Supplemental Digital Content is Available in the Text.Total hospital opioid distribution decreased by 46.6% from 2012 to 2019, and over half (25 of 50 states) of the United States saw a 50% opioid weight distribution decrease in that time.

Introduction: The Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine. Methods: All arrests (N=11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed. Results: The counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, where stimulants were most common. Medical distribution of opioids varied. With the exception of buprenorphine, which doubled, many prescription opioids like hydrocodone, fentanyl, and oxymorphone exhibited large (>50%) reductions. Methadone was the predominant opioid statewide (56.4% of the total MME) although there were sizeable differences (Presque Isle=8.6%, Bangor=78.9%) and this is likely impacted by use for SUD treatment. Amphetamine distribution increased by 67.9%. Conclusions: The DAP was useful to prevent information silos and enhance communication between law enforcement and health care providers. Maines DAP was a unique system to identify patients in need of additional treatment resources. The increase in prescription stimulants may warrant continued monitoring.

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There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007–2012) versus post (2013–2017) marijuana legalization revealed statistically significant decreases for Colorado (P < 0.05) and Maryland (P < 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (–31.5%) than the other states (–14.2% to –23.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.

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