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.
This study aims to examine the coherence of state-level qualifying conditions (QCs) for medical cannabis (MC) with the evidence-based conclusions of the 2017 National Academies of Sciences (NAS) report. Data was collected for the QCs from 38 states where MC was legal in 2023 and compared to the QC data from 31 states where MC was legal in 2017. Each condition was divided into a NAS-established category based on the level of evidence supporting their effectiveness. The findings revealed wide variation in the number of QCs between states, with only an average of 8.4% of QCs in each state generally satisfying the substantial evidence category. Over three fourths of states included QCs with limited evidence of ineffectiveness (78.9%) or no/insufficient evidence (76.3%). Additionally, four fifths (81.6%) of states included QCs not covered in the NAS report. Only a few states appeared to have updated their QCs after the NAS report was released. This investigation highlights a large discrepancy between the state-level recommendations for MC and the supporting data.
Background Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics. Methods Using data from the Pennsylvania Department of Health, we geocoded MMJ dispensary locations and linked them to U.S. Census Bureau data. We created dispensary access measures from the population-weighted centroid of Zip Code Tabulation Areas (ZCTAs): distance to nearest dispensary and density of dispensaries within a 15-minute drive. We evaluated associations between dispensary access and the proportion of adults who received MMJ certification and the proportion of certifications for insufficient evidence conditions (amyotrophic lateral sclerosis, epilepsy, glaucoma, Huntington's disease, opioid use disorder, and Parkinson's disease) using negative binomial modeling, adjusting for community features. To evaluate associations between the proportion of the population that was non-White, Hispanic, or both (NW-H) and distance to nearest dispensary, we used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for median income. Results Distance and density of MMJ dispensaries was associated with the proportion of the ZCTA population certified and the proportion of certifications for limited evidence conditions. Compared to ZCTAs with no dispensary within 15 minutes, the proportion of adults certified increased by up to 31% and the proportion of certifications for limited evidence decreased by up to 22% for ZCTAs with two dispensaries. In 2021, the odds of being within five miles of a dispensary was higher in ZCTAs with the highest proportions of NW-H individuals (OR: 26.05, CI: 16.7 - 40.6), compared to ZCTAs with the lowest proportions. Conclusions Greater dispensary access was associated with the proportions of certified residents and certifications for insufficient evidence conditions. Whether these patterns are due to differences in accessibility or demand is unknown. Associations between community demographics and dispensary proximity may indicate MMJ access differences.
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