Pronounced declines in dispensed licit fentanyl, but not fentanyl derivatives

Stemrich, Raymond A.; Weber, Jordan V.; McCall, Kenneth L.; Piper, Brian J.

doi:10.1016/j.sapharm.2021.08.001

Cited by 7 publications

(15 citation statements)

References 21 publications

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“…Although there have been overall reductions in opioid distribution, each opioid experienced varying degrees of distribution in a given year. The high-potency opioid fentanyl demonstrating the lowest variation (2011 percentile ratio = 1.77, 2019 ratio = 2.12) which extends upon prior reports [10,11]. Methadone rose to have the highest degree of variation in 2019 despite being 3rd highest in 2011.…”

Section: Discussionsupporting

confidence: 73%

“…Although there have been overall reductions in opioid distribution, this measure of variation was consistent over the last decade. Similarly, six opioids, oxymorphone, meperidine, methadone, tapentadol, hydrocodone, and oxycodone, had which extends upon prior reports [11,12].…”

Section: Discussionmentioning

confidence: 64%

“…There was a five-fold difference between the lowest (North Dakota = 485) and highest (Rhode Island = 2,624) states [3]. Examination of individual opioids [9,10] revealed a three-fold state-level difference for fentanyl [11], eighteen-fold for meperidine [12], and twenty-fold for buprenorphine [13].…”

Section: Introductionmentioning

confidence: 99%

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Declines and pronounced state disparities in prescription opioid distribution in the United States

Madera

Ruffino

Feliz

et al. 2021

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BackgroundThe United States (US) opioid epidemic is a persistent and pervasive public health emergency as it continues to claim the lives of Americans through addiction and overdose. There have been sustained efforts to reverse this iatrogenic crisis over the past decade. This study analyzed the changes in prescription opioid distribution for pain and identified regional differences between 2010 and 2019.Methods and FindingsOpioid production data was obtained from the DEA’s annual production quotas. Total opioid production has decreased 41.5% from 2013 (87.6 morphine mg equivalent metric tons) to 2019 (51.3). Opioid distribution from 2010 to 2019 was collected for ten prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) from the US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System. Regional variance was expressed as the ratio of the 95th to 5th percentiles of opioid distribution per state, corrected for population. The peak year for all ten prescription opioids was identified, individually, as between 2010 and 2013, except for codeine (2015). There was a 51.96% overall decrease in opioid distribution per capita with the largest decrease in Florida (−61.61%) and smallest in Texas (−18.64%). The largest quantities of opioid distribution were observed in Tennessee (520.70 morphine mg equivalent or MME per person) and Delaware (251.45) in 2011 and 2019. The smallest was Nebraska (153.39) in 2011 and Minnesota (90.49) in 2019. The highest to lowest state ratio of total opioid use, corrected for population, was sizable in 2011 (5.25) and 2019 (2.78). Similarly, the mean 95th/5th ratio was relatively stable in from 2011 (4.78 +0.70) and 2019 (5.64+0.98). The 95th/5th ratio in 2019 was greatest for methadone (10.23) and oxymorphone (10.09) and smallest for morphine (2.20) and fentanyl (2.12). Southern states (e.g MS, TN, AL, AK, DE, and NC) had the highest per capita distribution for eight of the ten opioids in 2019. The strength of the correlation between per capita hydrocodone and codeine, and hydromorphone and codeine increased significantly from 2011 to 2019ConclusionsThis study found a decline in total production and distribution for ten prescription opioids during the last half-decade. However, distribution was non-homogeneous at a state level. Analysis of regional differences revealed a three-fold difference in the 95th:5th percentile ratio between states which was unchanged over the past decade. Future research focused on identifying factors contributing to the observed regional variability could prove valuable to understanding, and potentially remediating, the pronounced disparities in prescription opioid use in the US.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 64%

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Declines and pronounced state disparities in prescription opioid distribution in the United States

Madera

Ruffino

Feliz

et al. 2021

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“…For comparison, the state-level variation in 2016 for the MME total of eight opioids used for pain was 3.6 fold between Tennessee (932 MME/person) and Washington D.C. (256 MME/person) (7). The difference for individual opioids was 4.3 fold for fentanyl to hospitals, 6.2 for fentanyl to pharmacies (9), but 18-fold for meperidine (8) and almost 20-fold different for buprenorphine (11). We do not believe that there are four-fold biological nociceptive differences between the residents of Tennessee relative to those in an adjacent state (e.g., Kentucky) that receive much less morphine.…”

Section: Discussionmentioning

confidence: 99%

Reductions and pronounced regional differences in morphine distribution in the United States

Dowd

Tang

Yan

et al. 2022

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BackgroundMorphine is one of the oldest, most commonly prescribed, and widely used opioids in the United States (US). Morphine’s potent analgesic properties have also been associated with the increase in misuse, addiction and opioid-related deaths in the US since the 1990s. Despite federal regulations, population-adjusted prescription opioid distribution varies markedly between states. The objective of this study was to describe the temporal pattern of morphine distribution nationally and between states.MethodsDrug weight and population data were obtained from Report 5 of the US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) to characterize patterns in the distribution of morphine from 2012 to 2020.Morphine distribution amounts were separated by state and business type and corrected for population. States outside a 95% confidence interval relative to the national average were considered statistically significant.ResultsPharmacies and hospitals distributed 24,200 kilograms of morphine in 2012. Tennessee (180.2 mg/person) was 4.7-fold higher than Texas (39.4 mg/person).National distribution decreased 56.4% to 10,723 kilograms in 2020. Tennessee (56.4 mg/person) was 3.8-fold higher than the District of Columbia (15.0 mg/person). The decline in Illinois (−40.9%) was significantly less than the national average (−56.8%) while that of Oregon (−71.1%) and Arizona (−70.4%) were significantly higher. Hospital decrease (−72.7%) from 2012-2020 was larger than that of pharmacies (−56.12%).ConclusionsThe national 56% decline in the distribution of morphine in the last decade may be attributable to prioritization of the opioid crisis as a public concern, including subsequent growth of opioid misuse and treatment programs and decreased production quotas for opioids, including morphine. This decline also coincides with the national shortage of parenteral opioids resulting in greater prescriptions of alternative opioids such as nalbuphine and buprenorphine. Further research is necessary to understand the persistent four-fold regional difference between states.

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“…distributed to hospitals, -89.6%). The overall change in codeine nationally is relatively modest relative to those of stronger opioids like hydrocodone, oxycodone, and fentanyl (24, 25). In addition, our data was indicative of regional disparities in codeine utilization when comparing 2011 to 2019.…”

Section: Discussionmentioning

confidence: 99%

Declining National Codeine Distribution in United States Hospitals and Pharmacies from 2011 to 2019

Kennalley

Boureghda

Ganesh

et al. 2022

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BackgroundPast research has identified pronounced regional disparities in use of different opioids but less is known for codeine. The primary objective of this study was to analyze the trends of distribution of prescriptions containing codeine in the United States (US) from 2010 to 2019. In addition, this study aimed to identify regional disparities in prescribed milligrams of codeine per person in 2019 and identify any unusual states.MethodsThe distribution of codeine via pharmacies, hospitals, and practitioners in kilograms was obtained from the Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) from 2010 to 2019. In addition, the number of prescriptions of codeine per 1,000 Medicaid enrollees was obtained from the State Drug Utilization Database.ResultsThe total grams of codeine decreased (−25.0%) through all distributors from 2010 to 2019. The largest increase in total grams of codeine distributed between two consecutive years (2014 to 2015) was +28.9%. For a given distributor type, the largest decrease from 2010 to 2019 was hospitals (−89.6%). In 2019, the total mg of codeine per person distributed in Texas (11.46) was significantly higher relative to the national average (3.06, 1.88 SD). Codeine prescriptions to Medicaid patients peeked in the third quarter of 2016.ConclusionThe peak of prescription codeine in 2011 was consistent with the overall peak in prescription opioids, with a subsequent decrease over the decade. This could be explained by relatively recent recommendations regarding the therapeutic use of codeine and how other antitussive agents may be of better use. The precipitous rise of codeine in Texas that we observed has been recognized in prior studies. These state-level disparities warrant further attention by opioid stewardship committees.

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Pronounced declines in dispensed licit fentanyl, but not fentanyl derivatives

Cited by 7 publications

References 21 publications

Declines and pronounced state disparities in prescription opioid distribution in the United States

Declines and pronounced state disparities in prescription opioid distribution in the United States

Reductions and pronounced regional differences in morphine distribution in the United States

Declining National Codeine Distribution in United States Hospitals and Pharmacies from 2011 to 2019

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