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.

Objective Understanding opioid use and distribution trends by geographic area is critical in addressing the ongoing opioid epidemic in the United States. This study is a county level analysis of oxycodone and hydrocodone use in Delaware, Maryland, and Virginia between 2006-2014. Materials and Methods A retrospective analysis of oxycodone and hydrocodone distributed as collected by the Drug Enforcement Administrations (DEA) Washington Post Automation of Reports and Consolidated Orders System (ARCOS) in Delaware, Maryland, and Virginia. Raw drug weights in each county were adjusted to daily average dose (grams/county population/365). Purchasing data collected from ARCOS was used to compare distribution trends during this period. Results There was a 57.59% in the weight of oxycodone and hydrocodone between 2006-2014. Oxycodone prescriptions increased by 75.50% and hydrocodone by 11.05%. Oxycodone increased across all three states between 2006-2010 and declined until 2014. Hydrocodone also increased but to a lesser extent than oxycodone. There was substantial variability in daily average dose of both opioids at the county level in all states. Pharmacies accounted for largest portion of oxycodone (69.17%) and hydrocodone (75.27%) purchased in the region. Hospitals accounted for 26.67% of oxycodone and 22.76% hydrocodone purchased. Practitioners and mid-level providers did not significantly contribute to this increase. Conclusion In the states of Maryland, Delaware, and Virginia, the distribution of the prescription opioids oxycodone and hydrocodone increased by 57.59%. Daily average dose increased between 2006-2010 in all three states followed by a decline until 2014. Variability in daily average dose by county highlights the relationship between geography and likelihood of receiving high dose opioids. It may further allude to effects of targeted distribution by pharmaceutical manufacturers and prescribing habits of geographically distinct healthcare entities. Relationships between location and opioid usage should continue to be investigated to promote rational use of controlled substances.

Objective Opioid medications are widely recognized for their use in analgesia and their addictive properties that have led to the opioid epidemic. Areas with historically high prescribing patterns have been shown to suffer more from the crisis. There is also regional variability in these trends. This study is a county level analysis of oxycodone and hydrocodone use in Delaware, Maryland, and Virginia between 2006 and 2014. Materials and methods A retrospective analysis of oxycodone and hydrocodone distributed as collected by the Drug Enforcement Administration’s (DEA) Washington Post Automation of Reports and Consolidated Orders System (ARCOS) in Delaware, Maryland, and Virginia. Raw drug weights in each county were adjusted to “daily average dose” (grams/county population/365) using publicly available population estimates for all state counties. Purchasing data collected from ARCOS was used to compare distribution trends during this period. This study was limited in that ARCOS report quantity of drug distribution rather than average dose of script written. Results There was a 57.59% increase in the weight of oxycodone and hydrocodone prescribed between 2006 and 2014. Oxycodone prescriptions increased by 75.50% and hydrocodone by 11.05%. Oxycodone increased across all three states between 2006 and 2010 and declined until 2014. Hydrocodone also increased but to a lesser extent than oxycodone. There was substantial variability in daily average dose of both opioids at the county level in all states. Pharmacies accounted for largest portion of oxycodone (69.17%) and hydrocodone (75.27%) purchased in the region. Hospitals accounted for 26.67% of oxycodone and 22.76% of hydrocodone purchased. Practitioners and mid-level providers, including Nurse Practitioners and Physician Assistants, did not significantly contribute to this increase. Conclusion In the states of Maryland, Delaware, and Virginia, the distribution of the prescription opioids oxycodone and hydrocodone increased by 57.59%. Daily average dose increased between 2006 and 2010 in all three states, followed by a decline until 2014. Variability in daily average dose by county highlights the relationship between geography and likelihood of receiving high-dose opioids. Increased monitoring at regional health centers and improving substance abuse treatment infrastructure at the county level may be a more efficient strategy in combating the opioid epidemic. Future research is needed to understand the socioeconomic trends that may influence prescribing trends of opioid medications.

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.