Updated: October 2024

Author: Division of Substance Use Programs, Vermont Department of Health

Vermont prescribers have made a concerted effort to only prescribe opioids when essential, and instead use other means for controlling pain. This has resulted in a significant decrease in opioids prescribed to Vermonters.

A single opioid prescription can be prescribed with a different number of doses, in differing strengths, or in different formulations. This can make comparisons across prescriptions challenging. Morphine milligram equivalents (MMEs) are a way to standardize and compare prescriptions across these variations. Many research experts, federal agencies (e.g., CDC, BJA, SAMHSA) and VPMS use MMEs in order to better understand the abuse and overdose potential of opioid analgesics. The recent increase from 2022 to 2023 is likely due to improvements in the number of products for which MME can be calculated, rather than an increase in prescribing.

Total MME is a indication of the total amount of opioids dispensed in the state. Reducing the amount of opioids dispensed is an important part of the statewide strategy to reduce opioid overdose and dependence. Total MME is reported as a rate per 100 people in Vermont to allow comparisons between counties of different sizes.

Many Americans suffer from chronic pain and deserve safe and effective pain management. Prescription opioids can help manage some types of pain in the short term. However, there is limited information about the benefits of opioids long term, and there are serious risks of opioid use disorder and overdose.

Prescription opioids provide a point of initiation of future opioid abuse or dependence. Pooling data from 2002 to 2012, the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not (0.39 vs. 0.02 percent) (Muhuri et al., 2013). A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (Lankenau et al., 2012). This rate represents a shift from historical trends. Of people entering treatment for heroin addiction who began abusing opioids in the 1960s, more than 80 percent started with heroin. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug (Cicero et al., 2014). Examining national-level general population heroin data (including those in and not in treatment), nearly 80 percent of heroin users reported using prescription opioids prior to heroin (Jones, 2013; Muhuri et al., 2013).

• Patients
• Prescribers
• Pharmacists
• Treatment Providers
• Insurers
• Community coalitions
• Harm reduction agencies
• Center for Disease Control
• Substance Abuse and Mental Health Administration

Vermont is taking a multi-faceted approach to addressing opioid addiction that involves multiple community partners. The Health Department has a leading role in the State’s response. Read more about Vermont's response to opioids.

Data are from the Vermont’s prescription drug monitoring program, known as the Vermont Prescription Monitoring System (VPMS). VPMS is a statewide electronic database of Schedule II – IV controlled substance prescriptions dispensed from Vermont-licensed pharmacies. It does not include all prescriptions.

VPMS is a clinical tool that exists to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse, and diversion of controlled substances.

• Individuals can, and do, fill prescriptions at pharmacies that are not Vermont-licensed. For example, some residents fill prescriptions in New Hampshire. These prescriptions are not included in the VPMS data.
• VPMS does not currently collect data on controlled substances dispensed from emergency rooms, veterinarian offices or opioid treatment programs (OTPs) that dispense methadone and buprenorphine for opioid addiction, such as those treated in a “hub’. It DOES contain data from office-based opioid treatment at a physician’s office, such as those treated in a “spoke”.
• Data submitted to VPMS by pharmacies can contain errors. Each data upload from a pharmacy is screened for errors and sent back to the pharmacy to be corrected if errors are discovered. However, not all errors are found or corrected.
• Finally, the VPMS data is for prescriptions dispensed. The VPMS does not contain information regarding when, or if, a prescription was picked up or how a prescribed medication is used.

Routine reporting on the VPMS is available on the Vermont Prescription Monitoring System website.

Note:  The 2014-2015 increase in MME is attributable in part to the August 14, 2014 rescheduling of tramadol from a Schedule V to a Schedule IV drug. VPMS only collects data on Schedule II-IV controlled substances; therefore prior to rescheduling, tramadol was not reported to VPMS and is not included in the calculations. The total MME of dispensed opioids has consistently decreased after 2015.

Information included on this page drew from research and the established literature. For more information, please see this CDC Fact Sheet.