Prescription Drug Monitoring Program, 2020

10/03/2022 2
Prescription DSrUuBgT I TML Eonitoring Program, 2020
Epidemiology, Drug Surveillance Unit

THE PRESCRIPTION DRUG
MONITORING PROGRAM (PDMP)
The purpose of this report is to describe opioid prescribing patterns in Georgia during 2020. 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 chronic diseases (https://www.cdc.gov/drugoverdose/prescribing/guideline.html). 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 stakeholders 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. It can also 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 across myriad 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.
Prescription Drug Monitoring Program Report, Georgia, 2020

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
Prescription Drug Monitoring Program Report, Georgia, 2020

Georgia PDMP, 2020: Key Findings
Georgia saw improvements in opioid prescribing practices from 2019 to 2020, as evidenced by these PDMP indicators: In 2020, there were 6,925,603 opioid prescriptions dispensed to 1,870,321 patients in Georgia. These
prescriptions averaged 18.3 days of opioids dispensed per prescription. From 2019 to 2020, the number of opioid prescriptions statewide decreased by 9%, benzodiazepine
prescriptions by 12%, and stimulants by 18%. The number of patients receiving opioid prescriptions decreased by 10% from 2019 to 2020. The average
number of days dispensed per opioid prescription increased by 2%. In the first quarter of 2019 (Q1), there were 1,946,048 opioid prescriptions dispensed compared to
1,786,245 prescriptions in the last quarter of 2020 (Q4). From 2019 to 2020 the rate of opioid prescriptions dispensed decreased by 12% among persons aged 5-
54 years, 5% among those aged 55-64 years, 1% among those aged 65-74 years, 1% among those aged 75-84 years, and 1% among those aged 85+. Opioid prescriptions decreased 6% among both males and females. High opioid dosages are associated with an increased risk of opioid use disorder and overdose; the 2016 CDC opioid prescribing guidelines recommended that daily opioid dosages should not exceed 90 morphine milligram equivalents (MME). The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of opioids decreased by 13.7% from Quarter 1 (Q1) 2019 to Q4 2020. Short-Acting Hydrocodone, Oxycodone, and Tramadol were the most-prescribed opioids in Georgia during both 2019 and 2020. The number of registered PDMP users increased by 12.5% from December 2019 to May 2020. Patient queries by prescribers (or their delegates) and dispensers increased from 9.0 million queries in 2019 to 10.5 million queries in 2020.
Prescription Drug Monitoring Program Report, Georgia, 2020

PDMP Data Indicators
Data Source
All schedule II-V drug prescriptions dispensed and reported to the Georgia Prescription Drug Monitoring Program during 20162020
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: (1) 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; (2) 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 2020 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 events that occurred among Georgia residents per 1,000 population using 2018 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.
Prescription Drug Monitoring Program Report, Georgia, 2020

Prescription Drug Monitoring Program Data Indicators

Prescriptions by Drug Type, Georgia, 2016-2020

2016 2017 2018 2019 2020

No. Rx (millions)

10.0

9.0

8.6 8.0

8.0 7.0

6.6 6.9 6.3

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Opioids

3.9 3.6 3.2 3.0 2.6
Benzodiazepines

2.4 2.3 2.0 2.2 1.8 Stimulants

Opioids are the most frequently prescribed controlled substance in Georgia, followed by benzodiazepines.
From 2019 to 2020, the number of opioid prescriptions decreased by 9%, benzodiazepine prescriptions by 12%, and stimulants by 18%.

Opioid Prescriptions by Quarter, Georgia, 2016-2020

March 8, 2016

2.30

CDC releases

2.2

guidelines for opioid

2.20 2.10

2.1 2.1 2.1

prescribing

2.1 2.1

2.1

July 1, 2017 Dispensers required to report within 24 hours;
DPH begins administering PDMP

March 11, 2020 COVID-19 pandemic
declared

No Rx (millions)

2.00

1.90

May 4, 2017 GA PDMP bill signed

into law 1.80

1.9 1.9

1.70

January 1, 2018

Prescribers

1.60

required to

register

2.0 1.9
1.8 1.8

1.8 1.8 1.8

July 1, 2018 Prescribers required to check PDMP prior to
prescribing

1.8 1.6

1.50 2016 Q1 2016 Q3 2017 Q1 2017 Q3 2018 Q1 2018 Q3 2019 Q1 2019 Q3 2020 Q1 2020 Q3 Year and Quarter
In the first quarter of 2019, there were 1,896,713 opioid prescriptions dispensed compared to 1,945,362 prescriptions in the last quarter of 2020.

Prescription Drug Monitoring Program Report, Georgia, 2020

Opioid Prescription Rates, by Age and Sex, Georgia, 2016-2020

Rx/ 1,000 population

1800.0 1600.0 1400.0 1200.0 1000.0
800.0 600.0 400.0 200.0
0.0 <1
2016 8.2 2017 6.8 2018 5.0 2019 7.1 2020 6.9

2016 2017 2018 2019 2020
1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ female male 17.6 43.8 242.5 599.8 899.4 1225.3 1683.3 1699.4 1650.0 1608.8 953.4 704.9 14.0 37.3 206.9 517.0 812.1 1105.4 1565.6 1612.5 1554.9 1510.2 875.9 651.0 11.8 29.8 161.7 406.4 646.1 875.2 1307.6 1411.0 1414.8 1344.4 727.3 537.7 14.1 33.2 161.4 391.6 663.7 912.5 1405.9 1593.8 1583.8 1562.0 781.6 578.4 10.7 27.1 141.7 346.4 610.2 838.4 1334.5 1572.5 1572.5 1553.5 738.0 544.6
Age Group (years)

From 2019 to 2020, the rate of opioid prescriptions dispensed in Georgia decreased by 12% among persons aged 5-54 years, 5% among those aged 55-64 years, 1% among those aged 65-74 years, 1% among those aged 75-84 years, and 1% among those aged 85+.
Opioid prescriptions decreased 6% among both males and females.

Average No. Days Supplied per Rx

No. Rx or Patients (millions)

Opioid Prescriptions, Patients, and Average Days Supplied per

Rx, Georgia, 2016-2020

10.0

17.8

18.1

18.2

17.9

18.3

20.0

8.0 8.6
6.0
4.0
2.0 2.3
0.0 2016

8.0
2.2 2017

7.5
2.0 2018

7.2
2.1 2019

15.0 6.9
10.0
5.0 1.9
0.0 2020

No. Rx

No. Patients/1000

Days/Rx

The number of opioid prescriptions and patients receiving opioid prescriptions decreased by 9% and 10%, respectively, from 2019 to 2020.
The average number of days dispensed per opioid prescription increased by 2%.

Prescription Drug Monitoring Program Report, Georgia, 2020

% of Patients

Percent Patients Receiving an Average Daily Dose 90 Morpine Miligram Equivalents of Opioids, by Quarter,
Georgia, 2016-2020

9.0 8.0 7.0

8.0 7.9 7.8 7.9 8.1 7.8 7.9 7.7 7.9 7.3 7.1 7.2 7.7 7.7 7.4 7.1 6.8 6.4 6.9 6.7

6.0

5.0

4.0

3.0

2.0

1.0

0.0 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 2019 2019 2019 2019 2020 2020 2020 2020 Q1 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 2016 CDC Opioid Prescribing Guidelines recommended that daily opioid dosages should not
exceed 90 morphine milligram equivalents (MME). The graph above represents the quarterly percent of patients in Georgia who were receiving an
average daily dose of 90 (MME) of opioids during 2016-2020. The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of
opioids decreased by 13% from Q1 2019 to Q4 2020.

Prescription Drug Monitoring Program Report, Georgia, 2020

Prescription Drug Monitoring Program Report, Georgia, 2020

Prescription Drug Monitoring Program Report, Georgia, 2020

Top Ten Opioids Prescribed, Georgia, 20192020

No. prescriptions No. prescription

Rank Opioid drug

2019

2020

1

Hydrocodone

2,395,539

2,161,64

2

Oxycodone

1,664,550

1,490,319

3

Tramadol

1,545,906

1,457,583

4

Codeine

402,845

351,153

5

Buprenorphine

268,732

219,944

6

Morphine

175,396

159,344

7

Fentanyl

106,358

91,953

8

Methadone

68,764

61,037

9

Oxycodone

72,384

63,223

10

Morphine

86,992

87,522

Prescription Drug Monitoring Program

Registrations and Patient Queries, Georgia, 20192020

No. registered No. registered No. patient

No. patient

PDMP user type

as of 12/31/2019

as of 12/31/2020

queries 2019 queries 2020

Dentist

4,804

4,906

68,296

56,497

Dispensing Physician

38

39

956

759

Medical Resident

2,619

3,155

31,309

48,709

Midwife

140

159

1,324

4,514

Nurse Practitioner

6,416

7,197

862,643

1,197,243

Optometrist

966

1,002

3,732

3,700

Out-of-State Pharmacist

142

164

4,460

2,209

Out-of-State Prescriber

190

282

6,674

8,564

Pharmacist

11,877

282

3,404,914

4,001,188

Pharmacist's Delegate

330

377

51,081

50,569

Physician (MD, DO)

27,059

29,034

3,657,990

4,154,509

Physician Assistant

3,209

3,517

396,128

503,405

Podiatrist

440

463

9,312

10,229

Prescriber Delegate

1,451

1,665

542,430

481,806

Veterans Affairs Prescriber

106

156

4,232

7,190

TOTAL

59,787

50,451

9,045,481

10,531,091

Prescription Drug Monitoring Program Report, Georgia, 2020

Prescription Drug Monitoring Program Indicators, Georgia, 20192020
See Prescription Drug Monitoring Program Data Indicators table for description of indicators below

2019

2020

Indicator description

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

No. opioid prescriptions

6,899,412 1,763,003 1,756,751 1,710,762 1,668,896 6,251,867 1,585,454 1,523,364 1,610,562 1,532,487

No. stimulant prescriptions No. benzodiazepine prescriptions 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

2,179,301 601,541 2,979,620 782,361

757.1

N/A

3,526,947 915,145

335.3

87.0

18.0

17.8

7.5

7.7

555,320 776,638
N/A 880,836
83.7 17.9
7.7

524,873 737,419
N/A 853,030
81.1 18.0
7.4

497,567 1,795,379 520,162 683,202 2,853,933 702,282

N/A

726.0

N/A

877,936 3,219,308 850,103

83.5

306.0

80.8

18.1

18.3

18.2

7.1

6.7

6.8

432,637 657,931
N/A 740,428
70.4 18.9
6.4

422,443 885,978
N/A 814,667
77.4 18.1
6.9

420,137 607,742
N/A 814,110
77.4 18.1
6.7

Prescription Drug Monitoring Program Report, Georgia, 2020

Prescription Drug Monitoring Program Indicators by Age and Sex, Georgia, 2020

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

870

6

517

6.9

1,212

6.5

8.9

1-4 years

5,652

882

7,778

10.7

5,073

9.6

7.9

5 -14 years

38,350

507,543

33,542

27.1

32,326

22.9

9.7

15-24 years 204,694

330,789

87,388

141.7

163,457

113.1

5.9

25-34 years 510,321

283,592

273,811

346.4

256,295

173.9

10.6

35-44 years 837,576

267,382

473,945

610.2

286,240

208.5

15.2

45-54 years 1,183,291

201,950

663,711

838.4

331,648

234.9

18.2

55-64 years 1,715,750

116,465

832,763

1,334.5

378,679

294.5

20.5

65-74 years 1,408,039

41,784

642,606

1,572.5

309,183

345.2

20.8

75-84 years 649,907

6,894

338,322

1,553.5

151,197

361.4

20.4

85+ years 226,572

1,101

142,768

1,545.2

51,864

353.7

19.1

Sex

Male 2,785,882

930,499

1,141,282

544.6

769,808

150.5

18.2

Female 3,988,339

873,195

2,237,245

738

1,098,045

203.2

18.0

DPH Epidemiology, Drug Surveillance Unit https://dph.georgia.gov/drug-overdose-surveillance-unit
Prescription Drug Monitoring Program Report, Georgia, 2020