Overprescription and the opioid crisis

2018 Gartner BI Bake Off

Overview

Overdosing on drugs is one of the leading causes of deaths in the United States. Over 60% of all drug overdose deaths are caused by prescription drugs.

Spotfire provides unique opportunity to look at the problem and identify actionable insights. Beyond the facts and statistics, we will explore several cause-and-effect relationships among prescription providers, state policies, social environment, and trends over time. Among our initial findings: 

• U.S. medical providers write opioid prescriptions at an alarming rate compared to other developed countries, with opioid usage 26x that of Japan
• Some providers consistently prescribe opioids at a rate higher than 60%, compared to the median of 29% and the average of 11%
• Among the highest prescribers of opioids are medical specialties that are arguably unfit to prescribe drugs

Spotfire is a smart, secure, governed, enterprise-class analytics solution with built-in data wrangling that delivers AI-driven, visual, geo, and streaming analytics. Spotfire interactive visualizations and recommendations engine help you get better answers and deeper understanding because you can cover more ground in less time. Spotfire empowers you to improve data quality and analytical results before you start or while you're immersed in the analysis so you can fix your data interactively while you analyze.

Video Walkthrough

The video shows a walk through of the analysis DXP and get under the hood of the dashboard visuals.

Data

Gartner provided data sets to the industry's top BI software vendors for their fourth annual BI Bake Off. In addition to showcasing critical analytics and data visualization capabilities, the data sets allow vendors to demonstrate how the data and analytics community can do good with data. At TIBCO, we embraced this opportunity to use data for a cause and create awareness around the opioid crisis.

This was the messiest data Gartner has provided for the BI Bake Off with five different data sets on Overdose Deaths, State Medicaid Support, National Opioid Provider Information, and U.S. Census data with population estimates, etc. The richness of the data allowed for several potential comparisons and findings. The findings we found the most interesting were on who is prescribing opioids and the magnitude of overprescription.

To get these insights, we performed wrangling options like unpivoting using Spotfire?s easy-access Data Panel. We also perform advanced wrangling tasks like column creation using partial string matching with TERR (now called Spotfire Enterprise Runtime for R) embedded in Spotfire. With TERR, we were able to connect to the data stored in Google sheets seamlessly through the "googlesheets" package. Once the data was imported into Spotfire, column relations across the data sets were detected automatically for similar columns like State and Year.

Video 1 demonstrates easy data wrangling in TIBCO Spotfire.

Analysis Methods

Exploratory Analysis

Our first goal was to perform an exploratory analysis to find different stories or points of focus from the data.

It turns out there are a lot of interesting patterns we could have focused on, including:

• The rise and fall of overdose deaths due to specific drugs, e.g., heroin, cocaine
• Statewide trends of most and least deaths due to overdose
• Statewide trends of most and least deaths due to overdose when taking into account population and the total number of deaths
• Drugs reimbursed the most through state-sponsored Medicaid programs

But none of these were as compelling as prescription rates by exact location and putting it in perspective with the rest of the developed world. As one may guess, there is substantial geographic variation in opioid prescription. Per capita use of six potent opioids is 26 times higher in the United States compared to Japan which has a larger proportion of an aging population.

Descriptive Analysis

After exploration, we create explanatory or descriptive visuals to help define the magnitude of the crisis and why it should be further examined.

Let's look at prescription rates around the U.S. The color shows opioid prescriptions as a percentage of all prescriptions. The size shows the percentage of extended-release opioid prescriptions. The map is filtered by the percentage of opioid prescriptions from 11% to 100%. The average prescription rate for opioids is 11% and the median is 29%. However, some providers consistently prescribe opioids at a rate higher than 60% - much higher than one would expect.

Video 2 shows the creation of brush-linked dashboards in Spotfire in minutes.

Video 3 shows advanced geospatial analytics with Spotfire.

Prescriptive Analytics

States with the highest prescription rates are at levels 4-5 times those of the lowest prescribing-rate states, even though health issues that cause people pain do not change much from state-to-state . We've established that prescribing rates are very high across the U.S. so let's look at why that is concerning.

Opioids activate the brain's reward system and release dopamine, often creating brain abnormalities when used over extended periods. These feelings of pleasure are associated with the environment leading to cravings that encourage drug dependence. Opioids are often prescribed in cases of chronic pain due to surgery but their long-term use can lead to dependence. Extended-release or XR opioids include OxyContin, Fentanyl, Methadone, Oxymorphone, etc. Although these drugs are hard to abuse directly, it takes the body longer to clear them from the system and so they tend to be more addictive. Fentanyl is allegedly the most potent opioid and is the #1 drug in overdoses in recent years.

To make our findings actionable we have to ask who is prescribing the most opioids and XR opioids and make a recommendation for action. (Note:  Of 1.1M rows of data, 78k had XR Prescription Rate provided so our average XR Prescription Rate may have quality issues but the patterns found below are still pertinent.)

In most countries, the use of opioid prescriptions is limited to acute hospitalization and trauma, such as burns, surgery, childbirth, and end-of-life care, including patients with cancer and terminal illnesses. But in the U.S., prescribing opioids is prevalent even for relatively minor aches and pains and often supersedes the painful but better option of extended physiotherapy.

Certain specialty practitioners like Licensed Acupuncturists can only prescribe drugless medication so for these specialties to appear among the highest XR prescription providers warrants a closer look.

Call to Action

From looking at some of the prescription trends, I recommend closer scrutiny of information from the National Opioid Provider database and questioning how 'Unknown suppliers' have ended up prescribing XR prescriptions at the highest rates. Similarly, states should investigate if specialties like Naturopaths, Acupuncturists, Denturists, and Dermatologists are honoring their licenses by providing opioid prescriptions.

In the data, I discovered many hidden dangers like the addictive nature of OxyContin, which is widely considered safe as it?s hard to abuse directly but often acts as a gateway drug. It is interesting to note that the coasts have higher overdose rates and higher prescription rates by mental health professionals (Neuropsychiatry, Psychiatry & Neurology, etc.) and nurses.

The CDC estimates that 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings. That patient could be someone you know so I recommend you consider spreading awareness and choose more holistic methods, like physiotherapy, to reduce dependence on opioids. Several states have enacted Good Samaritan laws that offer immunity against charges such as possession for reporting overdoses to 911.

We hope to continue this analysis further by looking at populations that are most at risk of addiction next.

Citations

1. Learn to Cope, Overdose Facts
2. Research Study, Journal of American Board of Family Medicine, Comparison of opioid prescribing patterns in United States and Japan
3. Official Website Gartner, About Us
4. Center for Disease Control, Prescribing Data
5. National Center for Biology Information (NCBI), Biology of Opioid dependence
6. National Conference of State Legislatures, Drug Overdose and Good Samaritan Laws
7.  National Center for Biology Information (NCBI), The Promotion and Marketing of OxyContin