PurposeThe opioid epidemic in the United States began with medical providers over-prescribing opioids. Florida, which led the country in opioid-prescribing physicians, was unique during this period because of its lax prescribing laws and high number of unregulated pain clinics. Here we address the difference in distribution rates of oxycodone and hydrocodone across Florida counties during the peak years of the opioid epidemic.MethodsWashington-Post and the United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) databases provided longitudinal oxycodone and hydrocodone prescription data in grams per county (2006-2014) and statewide (2006-2021). Grams of oxycodone and hydrocodone were converted to morphine milligram equivalents (MME) for comparison.ResultsThere was a steep increase in oxycodone from 2006 to 2010, with subsequent decline. Hydrocodone distribution decreased slightly from 2006 to 2014. In peak year, 2010, the average MME per person across all counties in Florida was 729.4, a 120.6% increase from 2006. The three individual counties with the highest MME per person in 2010 were Hillsborough (2,271.3), Hernando (1,915.3), and Broward (1,726.9) and were significantly (p < .05) elevated relative to the average county. MME per person was highly correlated (r=0.91) with MME per pharmacy, therefore in most counties, both values rose together.ConclusionThe novel data demonstrated pronounced differences in opioid distribution, particularly oxycodone, between Florida counties during the height of the opioid epidemic. Legislative action taken between 2009 and 2011 aligns with the considerable decline in opioid distribution after 2010.Key PointsThe 2000s saw a rise in opioid use, misuse, and overdose deaths across the United States, especially in Florida.Morphine Milligram Equivalents (MME) of oxycodone increased 230.2% in Florida from 2006 to the peak distribution year, 2010.Average MME per person in the state increased 120.6% from 2006 to 2010, while some counties’ MME per person rose over 150%.Eleven counties’ average MME per person were significantly higher than the state’s average.There was considerable variation between counties—16.6x higher MME per person in Hillsborough than in Liberty in 2010.Plain Language SummaryThe opioid epidemic in the United States began with medical providers over-prescribing opioids. Florida, which led the country in opioid-prescribing physicians, was unique during this period because of its lax prescribing laws and high number of unregulated pain clinics. Here we address the difference in the distribution of two popular opioids, oxycodone, and hydrocodone, across Florida counties during the peak years of the opioid epidemic. The United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) database obtained by the Washington Post provided oxycodone and hydrocodone data from 2006 to 2014. Grams of oxycodone and hydrocodone were converted to morphine milligram equivalents (MME), a standardized opioid measurement, for comparison. There was a steep increase in oxycodone from 2006 to 2010, followed by a decline. Hydrocodone decreased slightly from 2006 to 2014. In the peak year, 2010, the average MME per person across all counties in Florida was 729.4, a 120.6% increase from 2006. The three counties with the highest MME per person in 2010 were Hillsborough, Hernando, and Broward and were significantly (p < .05) elevated relative to the states average. The data demonstrated major differences in opioid distribution, particularly oxycodone, between Florida counties during this period.