Purpose

Overview of controlled substance dispensation trends from 2019–2024.

Definitions

• Controlled Substances: medications with the potential for misuse, dependence, or abuse, regulated under the Controlled Substances Act (United States Drug Enforcement Administration, 2022)

• Opioid: Includes opioid agonists and partial agonists, which are medications that activate opioid receptors to provide pain relief.

• Benzodiazepine: Includes benzodiazepine-based anticonvulsants and sedative/anxiolytic medications, commonly used for anxiety, insomnia, and seizures.

• Stimulants: Includes amphetamine derivatives, amphetamines, respiratory/CNS stimulants, and wakefulness-promoting agents, primarily used for ADHD, narcolepsy, cognitive alertness, and weight loss.

• Pills: Identifies medications in tablet or capsule form, distinguishing them from other dosage types.

• Buprenorphine: A partial opioid agonist used mainly for opioid dependence treatment and pain management.

• Unique searchers: The number of separate individuals performing searches in a database, system, or platform during a specific time frame.

• AWARxE: A CSPMP platform that allows authorized users to access and manage information about controlled substance prescriptions to enhance patient safety and reduce misuse.

• Gateway: A health information exchange or integration tool that allows prescribers and pharmacists to access PDMP data directly within their existing workflow systems, such as electronic health records or pharmacy management systems.

Figures

Controlled Substance Dispensations

In 2024, a total of 10,591,016 controlled substance prescriptions were dispensed, reflecting an 8.6% increase from 2023 (9,756,576) and a 4.9% increase compared to 2019 (10,098,791).

Over the six-year period, prescription trends show some fluctuations, with a decline from 2019 to 2023, followed by a notable rebound in 2024. This increase may be attributed to factors such as evolving prescribing practices, regulatory changes, increased healthcare access, or shifts in patient needs. The significant rise in 2024 highlights the importance of continued monitoring and policy adjustments to ensure appropriate use and mitigate risks associated with controlled substances.

Prescriptions from Arizona-based prescribers decreased each year until 2024, when they increased from 8,363,252 in 2023 to 8,621,141 in 2024. Similarly, prescriptions from out-of-state prescribers saw a significant increase of 41% in 2024.

Dispensations by Drug Type

Opioid: The number of opioid prescriptions dispensed has shown a consistent decline over the six-year period. In 2024, a total of 3,935,380 opioid prescriptions were dispensed, representing a 12.5% decrease compared to 2019 (4,499,834). This long-term decline reflects ongoing efforts to address the opioid epidemic through stricter prescribing guidelines, increased public health awareness, and alternative pain management approaches.

Compared to 2023 (3,858,702), there was a 2% increase in opioid prescriptions dispensed in 2024. This continued decline suggests that regulatory efforts and alternative pain management strategies remain effective in reducing opioid prescribing trends.

Prescriptions from Arizona-based prescribers remained relatively stable, totaling 3,536,348 prescriptions, slightly up from 3,528,432 in 2023. However, prescriptions from out-of-state prescribers saw a notable increase of 21%, in 2024.

The average number of pills dispensed per prescription has shown a slight decline over the past five years. From 65.0 pills in 2019, it decreased to 62.3 pills in 2024, marking a reduction of approximately 3 pills per prescription since 2019.

Benzodiazepine: The number of benzodiazepine prescriptions dispensed declined from 2019 to 2023 but saw a 9.0% increase in 2024, reaching 2,141,985 prescriptions, an increase of 176,417 prescriptions.

Benzodiazepine Dispensations by Prescriber State

Prescriptions from Arizona-based prescribers remained relatively stable, with 1,403,076 prescriptions, slightly down from 2023 (1,403,983). However, prescriptions from out-of-state prescribers saw a significant increase, rising from 561,346 in 2023 to 738,871 in 2024, an increase of 177,525 prescriptions and accounting for the entire increase in benzodiazepine prescriptions dispensed in the state. 

Stimulant: The number of stimulant prescriptions dispensed has shown a consistent increase over the last six years, reflecting growing demand for these medications. In 2024, a total of 2,100,102 stimulant prescriptions were dispensed, representing a 34.4% increase compared to 2019 (1,561,546) and a 10.9% increase compared to 2023 (1,893,655).

Prescriptions from Arizona-based prescribers have been steadily increasing with a drop in 2023 (85,909) and an increase in 2024(127,837). Prescriptions from out-of-state prescribers saw a significant increase of 49%, accounting for most of the increase in 2024

Buprenorphine Dispensations by Year

Buprenorphine: The total number of buprenorphine prescriptions dispensed has shown a steady increase over the six-year period, reflecting growing efforts to address opioid use disorder (OUD) through medication-assisted treatment (MAT). In 2024, a total of 367,127 buprenorphine prescriptions were dispensed, representing a 37.5% increase compared to 2019 (266,913) and a 13.2% increase compared to 2023 (324,406). 

Prescriptions from Arizona-based prescribers remained relatively stable, with a total of 333,019 prescriptions, slightly up from 301,247 in 2023. Prescriptions from out-of-state prescribers saw a significant increase of 49%, accounting for most of the increase in 2024

Androgen Dispensations by Prescriber State

Androgens: The number of androgen prescriptions dispensed has steadily increased over the six-year period, reaching 605,774 in 2024, a 43.9% rise from 2019 and a 21.7% increase from 2023. While prescriptions from Arizona-based prescribers grew by 12.6%, out-of-state prescriptions more than doubled. This trend may reflect expanding telemedicine services, increased cross-state patient care, or shifts in prescribing networks. 

Patient Demographics Analysis

Number of Dispensed Prescriptions by Age Group (2019–2024) 

In 2024, the 65 to 74 age group had the highest prescription count (2,285,352), a trend also reflected in opioid (977,595) and benzodiazepine (543,749) prescriptions.

The 25 to 34 age group experienced the highest growth, with prescriptions increasing 56.2% from 2019 to 2024, a trend also seen in stimulant prescriptions (416,708 in 2024), which may suggest an increasing number of ADHD diagnoses and treatments among younger adults. 

The 35 to 44 age group saw a 9.4% increase from 2023 to 2024, with stimulant (483,863) and buprenorphine (110,684) prescriptions contributing heavily to this rise.

A notable increase was observed in the 1 to 4 age group, where prescriptions for all controlled substances more than doubled, rising from 4,954 in 2022 to 11,960 in 2024. Similarly, prescriptions for opioids nearly doubled, benzodiazepines tripled, and stimulant prescriptions more than doubled. 

Number of Dispensed Prescriptions by Gender (2019–2024)

Prescription trends by gender show notable differences in controlled substance utilization. In 2024, female patients accounted for 6,089,705 prescriptions, while male patients received 4,457,878 prescriptions. Female patients consistently receive more opioids (2,268,721 vs. 1,662,728 for males), benzodiazepines (1,365,971 vs. 773,285 for males), and stimulants (1,184,017 vs 908,963 for males). Buprenorphine prescriptions, however, were higher in males (215,786 vs. 151,019 for females), which could reflect the higher prevalence of opioid use disorder (OUD) in men and the focus on expanding access to treatment.

Dispensations by Patient County

(mouse over the maps to view county statistics)

Geographic Analysis: In-depth review of prescription rates by county in 2019 and 2024.

Yavapai and Gila counties consistently reported the two highest prescription rates for controlled substances, as well as for opioids, benzodiazepines, and buprenorphine. 

Gila County reported the highest opioid prescription rate in 2024 at 776.11 per 1,000 people. Yavapai County followed closely, with 719.86 prescriptions per 1,000 people.

Yavapai County also had the highest benzodiazepine prescription rate at 274.10 per 1,000 people in 2024. Gila County (256.47) and Cochise County (220.07) also reported high benzodiazepine prescription rates.

Yavapai County also had the highest buprenorphine prescription rate in 2024 at 82.41 per 1,000 people. Gila followed closely with 71.12 per 1,000 people, leaving a large gap before the county with the third highest rate (Pima at 53.99 per 1,000).

Urban counties like Maricopa and Pima maintained stable and moderate controlled substance prescription rates due to below median opioid prescription rates. In 2024, Maricopa recorded 1,165.50 controlled substance prescriptions and 409.59 opioid prescriptions per 1,000 people, while Pima reported 1,170.65 controlled substance prescriptions and 433.94 opioid prescriptions per 1,000 people. 

Maricopa County had the highest stimulant prescription rate at 297.17 per 1,000 people, indicating significant prescribing for attention-deficit/hyperactivity disorder (ADHD) and related conditions in the state’s most populous county. Pima County followed with 258.59, and Pinal County reported 237.55, showing higher stimulant utilization in urban and suburban areas.

Mohave County, notably, had consistently high opioid prescription rates but relatively low buprenorphine prescribing rates. In 2024, Mohave had the third highest opioid prescription rate at 657.63 opioid prescriptions per 1000 people, and the ninth of fifteen counties in buprenorphine prescription rate at 36.29 buprenorphine prescriptions per 1000 people. In contrast, counties like Santa Cruz (245.82) and Greenlee (304.84) reported significantly lower opioid prescription rates. Santa Cruz County also reported the lowest stimulant prescription rate at 83.22 per 1,000 people.

Notable county-level changes in all controlled substances include: 

• La Paz County experienced a more significant decrease from 2019 to 2024.

• Gila County showed a slight decline from 2019 to 2024.

• Cochise County saw an increase in 2024 compared to 2023.

• Pinal County exhibited an increase in prescription rates in 2024 compared to 2023, reversing previous declines.

Top 5 Dispensed Prescriptions in 2024 by Drug Type

Top 5 Controlled Substances Dispensed in 2024

The top five controlled substances dispensed in 2024 remained the same as in 2023, though changes in prescription volumes indicate evolving utilization patterns. Oxycodone remained the most dispensed controlled substance, with a slight 2.0% increase, while dextroamphetamine saw the largest growth at 20.9%. Hydrocodone prescriptions declined by 5.2%, while tramadol prescriptions rose by 5.7%. Alprazolam prescriptions increased by 11.3%. These trends suggest rising stimulant use, stable opioid demand with some shifts, and persistent benzodiazepine utilization.

Top 5 Opioid Controlled Substances Dispensed in 2024

The top five opioids dispensed in 2024 remained the same as in 2023, though rankings and prescription volumes shifted. Oxycodone remained the most dispensed opioid, while tramadol moved up to second place with a 5.7% increase. Hydrocodone saw a 5.3% decline, dropping to third place, suggesting possible shifts in prescribing preferences. Buprenorphine prescriptions increased by 13.2%, reflecting continued efforts to expand opioid use disorder treatment, while morphine prescriptions remained stable. These trends indicate evolving pain management practices and a growing emphasis on treatment for opioid dependence.

Top 5 Stimulant Controlled Substances Dispensed in 2024

The top five stimulants dispensed in 2024 remained the same as in 2023, though shifts in rankings and prescription volumes highlight evolving utilization patterns. Dextroamphetamine saw the largest increase (20.9%), reinforcing its growing role in ADHD treatment. Methylphenidate and amphetamine also increased, maintaining their positions as primary ADHD medications. In contrast, phentermine prescriptions declined by 5.0%, suggesting changing trends in weight management treatments. Modafinil saw a significant rise (23.5%), possibly reflecting increased recognition of sleep disorders.

Other Important CSPMP Functions

Interstate Data Sharing

Arizona currently shares data nationwide with 46 states, as well as Puerto Rico and the Military Health System. Interstate data collaborative efforts have increased the availability of valuable information for medical professionals to assist them in making the best healthcare decisions for their patients and deter drug diversion. Interstate data availability varies based on each state’s statutory limitations.

Utilization

• Number of Unique Searchers (Prescribers and Pharmacists) (2019–2024)

The integration data provides insights into the utilization of the Controlled Substances Prescription Monitoring Program (CSPMP) by prescribers and pharmacists across two platforms: Gateway, which represents Arizona-based users, and AWARxE, which includes both in-state and out-of-state prescribers and pharmacists.

Between 2019 and 2024, the number of practitioners using Gateway increased significantly. The number of prescribers using Gateway integrated systems to perform searches rose from 8,056 in 2019 to 14,942 people in 2024, an 85.5% increase. The number of pharmacists using Gateway integrated systems to perform searches also grew, from 1,703 in 2019 to 3,078 people in 2024, reflecting an 80.7% increase. This upward trend may suggest the impact of policy changes and the adoption of CSPMP integration tools by pharmacy entities, leading to greater real-time monitoring of controlled substance prescriptions.

In contrast, the number of individuals using the AWARxE web portal to perform searches has remained relatively stable over time. The number of prescribers performing searches through the web portal peaked at 13,312 in 2019 but slightly declined to 12,027 in 2024. Pharmacist searchers followed a similar trend, decreasing from 4,227 in 2019 to 3,670 in 2024.

Registration

• New Registrations in 2024

In 2024, 4,833 new registrations were approved in the CSPMP AWARxE system.

• Analysis of Unregistered Prescribers 

The unregistered prescribers tracker monitors the number of healthcare professionals not enrolled in the Controlled Substances Prescription Monitoring Program (CSPMP) at specific reporting intervals. The number of unregistered prescribers in the Controlled Substances Prescription Monitoring Program (CSPMP) decreased by 30.9% from December 2021 to December 2024, reflecting progress in compliance and engagement efforts. While most licensing boards showed reductions, fluctuations occurred, including an 8.63% increase between June 2023 and June 2024.

The overall trend suggests meaningful progress in reducing unregistered prescribers, though ongoing outreach and targeted interventions are needed to sustain reductions, particularly for licensing boards with slower compliance rates. Monitoring trends at regular intervals will remain crucial to ensure consistent improvements.

State Indicators (previously Clinical Alerts)

Summary and Analysis of State Indicators

The Controlled Substances Prescription Monitoring Program (CSPMP) employs state indicators to notify prescribers and pharmacists when patients under their care meet certain risk-based criteria. The goal of these alerts is to promote early intervention, improve patient safety, and mitigate the risks associated with controlled substance prescribing.

The data for 2023 and 2024 shows a decrease in the total number of state indicators, from 652,671 in 2023 to 615,279 in 2024—a 5.7% reduction. This decrease represents a positive accomplishment, as fewer patients are meeting high-risk thresholds.

The three types of state indicators include:

• Daily MME Threshold Indicator: Triggered when a patient's daily morphine milligram equivalent (MME) exceeds 90, indicating high-risk opioid use.

  • This alert decreased by 5.5%, reflecting growing awareness and adherence to opioid prescribing guidelines aimed at reducing high-dose opioid use.

• Opioid-Benzodiazepine Combination Indicator: Generated when a patient has overlapping active prescriptions for both an opioid and a benzodiazepine.

  • The alert saw a 5.8% reduction, highlighting the impact of targeted education and interventions to mitigate the risks of this dangerous drug combination.

• Prescriber/Pharmacy Threshold Indicator: Issued when a patient has received controlled substance prescriptions from 5 or more prescribers and filled them at 5 or more pharmacies within 90 days, suggesting potential misuse or diversion.

  • This alert experienced the largest proportional decrease, dropping by 9.0%, suggesting improved oversight and coordination between prescribers and pharmacists.

Mandatory Use/Compliance

The Arizona Controlled Substances Prescription Monitoring Program (CSPMP) tracks compliance with A.R.S § 36-2606(F), which mandates that medical practitioners perform a patient history search before prescribing opioids or benzodiazepines listed in schedules II-IV. The data for 2023 and 2024 demonstrates overall improvement in compliance, influenced by enhancements in measurement methods and continuous monitoring efforts.

In 2023, the total number of prescriptions requiring a search (opioid or benzodiazepine, schedule II-IV, not a refill, etc. more information can be found in the readmes at https://github.com/jbgreenh/pmp-mandatory-use) was 3,381,439. Of those prescriptions, 1,738,452 had a matching search, resulting in a compliance rate of 51.41% for the year. In 2024, the compliance rate increased to 56.27% (3,036,326 prescriptions, 1,706,867 of which had matching searches).

The overall increase in compliance rates reflects greater awareness and adherence among prescribers to mandatory use requirements. This improvement is likely due to consistent collaboration with licensing boards and the incorporation of specialty exemptions into compliance reports. Refinements in tracking methodologies and more accurate reporting have contributed to the observed improvements in compliance, indicating the effectiveness of CSPMP's efforts to ensure accountability.

Key Takeaways

General Trends

• Shifts in Opioid Prescriptions: A general decline in opioid prescribing from 2019 to 2024 suggests the impact of public health initiatives aimed at reducing misuse. 

• Rising Stimulant Prescriptions: Stimulant use has significantly increased, particularly in urban areas, aligning with higher ADHD diagnoses and expanded treatment in adults.

• Expanding Buprenorphine Use: Increased buprenorphine prescriptions suggest broader access to opioid use disorder (OUD) treatment. The elimination of the DATA-waiver requirement has made it easier for more healthcare providers to prescribe buprenorphine. Buprenorphine's safety profile, characterized by its low risk of overdose and reduced potential for misuse, also supports its growing use as an effective treatment option for OUD.

• In-State vs. Out-of-State Prescribing Trends: Prescriptions from out-of-state prescribers have seen significant increases across multiple drug types, particularly opioids, benzodiazepines, and buprenorphine. This suggests a growing reliance on out-of-state prescribers, possibly due to expanded access through telemedicine, changes in treatment networks, and cross-state care.

Demographic Trends

• Highest Utilization among Older Adults: In 2024, the 65 to 74 age group had the highest prescription utilization, particularly for opioids and benzodiazepines.

• Rising Buprenorphine Use in Younger Adults: The increase in buprenorphine prescriptions among adults aged 25 to 44 suggests growing access to medication-assisted treatment (MAT) for opioid use disorder.

• Growth in Ages 1 to 4: The sharp rises in opioid, benzodiazepine, and stimulant prescriptions for the 1 to 4 age group highlight a critical area for further investigation and monitoring.

Geographic Trends

• Regional Variations in Prescription Rates: Yavapai and Gila Counties continue to report higher prescription rates across drug types, while Santa Cruz and Greenlee maintain lower utilization patterns.

• Stimulant Prescriptions in Urban Areas: Maricopa and Pima Counties lead in stimulant prescriptions, which may align with higher ADHD diagnoses and increased access to behavioral health services. These counties are also where the two biggest universities in the state are located.

• Buprenorphine Access by County: Higher buprenorphine prescription rates in Yavapai, Pima, and Navajo Counties suggest stronger efforts in combating opioid use disorder, while lower rates in counties like Yuma may suggest gaps in MAT program accessibility.

References

Paiva, T. J., Wightman, R. S., St. John, K., Nitenson, A. Z., Onyejekwe, C., & Hallowell, B. D. (2024). Buprenorphine prescribing and treatment accessibility in response to regulation changes due to the COVID-19 public health emergency. Journal of Substance Use and Addiction Treatment, 162, 209382. https://doi.org/10.1016/j.josat.2024.209382

Ling, S., Mangaoil, R., Cleverley, K., Sproule, B., & Puts, M. (2019). A systematic review of sex differences in treatment outcomes among people with opioid use disorder receiving buprenorphine maintenance versus other treatment conditions. Drug and Alcohol Dependence, 197, 168-182. https://doi.org/10.1016/j.drugalcdep.2019.02.007

Chua KP, Bicket MC, Bohnert ASB, Conti RM, Lagisetty P, Nguyen TD. Buprenorphine Dispensing after Elimination of the Waiver Requirement. N Engl J Med. 2024 Apr 25;390(16):1530-1532. doi: 10.1056/NEJMc2312906. PMID: 38657250; PMCID: PMC11103581

Fcc.gov, Federal Information Processing System (FIPS) Codes for States and Counties, 2025, https://transition.fcc.gov/oet/info/maps/census/fips/fips.txt. accessed April 16, 2025.

U.S. Census Bureau, "American Community Survey (ACS) 5-Year Detailed Tables", 2023, https://api.census.gov/data/2023/acs/acs5, accessed April 16, 2025.