Prescription Drug Monitoring Program, 2021

12/05/2022 2
Prescription DSrUuBgT I TML Eonitoring Program, 2021
Epidemiology, Drug Surveillance Unit

THE PRESCRIPTION DRUG
MONITORING PROGRAM (PDMP)
The purpose of this report is to describe opioid prescribing patterns in Georgia during 2021. 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.
Georgia PDMP, 2021: Key Findings
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Georgia saw improvements in opioid prescribing practices from 2020 to 2021, as evidenced by these PDMP indicators:
In 2021, there were 6,624,467 opioid prescriptions dispensed to 1,908,203 patients in Georgia. These prescriptions averaged 18.0 days of opioids dispensed per prescription.
From 2020 to 2021, the number of opioid prescriptions statewide decreased by 8%, benzodiazepine prescriptions by 14%, and stimulants by 8%.
The number of patients receiving opioid prescriptions did not change from 2020 to 2021. The average number of days dispensed per opioid prescription decreased by 2%.
In the first quarter of 2020 (Q1), there were 1,790,484 opioid prescriptions dispensed compared to 1,682,018 prescriptions in the last quarter of 2021 (Q4).
From 2020 to 2021, the rate of opioid prescriptions dispensed in Georgia decreased by 4% among persons aged 5-54 years, 4% among those aged 55-64 years, increased by 1% among those aged 65-74 years, increased by 3% among those aged 75-84 years, and decreased by 2% among those aged 85+. Opioid prescriptions decreased by 3% among males and 2% among 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) per day. The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of opioids decreased by 6% from Quarter 1 (Q1) 2020 to Q4 2021.
Hydrocodone, Oxycodone, and Tramadol were the most-prescribed opioids in Georgia during both 2020 and 2021.
The number of registered PDMP users increased by 13.7% from December 2020 to May 2021. Patient queries by prescribers (or their delegates) and dispensers increased from 10.5 million queries
in 2020 to 11.7 million queries in 2021.
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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 20162021.
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 ageadjusted 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 & Year, Georgia, 2016-2021

No. Prescriptions (millions)

10.0

2016 2017 2018 2019 2020 2021

9.0 8.6 8.0

8.0

7.5

6.9

7.0

6.3

6.0

5.8

5.0

4.0

3.9 3.6 3.5

3.0

3.0 2.6 2.3

2.4 2.3 2.5 2.2

2.0

1.8 1.7

1.0

0.0

Opioids

Benzodiazepenes

Stimulants

From 2020 to 2021, the number of opioid prescriptions decreased by 8%, benzodiazepine

prescriptions by 14%, and stimulants by 8%.

Opioids are the most frequently prescribed controlled substance in Georgia, followed by benzodiazepines and stimulants.

Opioid Prescriptions by Quarter, Georgia, 2016-2021

No Rx (millions)

July 1, 2017

2.30

Dispensers required to

2.2

2.20 2.1 2.1 2.1

2.1

2.10

2.1

report within 24 hours; DPH begins administering PDMP
2.1

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

March 8, 2016

CDC releases 2.00 guidelines for opioid
prescribing
1.90

1.9 1.9

1.80 May 4, 2017

2.0 1.9
1.8 1.8

1.8 1.8
1.8

GA PDMP bill signed

1.70

into law

January 1, 2018

Prescribers

1.6

required to

1.60

register

March 11, 2020 COVID-19
pandemic declared
1.8
1.7 1.6 1.6

1.50

2016 Q1 2016 Q3 2017 Q1 2017 Q3 2018 Q1 2018 Q3 2019 Q1 2019 Q3 2020 Q1 2020 Q3 2021 Q2 2021 Q4

Year and Quarter
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In the first quarter of 2020, there were 1,790,484 opioid prescriptions dispensed compared to 1,682,018 prescriptions in the last quarter of 2021.

Rx/ 1,000 population

1800 1600 1400 1200 1000
800 600 400 200
0
2016 2017 2018 2019 2020 2021

Opioid Prescription Rates, by Age and Sex, Georgia, 20162021
2016 2017 2018 2019 2020 2021

<1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ female male

8

18 44 243 600 899 1225 1683 1699 1650 1609 953 705

7

14 37 207 517 812 1105 1566 1613 1555 1510 876 651

5

12 30 162 406 646 875 1308 1411 1415 1344 727 538

7

14 33 161 392 664 913 1406 1594 1584 1562 782 578

7

11 27 142 346 610 838 1335 1573 1573 1554 738 545

6

11 26 140 319 590 801 1283 1587 1610 1521 725 528

Age Group (years)

From 2020 to 2021, the rate of opioid prescriptions dispensed in Georgia decreased by 4% among persons aged 5-54 years, 4% among those aged 55-64 years, increased by 1% among those aged 65-74 years, increased by 3% among those aged 75-84 years, and decreased by 2% among those aged 85+.
Opioid prescriptions decreased by 3% among males and 2% among females.

Average No. Days Supplied per Rx

No. Rx or Patients (millions)

Opioid Prescriptions, Patients, and Average Days Supplied per Rx,

Georgia, 2016-2021

10.0

17.8

18.1

18.2

17.9

18.3

18.0

20.0

8.0

8.6

6.0

4.0

2.0 2.3
0.0 2016

8.0

7.5

7.2

6.9

2.2 2017
No. Rx

2.0

2.1

2018

2019

No. Patients/1000

1.9 2020 Days/Rx

15.0

6.6

10.0

5.0
1.9 0.0
2021

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% of Patients

The number of opioid prescriptions decreased by 4% and no changes seen in patients receiving opioid prescriptions, from 2020 to 2021.
The average number of days dispensed per opioid prescription decreased by 2%.
Percent Patients Receiving an Average daily Dose 90 Morpine Miligram Equivalents of Opioids, by Quarter,
Georgia, 2017-2021
10.0 8.0 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 6.2 6.4 6.3 6.3 6.0 4.0 2.0 0.0 2017 2017 2017 2017 2018 2018 2018 2018 2019 2019 2019 2019 2020 2020 2020 2020 2021 2021 2021 2021 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 graph above represents the quarterly percent of patients in Georgia who were receiving an
average daily dose of 90 (MME) of opioids during 2017-2021. The percent of patients in Georgia who were receiving an average daily dose of 90 (MME) of
opioids decreased by 6% from Q1 2020 to Q4 2021.
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8

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Top Ten Opioids Prescribed, Georgia, 20202021

Rank

Opioid drug

No. prescriptions No. prescription

2020

2021

1

Hydrocodone

2,322,421

2,256,119

2

Oxycodone

1,717,871

1,740,226

3

Tramadol

1,495,536

1,445,006

4

Codeine

507,528

473,779

5

Buprenorphine

328,838

321,426

6

Morphine

260,887

246,195

7

Fentanyl

95,092

84,778

8 Hydromorphone

63,665

60,210

9

Methadone

65,148

57,270

Codeine,
10
Bultabital

23,476

21,401

Prescription Drug Monitoring Program

Registrations and Patient Queries, Georgia, 20202021

PDMP user type No. registered as No. registered as No. patient of 12/31/2020 of 12/31/2021 queries 2020

No. patient queries 2021

Dentist

4,906

5,085

56,497

61,705

Dispensing Physician

39

42

759

2,612

Medical Resident

3,155

3,695

48,709

59,915

Midwife

159

164

4,514

7,295

Nurse Practitioner

7,197

7,840

1,197,243

1,459,237

Optometrist

1,002

1,049

3,700

5,042

Out-of-State Pharmacist

164

177

2,209

1,498

Out-of-State Prescriber

282

275

8,564

7,242

Pharmacist

282

13,536

4,001,188

4,087,125

Pharmacist's Delegate

377

429

50,569

54,074

Physician (MD,DO)

29,034

30,916

4,154,509

4,889,312

Physician Assistant

3,517

3,835

503,405

632,821

Podiatrist

463

554

10,229

12,521

Prescriber Delegate

1,665

1,839

481,806

480,392

Veterans Affairs Prescriber

156

202

7,190

13,739

TOTAL

50,451

69,638

10,531,091

11,774,530

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Prescription Drug Monitoring Program Indicators, Georgia, 20202021
See Prescription Drug Monitoring Program Data Indicators table for description of indicators below

2020

2021

Indicator description

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

No. opioid prescriptions

6,251,867 1,585,454 1,523,364 1,610,562 1,532,487 6,743,732 1,669,675 1,708,774 1,683,265 1,682,018

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

1,795,379 520,162 2,853,933 702,282

726.0

N/A

3,219,308 850,103

306.0

80.8

18.3

18.2

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 1,656,746 414,064 607,742 3,192,057 804,775

N/A

726.0

N/A

814,110 3,210,428 791,281

77.4

305.0

75.2

18.1

17.9

17.9

6.7

6.3

6.2

406,160 801,127
N/A 815,268
77.5 17.8
6.4

418.422 800,520
N/A 798,907
75.9 18.0
6.3

418,100 785,635
N/A 804,972
76.5 17.9
6.3

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Prescription Drug Monitoring Program Indicators by Age and Sex, Georgia, 2021

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

747

7

408

5.9

617

4.0

12.0

1-4 years

5,917

804

7808

11.2

4,888

11.5

9.0

5 -14 years

38,922

447,151

33,073

27.5

28,496

20.2

10.0

15-24 years 207,835

312,905

77,398

143.8

152,023

105.2

6.0

25-34 years 482,624

274,911

241,504

333.0

232,380

157.7

10.0

35-44 years 828,722

266,557

448,840

603.8

274,230

199.8

15.0

45-54 years 1,155,328

197,158

567,128

818.5

306,698

217.3

18.0

55-64 years 1,677,706

110,610

714,739

1,304.9

358,588

278.9

20.0

65-74 years 1,440,719

38,780

617,866

1,608.9

310,465

346.7

21.0

75-84 years 682,358

6,886

341,317

1,631.0

161,827

386.8

20.0

85+ years 225,330

979

141,976

1,536.6

57,163

389.8

19.0

Sex

Male 2,747,044

835,330

1,065,204

537.0

773,438

151.2

18.0

Female 3,993,426

821,301

2,123,392

738.9

1,111,675

205.7

18.0

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