Prescription Drug Monitoring Program, 2022

04/25/2022 2
Prescription DSrUuBgT I TML Eonitoring Program, 2022
Epidemiology, Drug Surveillance Unit

THE PRESCRIPTION DRUG
MONITORING PROGRAM (PDMP)
The purpose of this report is to describe opioid prescribing patterns in Georgia during 2022. Prescription data from the Georgia Prescription Drug Monitoring Program (PDMP) were analyzed by the Georgia Department of Public Health (DPH) Epidemiology Program Drug Surveillance Unit. Certain prescribing practices are considered high-risk, and may predispose patients to opioid use disorder and overdose, hence contributing to the growing opioid epidemic (for more information about the opioid epidemic in Georgia, see the Georgia opioid overdose surveillance reports available at https://dph.georgia.gov/drug-surveillanceunit). These prescribing practices are presented as PDMP indicators in this report; detailed analyses of the PDMP data were conducted to measure the total number of opioid prescriptions, number of patients receiving opioids, drug type, days dispensed, and other indicators of prescribing such as opioid and benzodiazepine prescriptions.
In 2016, the Centers for Disease Control and Prevention (CDC) released opioid prescribing guidelines for healthcare providers for pain management (https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm). Appropriate prescribing and adhering to these CDC guidelines to prevent problematic prescribing may help improve patient care and safety and decrease the risk of opioid use disorder and overdose. Data in this report will be used to educate partners and inform prevention efforts across the state.
The PDMP can help prescribers and dispensers of controlled substances identify patients who are at risk of a substance use disorder, who "doctor shop", or who are prescribed dangerous amounts and/or combinations of controlled substances. PDMP data is only accessible to prescribers or dispensers, who can use it to help identify inappropriate prescribing practices. The PDMP does not interfere with appropriate, professional prescribing and dispensing; it is intended only to help eliminate duplicative prescribing, overprescribing, and diversion of controlled substances. PDMP data are also used to support and inform Georgia's overarching statewide opioid and substance use response strategic plan, which spans a myriad of agencies and activities.
PDMP Requirements
Since July 1, 2017, dispensers have been required by Georgia law (https://dph.georgia.gov/sites/dph.georgia.gov/files/HB249_law.pdf) to enter prescription information for any Schedule II-V controlled substance within 24 hours of dispensing. Prescribers were required to register into the PDMP system by January 1, 2018. Beginning July 1, 2018, prescribers are required to check the PDMP before prescribing schedule II opioids and cocaine derivatives, or benzodiazepines, with some exceptions (https://dph.georgia.gov/pdmp). The PDMP is a tool for prescribers to review a patient's prescription history to assist with appropriate and safe prescribing of controlled substances. Only prescribers and dispensers who practice in Georgia are required to use the PDMP. Prescribers and dispensers are allowed to register two delegates (staff without a DEA number) per shift or rotation to check the PDMP and retrieve patient prescription histories.
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PDMP Data Sharing
Georgia law (2017 Georgia House Bill 249) allows DPH to share PDMP prescription information with electronic health record systems, and other States, including law enforcement from other states through subpoenas. Law enforcement agencies may need these data when they are conducting investigations into inappropriate prescribing or dispensing of controlled substances.
Georgia Opioid and Substance Misuse Response
For more information: County level data and other Georgia drug surveillance reports:
https://dph.georgia.gov/drug-surveillance-unit Georgia Department of Public Health (DPH) Main Opioid Page:
https://dph.georgia.gov/stopopioidaddiction Georgia drug overdose mortality interactive maps and statistics:
https://oasis.state.ga.us/PageDirect.aspx?referer=MortalityDrugOverdoses Prescription Drug Monitoring Program (PDMP) information, GA PDMP Overview, and FAQs:
https://dph.georgia.gov/pdmp
Note: The data in this report should not be compared to reports prior to 2021 due to changes in data processing.
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Georgia PDMP, 2022: Key Findings
Georgia saw improvements in opioid prescribing practices from 2021 to 2022, as evidenced by these PDMP indicators:
In 2022, there were 6,525,725 opioid prescriptions dispensed to 1,867,887 patients in Georgia. These prescriptions averaged 18.0 days of opioids dispensed per prescription.
From 2021 to 2022, the number of opioid prescriptions statewide decreased by 3%, benzodiazepine prescriptions by 3%, and stimulants increased by 1%.
The number of patients receiving opioid prescriptions did not change from 2021 to 2022. The average number of days dispensed per opioid prescription decreased by 1%.
In the first quarter of 2021 (Q1), there were 1,669,678 opioid prescriptions dispensed compared to 1,626,586 prescriptions in the last quarter of 2022 (Q4).
From 2021 to 2022, the rate of opioid prescriptions dispensed in Georgia decreased by 4% among persons aged 5-54 years, 3% among those aged 55-64 years, increased by 2% among those aged 65-74 years, increased by 7% among those aged 75-84 years, and increased by 3% among those aged 85+. Opioid prescriptions decreased by 5% among males and 3% among females.
High opioid dosages are associated with an increased risk of opioid use disorder and overdose; the 2022 CDC opioid prescribing guidelines recommended that daily opioid dosages should not exceed 90 morphine milligram equivalents (MME) per day. The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of opioids decreased by 4% from Quarter 1 (Q1) 2021 to Q4 2022.
Hydrocodone, Oxycodone, and Tramadol were the most-prescribed opioids in Georgia during both 2021 and 2022.
The number of registered PDMP users increased by 7% from December 2021 to December 2022. Patient queries by prescribers (or their delegates) and dispensers increased from 11.7 million queries
in 2021 to 13.9 million queries in 2022.
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PDMP Data Indicators
Data Source
All schedule II-V drug prescriptions dispensed and reported to the Georgia Prescription Drug Monitoring Program during 20182022.
PDMP Indicator Description
Opioid analgesic prescriptions Opioid analgesic-controlled substance prescriptions dispensed and reported to the PDMP. Drugs administered to patients by substance abuse treatment programs are usually excluded from PDMP files and therefore are not captured by this indicator. Additional exclusion criteria include: Drugs not typically used in outpatient settings or otherwise not critical for calculating dosages in morphine
milligram equivalents (MME), such as cough and cold formulations including elixirs, and combination products containing antitussives, decongestants, antihistamines, and expectorants; All buprenorphine products. Rate is calculated per 1,000 population (Georgia residents). Rate is age-adjusted except when age categories are presented. County level prescription rates are age adjusted. Opioid prescription patients The number of individual patients receiving an opioid analgesic controlled substance prescription that was dispensed and reported to the PDMP. Rate is calculated per 1,000 population (Georgia residents). Rate is age-adjusted except when age categories are presented. Days per opioid prescriptions The average number of days of opioid analgesics supplied per prescription. Patients receiving avg. daily dose 90 morphine milligram equivalents % of patients with an average of 90 MME of opioid analgesic drugs prescribed per day. Numerator: the number of patients with an average of 90 MME of opioid analgesic drugs prescribed per day Denominator: state residents who received an opioid analgesic prescription Average MME per day is calculated from total number of MMEs from all-drugs prescribed per day, inclusive of overlapping prescriptions of either the same and/ or differing drugs, divided by the total number of prescription days
Other Definitions or Limitations
Not all out of state pharmacies report to the Georgia PDMP, therefore some prescriptions obtained in another state, or by mail, could be missing from these data. Some 2021 prescription data were missing sex and age (<2% missing), therefore the race and age data represents only prescriptions for which sex and age where completed. Rate indicates the number of events that occurred among Georgia residents per 1,000 population using 2020 census data as the denominator, and all rates are age-adjusted unless age category is presented. We report on three categories of controlled substances in this report, these categories include: Opioids: Buprenorphine, Butorphanol, Codeine, Dezocine, Dihydrocodeine, Fentanyl, Fentanyl, Hydrocodone,
Hydromorphone, Meperidine, Methadone, Morphine, Nalbuphine, Opiate Agonists, Oxycodone, Oxymorphone, Pentazocine, Tapentadol, Tramadol, and other opioids Benzodiazepines: Alprazolam, Chlordiazepoxide, Clonazepam, Clorazepate, Diazepam, Estazolam, Flurazepam, Lorazepam, Oxazepam, Temazepam, Triazolam, and other benzodiazepines Stimulants: Amphetamine, Benzphetamine, Desoxyephedrine, Dexmethylphenidate, Dextroamphetamine, Lisdexamfetamine, Methylphenidate, and other stimulants.
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Prescription Drug Monitoring Program Data Indicators

Prescriptions by Drug Type and Year, Georgia, 2018-2022

N
No. Prescriptions (millions)

1P8327610.0

2018 2019 2020 2021 2022

9.0

7.9

8.0 7.0

7.4 6.9 6.7 6.5

6.0

5.0

4.0 3.0 2.0

3.6 3.4 3.3 3.2 3.1

2.7 2.2 1.8 1.7 1.7

1.0

0.0

Opioids

Benzodiazepenes

Stimulants

From 2021 to 2022, the number of opioid prescriptions decreased by 3%, benzodiazepine prescriptions by 3%, and stimulants increased by 1%.
Opioids are the most frequently prescribed controlled substance in Georgia, followed by benzodiazepines and stimulants.

No Rx (millions)

2.2 2.1
2.1
2.0
1.9
1.8

Opioid Prescriptions by Quarter, Georgia, 2018-2022

2.0 1.9
1.8 1.8

1.8 1.8 1.8

March 11, 2020
COVID-19 pandemic declared
1.8 1.8

1.7 July 1, 2018
Prescribers required 1.6 to check PDMP prior
to prescribing
1.5

1.7

1.6

1.6

1.6 1.6

1.6

2018 Q1 2018 Q3 2019 Q1 2019 Q3 2020 Q1 2020 Q3 2021 Q1 2021 Q3 2022 Q1 2022 Q3

Year and Quarter
In the first quarter of 2021, there were 1,643,937 opioid prescriptions dispensed compared to 1,586,318 prescriptions in the last quarter of 2022.

5

Rx/ 1,000 population

2000 1800 1600 1400 1200 1000
800 600 400 200
0 <1
2018 5
2019 7
2020 7
2021 6
2022 5

Opioid Prescription Rates, by Age and Sex, Georgia, 2018-2022
2018 2019 2020 2021 2022
1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ female male 12 30 162 406 646 875 1308 1411 1415 1344 727 538 14 33 161 392 664 913 1406 1594 1584 1562 782 578 11 27 142 346 610 838 1335 1573 1573 1554 738 545 11 26 140 319 590 801 1283 1587 1610 1521 725 528 10 26 132 295 566 775 1244 1616 1720 1565 702 503
Age Group (years)

From 2020 to 2021, the rate of opioid prescriptions dispensed in Georgia decreased by 4% among persons aged 5-54 years, 3% among those aged 55-64 years, increased by 2% among those aged 65-74 years, increased by 7% among those aged 75-84 years, and increased by 3% among those aged 85+.
Opioid prescriptions decreased by 5% among males and 3% among females.

Average No. Days Supplied per Rx

No. Rx or Patients (millions)

Opioid Prescriptions, Patients, and Average Days Supplied per Rx, Georgia, 2018-2022

8.0

18.2

7.0

7.5

6.0

5.0

4.0

3.0

2.0

1.0

2.0

0.0 2018

17.9 7.2
2.1 2019

18.3 6.9
1.9 2020

18.0 6.6
1.9 2021

17.9

20.0

18.0

16.0

6.5

14.0

12.0

10.0

8.0

6.0

4.0 1.9
2.0

0.0 2022

No. Rx

No. Patients/1000

Days/Rx

The number of opioid prescriptions decreased by 1% and no changes seen in patients receiving opioid prescriptions, from 2021 to 2022.
The average number of days dispensed per opioid prescription decreased by 2%.
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% of Patients

Percent Patients Receiving an Average Daily Dose 90 Morpine Miligram Equivalents of Opioids, by Quarter,
Georgia, 2018-2022

9.0 8.0 7.0

7.3 7.1 7.2 7.7 7.7 7.4 7.1 6.8 6.4 6.9 6.7 6.2 6.4 6.3 6.3 6.0 6.0 5.8 6.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

2018 2018 2018 2019 2019 2019 2019 2020 2020 2020 2020 2021 2021 2021 2021 2022 2022 2022 2022

Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Year and Quarter

High opioid dosages are associated with an increased risk of opioid use disorder and overdose. The graph above represents the quarterly percent of patients in Georgia who were receiving an
average daily dose of 90 (MME) of opioids during 2018-2022. The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of
opioids decreased by 6% from Q1 2021 to Q4 2022.

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8

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Top Ten Opioids Prescribed, Georgia, 20212022

Rank

Opioid drug

No. prescriptions No. prescriptions

2021

2022

1

Hydrocodone

2,256,119

2,136,284

2

Oxycodone

1,740,226

1,734,241

3

Tramadol

1,445,006

1,376,600

4

Codeine

473,779

471,805

5

Buprenorphine

328,838

336,005

6

Morphine

246,195

237,222

7

Fentanyl

84,778

75,227

8 Hydromorphone

60,210

61,148

9

Methadone

57,270

52,493

Codeine,
10
Bultabital

21,401

19,862

Prescription Drug Monitoring Program

Registrations and Patient Queries, Georgia, 20212022

PDMP user type No. registered as No. registered as No. patient of 12/31/2021 of 12/31/2022 queries 2021

No. patient queries 2022

Dentist

5,085

5,214

61,705

51,082

Dispensing Physician Medical Resident Midwife Nurse Practitioner Optometrist Out-of-State Pharmacist Out-of-State Prescriber Pharmacist Pharmacist's Delegate Physician (MD,DO) Physician Assistant Podiatrist Prescriber Delegate Veterans Affairs Prescriber
TOTAL

42 3,695 164 7,840 1,049 177
275 13,536
429
30,916
3,835 554 1,839
202 69,638

34 4,312 171 8,583 1,057 183
301 14,489
507
32,341
4,189 567 2,004
203 92,132

2,612 59,915 7,295 1,459,237 5,042 1,498
7,242 4,087,125
54,074
4,889,312
632,821 12,521 480,392
13,739 11,774,530

10,188 86,380 2,938 1,491,945
92 1,442
11,500 4,338,460
72,030
4,667,013
617,114 10,367 238,972
13,571 11,602,906

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Prescription Drug Monitoring Program Indicators, Georgia, 20212022
See Prescription Drug Monitoring Program Data Indicators table for description of indicators below

2021

2022

Indicator description

Total Jan-Mar Apr-Jun Jul-Sep Oct-Dec Total Jan-Mar Apr-Jun Jul-Sep Oct-Dec

No. opioid prescriptions

6,743,732 1,669,675 1,708,774 1,683,265 1,682,018 6,525,725 1,625,268 1,641,479 1,633,868 1,625,110

No. stimulant prescriptions

1,656,746 414,064 406,160 418,422 418,100 1,674,106 433,840 403,245 399,606 437,415

No. benzodiazepine prescriptions

3,192,057 804,775 801,127 800,520 785,635 3,092,130 778,461 780,494 775,351 757,824

Opioid Rx/ 1,000 population (age adjusted)
No. opioid patients
Opioid patients/ 1,000 population Days/ opioid prescription % Patients receiving avg. daily dose 90 morphine milligram equivalents

726.0

N/A

3,210,428 791,281

305.0

75.2

17.9

17.9

6.3

6.2

N/A 815,268
77.5 17.8
6.4

N/A 798,907
75.9 18.0
6.3

N/A

737

N/A

804,972 3,040,343 755,828

76.5

281.4

70.0

17.9

17.9

18.0

6.3

6.1

6.1

N/A 766,053
70.9 18.0
6.0

N/A 761,458
70.5 18.0
6.0

N/A 757,004
70.0 17.9
6.1

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Prescription Drug Monitoring Program Indicators by Age and Sex, Georgia, 2022

See Prescription Drug Monitoring Program Data Indicators table for description of indicators below

Indicator

No. opioid

No.

No. benzo.

Rx

stimulant Rx

Rx

Opioid Rx/ 1,000
population

No. opioid patients

Opioid patients/
1,000 population

Avg days/ opioid Rx

Age Group

<1 year

680

3

113

5.4

572

4.5

12.0

1-4 years

5,227

755

7,580

10.0

4,275

8.0

9.0

5 -14 years

34,774

433,566

32,164

24.6

26,582

18.8

10.0

15-24 years 185,918

317,310

72,222

128.6

142,857

98.8

6.0

25-34 years 422,545

283,359

218,671

286.8

214,639

145.6

10.4

35-44 years 757,299

280,743

427,090

551.7

261,568

190.5

15.0

45-54 years 1,066,912

201,179

543,603

755.9

295,441

209.3

18.0

55-64 years 1,567,657

110,808

676,915

1,219.3

352,336

274.0

20.0

65-74 years 1,421,657

38,982

610,748

1,587.7

317,559

354.6

20.0

75-84 years 707,509

7,094

357,631

1,691.1

174,297

416.6

19.0

85+ years 226,778

911

145,498

1,546.6

58,834

401.2

18.0

Sex

Male 2,600,988

830,783

1,034,311

493.5

755,131

143.2

18.0

Female 3,792,185

843,809

2,054,975

685.7

1,092,342

197.5

18.0

DPH Epidemiology, Drug Surveillance Unit https://dph.georgia.gov/drug-overdose-surveillance-unit

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