryland from January 2015 – June 2018. How many and what proportion of
prescription drugs are filled by youth, and young adults?
Aim 2 Characterize the prescribing patterns of schedule II-V prescription drugs on a local-
level in each jurisdiction within Maryland from January 2015 – June 2018. How many
prescription drugs are filled by youth and young adults?
Aim 3 Characterize the proportion of prescription fills by therapeutic class from each
jurisdiction compare with the State average from January 2015 – June 2018 for youth
and young adults.
Aim 4 Characterize the prescribing patterns of healthcare providers (e.g., doctor, dentist, etc.)
practicing in the State of Maryland across therapeutic classes for youth and young adult
recipients.
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2.0 METHODOLOGY
2.1 PDMP DATA & TIMELINE
The most current PDMP data from CRISP was used for this assessment (updated as of
November 2018). Records from January 2015 through June 2018 in the state of Maryland were
selected for analyses. Data were further analyzed by 6 month periods for a total of seven time
intervals: Jan-Jun 2015, Jul-Dec 2015, Jan-Jun 2016, Jul-Dec 2016, Jan-Jun 2017, Jul-Dec 2017,
and Jan-Jun 2018.
2.2 DRUG CATEGORIES BASED ON THERAPEUTIC CLASS
All prescription medications in the PDMP database were sorted by their generic name (GNN)
and grouped into four categories of interest: Benzodiazepines, Opioids, Stimulants, and Other.
The ‘Other’ drug category includes sedatives, muscle relaxants, etc, (all GNNs by each of the
four drug categories can be found in Appendix 1).
Records of prescription fills were assigned to each of the seven time periods based on the date
they were dispensed. All other prescription fill records outside of these time intervals were not
included in the present analyses.
2.3 DEMOGRAPHICS
All recipients are designated a unique CRISP identification number, or CRISP ID within the
PDMP database which provides demographic information within each record. The age of the
prescription fill recipient was determined by their date of birth. Recipients’ age was designated
as of the end of the year for the year of their prescription fill. State-wide, jurisdiction, and
prescriber totals include all recipients of all ages, including those without a complete or valid
record of their age entered into CRISP. From that data, only those recipients with a complete or
valid record of the age and within the 12 – 29 year old range, were grouped into the following
age categories: 12- 17 year olds, 18 -24 year olds, and 25-29 year olds for analyses.
2.4 PRESCRIBER IDENTIFICATION
All healthcare providers who are licensed to prescribe schedule II-V prescription drugs in the
state of Maryland and are also registered in CRISP and PDMP were included in analyses.
Healthcare providers were determined by their Enforcement Agency (DEA) degree to identify
types of healthcare providers: Dentists (DDS or DMD), Doctors (DO or MD), Podiatrists (DPM),
Nurse Practitioners (NP), Optometrists (OD), Physician Assistants (PA), and Veterinarians
(DVM). All prescribers registered in CRISP with all other degree types or missing degree entries
were included in an ‘Other’ category.
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2.5 FILL-LEVEL ANALYSIS
Analyses were conducted at both the fill and person-level. All fills from all drug categories
dispensed to each person (identified by unique CRISP ID) were captured in the fill-level
analyses. Multiple prescriptions filled by the same person in the same six month time interval
would be captured for each drug category.
2.5.1 STATE-WIDE
Quantification of prescription fills were analyzed by state-wide totals for those recipients
aged 12-17, 18-24, 25-29, and a state-wide total for all records of prescription fills
dispensed to recipients of all ages regardless of incomplete or missing demographic data
available through CRISP. Data were also analyzed at a state-level by prescription fills to
Maryland residents only, to control for recipients who may be travelling from surrounding
states and filled a prescription in Maryland. Finally, a state-level analysis was conducted
to quantify all prescription fills provided by a dispenser located in Maryland to control for
all instances when a Maryland resident travelled outside of the state to fill their
prescription.
2.5.2 JURISDICTION-LEVEL
Quantification of prescription fills were analyzed at a local level by each of Maryland’s 24
jurisdictions: Allegany, Anne Arundel, Baltimore, Baltimore City, Calvert, Caroline,
Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Howard, Kent,
Montgomery, Prince George’s, Queen Anne’s, St. Mary’s, Somerset, Talbot, Washington,
Wicomico, Worcester. Missing or incomplete were included in a separate
‘Other/Unknown’ category.
Within each jurisdiction, prescription fills were quantified by those dispensed to registered
residents of each jurisdiction, regardless of whether the fill was dispensed within their
home jurisdiction. Additionally, prescription fills were quantified by those provided by a
registered dispenser within each jurisdiction, regardless of whether the recipient was a
resident of that jurisdiction.
2.5.3 PRESCRIBER-LEVEL
Quantification of all prescription fills were analyzed by type of healthcare provider who
provided each prescription. Data were analyzed by the total number of fills provided by all
prescribers and the total for each prescriber type for each drug category of interest, across
age groups of interest, and within January 2015 – June 2018.
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2.6 PERSON-LEVEL ANALYSIS
Analyses conducted at the person-level quantified all persons or recipients of a prescription fill.
Persons were identified by their unique CRISP ID and were counted once for each drug category
where they had at least one dispensed prescription within a six month time interval, and by their
age group. In other words, if a recipient had four prescription fills within the opioid drug
category from February to May, that person would be represented once within the opioid drug
category, time interval, and age group.
2.6.1 STATE-WIDE
Quantification of unique persons were analyzed by state-wide totals for those recipients
aged 12-17, 18-24, 25-29, and a state-wide total for all recipients of all ages regardless of
incomplete or missing demographic data available through CRISP. Data were also
analyzed at a state-level by only those unique persons who are also Maryland residents.
Finally, a state-level analysis was conducted to quantify all unique persons that filled their
prescriptions at a dispenser.
2.6.2 JURISDICTION-LEVEL
Quantification of unique persons that filled a prescription medication were also analyzed
at a local level by each of Maryland’s 24 jurisdictions: Allegany, Anne Arundel,
Baltimore, Baltimore City, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester,
Frederick, Garrett, Harford, Howard, Kent, Montgomery, Prince George’s, Queen Anne’s,
St. Mary’s, Somerset, Talbot, Washington, Wicomico, Worcester. All records where the
recipient’s address was missing or incomplete were included in a separate
‘Other/Unknown’ category.
Within each jurisdiction, unique persons were quantified by those who were registered
residents of each jurisdiction, regardless of whether the fill was dispensed within their
home jurisdiction. Additionally, unique persons were quantified by those who filled their
prescription at a registered dispenser within each jurisdiction, regardless of whether the
recipient was a resident of that jurisdiction.
2.6.3 PRESCRIBER-LEVEL
Unique persons were represented once in each age group, time period, and drug category
if they had at least one prescription from a prescriber. If a recipient received three
prescriptions within the stimulant category prescribed by a doctor, and two stimulant
prescription from a nurse practitioner, they would be counted once within the
stimulant/doctor analyses, and once within the stimulant/nurse practitioner analyses for
each time period of interest.
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3.0 DATA ANALYSIS
3.1 PRESCRIBING & DISPENSING RATES IN THE STATE OF MARYLAND
3.1.1 MARYLAND RECIPIENTS OF ALL AGES
In Maryland, opioid medication fills are the most dispensed schedule II-V prescription drugs across all
age groups and all drug categories from January 2015 through June 2018 shown in Figure 1A. The rate
of Maryland dispensers filling opioid prescriptions shows a trending decrease from the beginning of 2015
(n=2.3 million fills) to mid-2018 (n= 1.9 million fills). This trend is reflected in the number of persons
receiving prescription opioids from Maryland dispensers in the beginning of 2015 (n=865,762) through
mid-2018 (n=697,792) as demonstrated in Figure 1B.
Figure 1. Prescription drug dispensing patterns in the state of Maryland from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to
recipients of all ages. ‘MD Residents’ denotes all records of prescription fills that were dispensed in MD to recipients of all ages and who are registered MD residents. ‘MD Dispenser’ denotes
all records of prescriptions fills for recipients of all ages provided by a registered dispenser of Maryland. (A) Total number of prescription drug fills to recipients of all ages within Maryland
(MD); (B) Total number of unique recipients (of all ages) who received a prescription medication fill in Maryland.
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3.1.2 MARYLAND YOUTH & YOUNG ADULTS
Total prescription drug fills for 12-17, 18-24, and 25-29 year olds, and total percentages of drug category
fills within each age group for six-month intervals from early 2015 to mid-2018 are displayed in Table 1.
Although overall fills across all age groups and drug categories have decreased over time, percentages
within age group have remained steady.
Of the Maryland youth (12-17 year olds) and young adults (18-29), youth have the highest proportion of
stimulant prescription and lowest proportion of opioid prescription fills from combined 2015 to 2018 fill
totals as shown in Figure 2. Proportions of prescription fill rates of benzodiazepines and opioids show a
stepwise increase from the youth to the late-20 year old recipients.
Table 1. Total Schedule II-V Drug Fills to Youth & Young Adults in the State of Maryland from January 2015- June 2018
Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total Fills %Total
Benzodiazepines
12 to 17 7,812 4.6 8,696 5.1 7,542 4.3 7,948 4.8 7,242 4.2 7,700 4.8 6,638 3.9
18 to 24 27,152 13.0 30,783 14.0 27,096 13.2 28,640 13.9 24,768 12.6 25,210 13.4 23,091 12.8
25 to 29 42,714 17.2 44,907 17.6 41,534 17.2 42,310 17.5 38,964 16.8 38,497 17.3 34,885 16.6
Opioids
12 to 17 22,537 13.3 26,375 15.6 21,259 12.2 24,151 14.5 19,348 11.1 20,729 12.9 15,072 8.8
18 to 24 85,022 40.7 88,404 40.1 75,470 36.7 74,986 36.4 66,793 34.1 61,093 32.5 53,511 29.6
25 to 29 123,819 49.7 123,031 48.2 110,945 45.9 108,932 45.1 100,004 43.2 92,252 41.4 83,302 39.6
Stimulants
12 to 17 134,517 79.3 129,578 76.4 140,521 80.7 129,149 77.8 142,400 81.9 126,853 79.1 144,366 84.5
18 to 24 88,569 42.4 92,214 41.9 95,615 46.5 94,175 45.7 96,697 49.3 93,265 49.7 95,393 52.8
25 to 29 67,354 27.1 71,477 28.0 74,851 31.0 75,557 31.3 79,134 34.2 78,556 35.2 80,305 38.2
Other
12 to 17 4,810 2.8 4,896 2.9 4,872 2.8 4,803 2.9 4,980 2.9 5,090 3.2 4,746 2.8
18 to 24 8,051 3.9 8,892 4.0 7,598 3.7 8,080 3.9 7,779 4.0 8,264 4.4 8,535 4.7
25 to 29 15,101 6.1 15,600 6.1 14,215 5.9 14,561 6.0 13,318 5.8 13,703 6.1 11,918 5.7
Drug Category by
Age Groups (Yrs)Jan-Jun
2015 2016 2017 2018
Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec
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Table 2. Census data population estimates of 12-17, 18-24, and 25-29 year olds in the State of Maryland (2017)
in 2017 (Census)
‘
Based on the most recent year of available Census data in 2017 (Table 2), approximately 11-12% of
Maryland youth (12-17 years old), 9-10% and 12-13% of Maryland young adult (18-24 and 25-29 years
old, respectively) filled a prescription drug from January through June 2018 (Figure 3A). The vast
majority of fills for all age groups were stimulant medications (Figure 3B).
Age Categories of Interest Population % of MD’s Total Population
12-17 years old 454, 523 7.51%
18-24 years old 553, 039 9.14%
25-29 years old 417, 161 6.89%
Figure 2. The proportion of schedule II-V prescription drug fills by age group; dispensed to 12-17 year olds, 18-24 year olds, and 25-29 year olds in Maryland from 2015-2018 combined. ‘All’
denotes all records of prescription fills that were dispensed in Maryland to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were
dispensed in Maryland to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered
dispenser of Maryland.
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
12 to 17 18 to 24 25 to 29 12 to 17 18 to 24 25 to 29 12 to 17 18 to 24 25 to 29
All Only MD Residents MD+ Surrounding State Residents
PR
OP
OR
TIO
N O
F F
ILL
S B
Y A
GE
GR
OU
PProportion of Schedule II-V Prescription Drugs Fills by Youth & Young Adults in the
State of Maryland
Benzo Opioid Stimulant Other
MD Dispenser
17 | P a g e
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
All MD Resident MD Dispenser
% O
F P
EO
PL
E W
HO
FIL
LE
D A
PR
ES
CR
IPT
ION
ME
DIC
AT
ION
Percentage of Youth and Young Adults who Filled a Prescription (by Drug
Categories of Interest) from their Total Respective Populations in the State of
Maryland from Jan-Jun 2018
12 to 17 18 to 24 25 to 29
Figure 3. The percentage of people of each age group from their respective total population in Maryland based on the most recent 2017 Census data (12-17, 18-24, and 25-29 years old) who
(A) received any prescription drug fill in Jan-Jun 2018; and (B) by drug categories of interest in Jan-Jun 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to
recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD
Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
B
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
All MD Residents MD Dispenser
% O
F P
EO
PL
E W
HO
FIL
LE
D A
PR
ES
CR
IPT
ION
ME
DIC
AT
ION
SPercentage of Youth and Young Adults who Filled Any Prescription Medication from their
Total Respective Populations in the State of Maryland from Jan-Jun 2018
12 to 17 18 to 24 25 to 29
A
18 | P a g e
The majority of prescription fills to youth recipients (12-17 years old) were consistently stimulant
medications from January 2015 through June 2018 (Figure 4A). Young adults (18-24 years old) filled
nearly equal amounts of opioid and stimulant prescriptions at the start of 2015, but opioid prescription
fills have gradually decreased by mid-2018 (Figure 4B). Young adults (25-29 years old) demonstrate the
same trending decrease in opioid prescription fills from 2015 to mid-2018, but recipients in their mid-to–
late twenties fill the most opioid medications across all age groups (Figure 4C).
0
50000
100000
150000
Ja
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Ja
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Ju
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Ja
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Ja
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Ja
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Ja
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Ja
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un
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
F P
RE
SC
RIP
TIO
N D
RU
G F
ILL
S
Total Prescription Drug Fills to Youth Recipients (12-17 years old)
Benzo Opioid Stimulant Other
A
0
50000
100000
150000
Ja
n-J
un
Ju
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Ja
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un
Ju
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Ju
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Ja
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Ja
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Ja
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Ju
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Ja
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Ju
l-D
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Ja
n-J
un
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
F P
RE
SC
RIP
TIO
N D
RU
G F
ILL
S
Total Prescription Drug Fills to Young Adult Recipients (18-24 years old)
Benzo Opioid Stimulant Other
B
19 | P a g e
0
25000
50000
75000
100000
125000
150000
Jan
-Ju
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Jan
-Ju
n
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
F P
RE
SC
RIP
TIO
N D
RU
G F
ILL
S
Total Prescription Drug Fills to Young Adult Recipients (25-29 year olds)
Benzo Opioid Stimulant Other
Figure 4. Total number of prescription drug fills to (A) Maryland youth (ages 12-17); (B) young adult (ages 18-24); and (C) young adult (25-29) recipients from January 2015 through June
2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that
were dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered
dispenser of Maryland.
C
20 | P a g e
The majority of recipients across all age groups of interest represent unique persons who filled a stimulant
prescription (Figures 5A, B, C). There are approximately half as many unique persons who filled an opioid
prescription within the same time period of January 2015 to June 2018.
0
10000
20000
30000
40000
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Ja
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Ja
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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# U
NIQ
UE
PE
OP
LE
BY
CR
ISP
ID
Youth Recipients of Prescription Drugs in Maryland (12-17 year olds)
Benzo Opioid Stimulant Other
A
0
10000
20000
30000
40000
50000
60000
Ja
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Ja
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Ja
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Ja
n-J
un
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
F U
NIQ
UE
PE
OP
LE
BY
CR
ISP
ID
Young Adult Recipients of Prescription Drugs in Maryland (18-24) years old)
Benzo Opioid Stimulant Other
B
21 | P a g e
Figure 5. Total number of unique people who received prescription drug fills, specifically (A) Maryland youth (ages 12-17); (B) young adult (ages 18-24); and (C) young adult (25-29)
recipients from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of
prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each
age group provided by a registered dispenser of Maryland.
C
0
10000
20000
30000
40000
50000
60000
Ja
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Ja
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Ja
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Ja
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Ja
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Ja
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Ja
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Ja
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Ju
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Ja
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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
F U
NIQ
UE
PE
OP
LE
Y C
RIS
P I
DYoung Adult Recipients of Prescription Drugs in Maryland (25-29 years old)
Benzo Opioid Stimulant Other
22 | P a g e
Proportionally, youth (12-17 year olds) fill more stimulant prescriptions than all young adults but young adults
in their late twenties (25-29) fill proportionally more benzodiazepines, opioids, and other prescription
medications than their younger counterparts (Figure 7).
Figure 6. Total prescription fills by drug category of interest in Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) from all 12-29 year old recipients’ fills. ‘All’
denotes all records of prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were
dispensed in MD to recipients who are registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of
Maryland.
Figure 7. Proportion of prescription fills by drug category for all youth and young adult recipients (12-29 years old). ‘All’ denotes all records of prescription fills that were dispensed in MD to
recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents. ‘MD
Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
0
0.1
0.2
0.3
0.4
0.5
0.6
Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other
All Only MD Residents MD Dispenser
PR
OP
OR
TIO
N O
F F
ILL
S B
Y D
RU
G C
AT
EG
OR
Y
Proportion of Prescription Fills by Drug Category in Youth & Young Adults
12 to 17 18 to 24 25 to 29
0
200000
400000
600000
800000
1000000
Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other Benzo Opioid Stimulant Other
All Only MD Residents MD Dispenser
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
Total Prescription Fills by Drug Category Dispensed to Youth & Young Adults
12 to 17 18 to 24 25 to 29
23 | P a g e
3.2 PRESCRIBING PATTERNS OF HEALTHCARE PROVIDERS
Unsurprisingly, the greatest amount of fills dispensed to Maryland youth and young adults were prescribed by doctors followed by dentists (Figure
8). Aside from opioid prescriptions to all age groups of interest, there was no data to support podiatrist providing any other prescriptions. Notably,
the ‘Other’ category captures records where the prescriber’s degree fill is missing, therefore capturing an unknown percentage of all other listed
prescriber types. As such, these rates may underrepresent accurate prescription rates and should be considered an estimate.
Insert prescription fills by prescriber type (drug categories on separate graphs)
Particular interest: dentist breakdown, doctor breakdown
Figure 8. Overview of all dispensed prescription medications prescribed to Maryland youth (12-17 years old) and young adults (18-24; 25-29 years old) by registered healthcare providers (by DEA degree) in the state of Maryland from Jan 2015 through
June 2018. The ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing an unknown percentage of listed prescriber types. * denotes drug categories with a fill quantity unavailable from data, or specifically
unavailable for an age group.
0
90000
180000
270000
360000
450000
540000
630000
720000
Ben
zo
Op
ioid
Sti
mu
lan
ts
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Ben
zo
Op
ioid
Sti
mu
lan
t
Oth
er
Dentist Podiatrist Doctor Nurse Practioner Physician Assistant Veterinarian Other
# O
F P
RE
SC
RIP
TIO
N D
RU
G F
ILL
S
Total Prescription Drug Fills Prescribed to Maryland Youth and Young Adults by Maryland Healthcare
Providers
12 to 17 18 to 24 25 to 29
*n
o d
ata
avail
able
for
12
-17
* * *no d
ata
avail
able
for
12
-17
*n
o d
ata
avail
able
for
12
-17
*n
o d
ata
avail
able
for
12
-17
*n
o d
ata
avail
able
for
12
-17
*n
o d
ata
avail
able
for
12
-17
*n
o d
ata
avail
able
for
18-2
4 o
r 25-2
9
*n
o d
ata
avail
able
for
18-2
4 o
r 25
-29
Nurse Practitioner
24 | P a g e
Benzodiazepines
Overall, the rate of prescription benzodiazepines demonstrates a trending decline in fills to young adults (18-29
years old), with an increase in dispensed rates noted within the second half of each year suggesting a seasonal
influence (Figure 9B). The rate of prescription benzodiazepines in youth has remained steady at just under
10,000 prescription fills every six months from 2015 through mid-2018.
0
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20000
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50000
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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
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N F
ILL
S
Benzodiazepine Prescription Drug Fills Dispensed to
Youth and Young Adults Over Time
12 to 17 18 to 24 25 to 29
Figure 9. Prescription benzodiazepine fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database
(by DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity
unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription benzodiazepine medication from January 2015 through June 2018. ‘All’ denotes all records of
prescription fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are
registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
Dentist Podiatrist Doctor Nurse
Practitioner
Physician
Assistant
Veterinarian Other
Benzodiazepine Prescriptions
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
All Benzodiazepine Prescription Fills by Healthcare Provider
12 to 17 18 to 24 25 to 29
* *no d
ata
ava
ila
ble
for
12
-17
*n
o d
ata
ava
ila
ble
for
12
-17
A
B
25 | P a g e
Opioids
Notably, opioids are the only drug category that is prescribed by healthcare provider or prescriber (with the
exception of optometrists, who are within PDMP but do not have any prescription records to 12-29 year olds in
Maryland). Dentists provided equally as many opioid prescriptions as doctors to Maryland youth (12-17 years
old) from all opioid prescriptions combined from January 2015 through June 2018. Prescription opioid
medications dispensed to young adults (18-29 years old) has shown a sharp decrease from the beginning of
2015 to mid-June 2018 (Figure 10B)
0
20000
40000
60000
80000
100000
120000
140000
Jan
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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
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SC
RIP
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N F
ILL
S
Opioid Prescription Drug Fills Dispensed to Youth and Young Adults Over Time
12 to 17 18 to 24 25 to 29
0
50000
100000
150000
200000
250000
300000
350000
400000
Dentist Podiatrist Doctor Nurse
Practitioner
Physician
Assistant
Veterinarian Other
Opioid Prescriptions
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
All Opioid Prescription Fills by Healthcare Provider
12 to 17 18 to 24 25 to 29
Figure 10. Prescription opioid fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by DEA
degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity unavailable
from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription opioid medication from January 2015 through June 2018. ‘All’ denotes all records of prescription fills that were
dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered MD residents.
‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
A
B
26 | P a g e
Stimulants
Stimulant medications are most readily prescribed to Maryland youth (12-17 years old) by doctors (Figure
11A). Interestingly, the rate of prescriptions to youth from January 2015 to June 2018 has demonstrated a
pattern of more prescriptions filled in the first six months of the year, followed by a drop in the second half of
the year suggesting a seasonal influence. The rate of prescription stimulants to young adults (18-24) has
remained stable over the same time period, while young adults in their mid to late twenties are demonstrating a
gradual increase in dispensed stimulants (Figure 11B).
0
150000
300000
450000
600000
750000
Dentist Podiatrist Doctor Nurse
Practitioner
Physician
Assistant
Veterinarian Other
Stimulant Prescriptions
#
OF
PR
ES
CR
IPT
ION
FIL
LS
All Stimulant Prescription Fills by Healthcare Provider
12 to 17 18 to 24 25 to 29
0
20000
40000
60000
80000
100000
120000
140000
160000
Jan
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2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
# O
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SC
RIP
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N F
ILL
S
Stimulant Prescription Drug Fills Dispensed to
Youth and Young Adults Over Time
12 to 17 18 to 24 25 to 29Figure 11. Prescription stimulant fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by
DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity
unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription stimulant medication from January 2015 through June 2018. ‘All’ denotes all records of prescription
fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are registered
MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
*n
o d
ata
ava
ila
ble
for
12
-17
*
*n
o d
ata
ava
ila
ble
for
18
-29
A
B
27 | P a g e
Other
Other prescription medication fills comprise a small proportion of all dispensed medications to youth and young
adults in Maryland, however they are largely dispensed to young adults (18-29 years old) by doctors (Figure
12A).
0
10000
20000
30000
40000
50000
60000
70000
Dentist Podiatrist Doctor Nurse
Practitioner
Physician
Assistant
Veterinarian Other
Other Prescriptions
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
All Other Prescription Fills by Healthcare Provider
12 to 17 18 to 24 25 to 29
0
4000
8000
12000
16000
20000
Jan
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Jan
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Jan
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Jan
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Jan
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Jan
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Jan
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n
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
All MD Residents MD Dispenser
Other Prescription Drug Fills Dispensed to Youth and Young Adults Over Time
12 to 17 18 to 24 25 to 29
* *no d
ata
ava
ila
ble
for
12
-17
*n
o d
ata
ava
ila
ble
for
12
-17
*n
o d
ata
ava
ila
ble
for
12
-17
*n
o d
ata
ava
ila
ble
for
18
-29
Figure 12. Prescription other fills dispensed to Maryland youth (12-17 years old), and young adults (18-24; 25-29 years old) by (A) all registered healthcare providers within the PDMP database (by
DEA degree); the ‘Other’ category captures all records where the prescriber’s degree field was missing, therefore capturing x% of listed prescriber types. * denotes drug categories with a fill quantity
unavailable from data, or specifically unavailable for an age group; (B) Rate of dispensed prescription other medication from January 2015 through June 2018. ‘All’ denotes all records of prescription
fills that were dispensed in MD to recipients of each age group. ‘MD Residents’ denotes all records of prescription fills within each age group that were dispensed in MD to recipients who are
registered MD residents. ‘MD Dispenser’ denotes all records of prescriptions fills for recipients for each age group provided by a registered dispenser of Maryland.
A
B
28 | P a g e
Spotlight on Doctors
Proportionally, doctors prescribe more stimulants than any medication with the other drug categories (Figure
13A). From January 2015 to June 2018, doctors’ prescribing rates for benzodiazepines and other medications
remain unchanged across all age groups. Doctors’ prescribing patterns for stimulants may be based on a
seasonal influence in Maryland youth, as they consistently prescribe more stimulant medications during the first
half of the year. Notably, rates of doctors’ prescription opioids have decreased by approximately 30% since the
beginning of January 2015 to June 2018 in young adults (18-29; Figure 13B).
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Benzo Opioid Stimulant Other
PR
OP
OR
TIO
N O
F F
ILL
S
Proportion of Prescription Drugs Prescribed by Maryland Doctors
to Youth and Young Adults
12 to 17 18 to 24 25 to 29
Figure 13. Maryland doctors’ prescribing patterns and rates; (A) Proportion of prescription drugs prescribed to youth (12-17 years old) and young adults (18-24; 25-29 years old); (B) All patterns of
dispensed medications fills by drug category across January 2015 to June 2018. All registered healthcare providers within the PDMP database (by DEA degree: MD or DO).
0
20000
40000
60000
80000
100000
120000
Jan
-Ju
n
Ju
l-D
ec
Jan
-Ju
n
Ju
l-D
ec
Jan
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n
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n
Jan
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Jan
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Jan
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n
Jan
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Jan
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n
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Jan
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Jan
-Ju
n
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
Benzos Opioids Stimulants Other
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
All Dispensed Medication Fills Prescribed To Maryland Youth and Young Adults by
Doctors Over Time
12 to 17 18 to 24 25 to 29
A
B
29 | P a g e
Spotlight on Dentists
Proportionally, of all medications that dentists have prescribed from January 2015 to June 2018, just over 90%
of prescriptions are opioids; consistent across all age groups. Over time, rates of opioid prescriptions have
decreased in young adults (18-29 years old), but prescribing patterns for youth may be based on a seasonal
influence as rates of opioids are higher in the second half of the year than the first.
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Jan
-Ju
n
Ju
l-D
ec
Jan
-Ju
n
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ec
Jan
-Ju
n
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Jan
-Ju
n
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-Ju
n
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Jan
-Ju
n
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Jan
-Ju
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Jan
-Ju
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Jan
-Ju
n
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l-D
ec
Jan
-Ju
n
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l-D
ec
Jan
-Ju
n
2015 2016 2017 2018 2015 2016 2017 2018 2015 2016 2017 2018
Benzos Opioids Stimulants & Other
# O
F P
RE
SC
RIP
TIO
N F
ILL
S
All Dispensed Medication Fills Prescribed to Maryland Youth and Young Adults
by Dentists Over Time
12 to 17 18 to 24 25 to 29
0.000
0.100
0.200
0.300
0.400
0.500
0.600
0.700
0.800
0.900
1.000
Benzo Opioid Stimulant & Other
PR
OP
OR
TIO
N O
F F
ILL
S
Proportion of Prescription Drugs Prescribed by Maryland Dentists
to Youth and Young Adults
12 to 17 18 to 24 25 to 29
Figure 14. Maryland dentists’ prescribing patterns and rates; (A) Proportion of prescription drugs prescribed to youth (12-17 years old) and young adults (18-24; 25-29 years old); (B) All
patterns of dispensed medications fills by drug category across January 2015 to June 2018. All registered healthcare providers within the PDMP database (by DEA degree: DDS or DMD).
A
B
30 | P a g e
3.3 PRESCRIBING PATTERNS ACROSS JURISDICTIONS
The tables that follow show each Maryland jurisdiction for each age group and drug category in comparison to
the State’s average for the same age group and drug category within January to June 2018. Bars in red represent
jurisdictions above the State average. Bars in green represent jurisdictions below the State average.
Kent County has the highest proportion of benzodiazepines dispensed to youth (12-17 years old; Figure 15A),
while opioids were largely dispensed in Charles, Prince George’s, and St. Mary’s relative to the state average
(Figure 15B).
0
0.05
0.1
0.15
0.2
0.25
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
PIO
ID F
ILL
S
Proportion of Opioid Fills Dispensed to Youth (12-17 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
0
0.02
0.04
0.06
0.08
0.1
0.12
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n
PR
OP
OR
TIO
N O
F B
EN
ZO
DIA
ZE
PIN
E F
ILL
S
Proportion of Benzodiazepine Fills Dispensed to Youth (12-17 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 15. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.0374); and (B)
opioid medications (state average for 12-17 year olds in Jan-Jun 2018: 0.0904) dispensed to Maryland youth (12-17 years old) within each of Maryland’s jurisdiction from January to June
2018. Red bars denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.
A
B
31 | P a g e
Allegany County has the highest proportion of stimulant medications dispensed to youth (12-17 years old;
Figure 16A), while St. Mary’s has the highest proportion of other fills (Figure 16B) relative to the state
average.
0
0.01
0.02
0.03
0.04
0.05
0.06
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
TH
ER
FIL
LS
Proportion of Other Fills Dispensed to Youth (12-17 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
* * *
0.65
0.7
0.75
0.8
0.85
0.9
0.95
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F S
TIM
UL
AN
T F
ILL
S
Proportion of Stimulants Fills Dispensed to Youth (12-17 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 16. Relative to the state of Maryland’s average, the proportion of (A) stimulant prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.843); and (B) other
medications (state average for 12-17 year olds in Jan-June 2018: 0.0271) dispensed to Maryland youth within each of Maryland’s jurisdiction from January to June 2018. Red bars denote a
jurisdiction that is above the state average, and green bars denote jurisdictions that are below. * denotes drug categories with a fill quantity unavailable from data, or specifically unavailable for
an age group.
A
B
32 | P a g e
Allegany has the highest proportion of benzodiazepine medications dispensed to young adults (18-24
years old; Figure 17A), while Baltimore City, Charles, and Garrett Counties have the highest proportion of
opioid medications (Figure 17B) relative to the state average.
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0.55
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Ba
ltim
ore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
PIO
ID F
ILL
S
Proportion of Opioid Fills Dispensed to Young Adults (18-24 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
0.05
0.1
0.15
0.2
0.25
0.3
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F B
EN
ZO
DIA
ZE
PIN
E F
ILL
S
Proportion of Benzodiazepine Fills Dispensed to Young Adults (18-24 years old)
within Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 17. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 12-17 year olds in Jan-June 2018: 0.1194); and (B)
opioid medications (state average for 18-24 year olds in Jan-June 2018: 0.3337) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red
bars denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.
B
A
33 | P a g e
Howard, Montgomery, and Queen Anne’s Counties have the highest proportion of stimulant medications
dispensed to young adults (18-24 years old; Figure 18A), while Caroline and Carroll Counties have the highest
proportion of other prescriptions dispensed (Figure 18B) relative to the state average.
0.3
0.35
0.4
0.45
0.5
0.55
0.6
0.65
0.7
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
therPR
OP
OR
TIO
N O
F S
TIM
UL
AN
T F
ILL
S
Proportion of Stimulant Fills Dispensed to Young Adults (18-24 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 18. Relative to the state of Maryland’s average, the proportion of (A) stimulant prescription medications (state average for 18-24 year olds in Jan-June 2018: 0.498485); and (B) other
medications (state average for 18-24 year olds in Jan-June 2018: 0.048419); dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars
denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.
A
B
0.03
0.035
0.04
0.045
0.05
0.055
0.06
0.065
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
TH
ER
FIL
LS
Proportion of Other Fills Dispensed to Young Adults (18-24 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
*
34 | P a g e
Allegany County has the highest proportion of benzodiazepine prescriptions dispensed to young adults (25-29
years old; Figure 19A), while Garrett County has the highest proportion of opioid prescriptions dispensed
(Figure 19B) relative to the state average.
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0.55
0.6
0.65
0.7
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
PIO
ID F
ILL
S
Proportion of Opioid Fills Dispensed to Young Adults (25-29 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
0.1
0.12
0.14
0.16
0.18
0.2
0.22
0.24
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F B
EN
ZO
DIA
ZE
PIN
E F
ILL
S
Proportion of Benzodiazepine Fills Dispensed to Young Adults (25-29 years old)
within Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 19. Relative to the state of Maryland’s average, the proportion of (A) benzodiazepine prescription medications (state average for 25-29 year olds in Jan-June 2018: 0.154493); and (B) opioid
medications (state average for 25-29 year olds in Jan-June 2018: 0.45485) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars denote a
jurisdiction that is above the state average, and green bars denote jurisdictions that are below.
B
A
35 | P a g e
Howard, Montgomery, and Queen Anne’s Counties have the highest proportion of stimulant prescriptions
dispensed to young adults (25-29 years old; Figure 20A), while Wicomico County has the highest proportion of
other prescriptions dispensed (Figure 20B) relative to the state average.
0.035
0.04
0.045
0.05
0.055
0.06
0.065
0.07
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
…
Ca
lvert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F O
TH
ER
FIL
LS
Proportion of Other Fills Dispensed to Young Adults (25-29 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0.55
All
ega
ny
An
ne A
run
del
Balt
imore
Cit
y
Balt
imore
Cou
nty
Calv
ert
Caro
lin
e
Carr
oll
Ceci
l
Ch
arl
es
Dorc
hest
er
Fre
deri
ck
Ga
rrett
Ha
rford
How
ard
Ken
t
Mon
tgom
ery
Pri
nce
Georg
e's
Qu
een
An
ne's
St.
Ma
ry's
Som
ers
et
Ta
lbot
Wash
ingto
n
Wic
om
ico
Worc
hest
er
Un
kn
ow
n/O
ther
PR
OP
OR
TIO
N O
F S
TIM
UL
AN
T F
ILL
S
Proportion of Stimulant Fills Dispensed to Young Adults (25-29 years old) within
Jurisdictions relative to the Maryland State Average during Jan-Jun 2018
Figure 20. Relative to the state of Maryland’s average, the proportion of (A) stimulant prescription medications (state average for 25-29 year olds in Jan-June 2018: 0.336531); and (B) other
medications (state average for 25-29 year olds in Jan-June 2018: 0.054126) dispensed to Maryland young adults within each of Maryland’s jurisdiction from January to June 2018. Red bars
denote a jurisdiction that is above the state average, and green bars denote jurisdictions that are below.
A
B
36 | P a g e
The figures that follow show the proportion of each drug category within each jurisdiction from January 2015 – June 2018. The proportion of
benzodiazepine prescriptions filled in Queen Anne’s County in 2015 was almost 50% of all the fills over time (Figure 21). This fill pattern is
different from all other jurisdictions.
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George's
Queen Anne's
St. Mary's
Somerset
Talbot
Washington
Wicomico
Worcester
Unknown/Other
PROPORTION OF BENZODIAZEPINE FILLS
MA
RY
LA
ND
JU
RIS
DIC
TIO
N
Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12 - 17 years old)
Jan-Jun 2015 Jul-Dec 2015 Jan-Jun 2016 Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Jan-Jun 2018
Figure 21. Benzodiazepines prescription fills dispensed to youth (12-17 years old) within each of Maryland’s 24 jurisdictions, proportional to six month intervals beginning with January 2015 through June 2018.
37 | P a g e
The proportion of opioid fills within Garrett County in 2015 was about 40% of all the fills over time (Figure 22). Over time, fills become
proportionally similar to the other jurisdictions.
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George's
Queen Anne's
St. Mary's
Somerset
Talbot
Washington
Wicomico
Worcester
Unknown/Other
PROPORTION OF BENZODIAZEPINE FILLS
MA
RY
LA
ND
JU
RIS
DIC
TIO
N
Proportion of Benzodiazepines within each Maryland Jurisdiction among Youth (12 - 17 years old)
Jan-Jun 2015 Jul-Dec 2015 Jan-Jun 2016 Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Jan