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.
There have been increasing concerns about adverse effects and drug interactions with meperidine. The goal of this study was to characterize meperidine use in the United States. Meperidine distribution data were obtained from the Drug Enforcement Administration's Automated of Reports and Consolidated Orders System. The Medicare Part D Prescriber Public Use File was utilized to capture overall trends in national prescriptions in this observational report. Nationally, meperidine distribution decreased by 94.6% from 2001 to 2019. In 2019, Arkansas, Alabama, Oklahoma, and Mississippi saw significantly greater distribution when compared with the US state average of 9.27 mg per 10 persons (SD = 6.82). Meperidine distribution showed an 18‐fold difference between the highest state (Arkansas = 36.8 mg) and lowest state (Minnesota = 2.1 mg). Five of the six states with the lowest distribution were in the Northeast. Meperidine distribution per state was correlated with the prevalence of adult obesity ( r (48) = +0.48, p < .001). Family medicine and internal medicine physicians accounted for 28.9% and 20.5%, respectively, of meperidine total daily supply (TDS) in 2017. Interventional pain management (5.66) and pain management (3.48) physicians accounted for the longest TDS per provider. The use of meperidine declined over the last two decades. Meperidine varied by geographic region with south‐central states, and those with more obesity, showing greater distribution. Primary care doctors continue to account for the majority of meperidine daily supply. Increasing knowledge of meperidine's undesirable adverse effects like seizures and serious drug–drug interactions is likely responsible for these pronounced reductions.
Study Objective: The US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted. Study Design: This study was conducted to quantify prescription opioid use in Texas. Data Source: Data was obtained from the publically available US Drug Enforcement Administration Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution. Results: Data for 2006 to 2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. The change in Morphine Mg Equivalent (MME) of all opioids (+23.3%) was only slightly greater than the states population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (-80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine. Conclusions: Collectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre opioid crisis prescription levels.
Purpose: There have been increasing concerns about adverse effects and drug interactions with meperidine including removal from the World Health Organizations list of essential medications. The goal of this study was to characterize pharmacoepidemiological patterns in meperidine use in the United States. Methods: Meperidine distribution data was obtained from the Drug Enforcement Administrations Automation of Reports and Consolidated Orders System (ARCOS). Medicare Part D Prescriber Public Use Files (PUF) were utilized to capture overall trends in national meperidine prescriptions. Results: National meperidine distribution decreased from 2001 to 2019 by 94.6%. In 2019 Arkansas, Alabama, Oklahoma, and Mississippi saw significantly greater distribution per person when compared to the average state (9.27, SD = 6.82). Meperidine per ten persons showed an eighteen-fold difference between the highest (Arkansas = 36.8 mg) and lowest (Minnesota = 2.1 mg) states. Five of the six lowest states were in the northeast. Meperidine distribution per state was significantly correlated with the prevalence of adult obesity (r(47) = +0.47, p < 0.001). Family medicine and internal medicine physicians accounted for 28.9% and 20.5% of Medicare Part D total daily supply (TDS) of meperidine in 2017. However, interventional pain management (5.66) and pain management (3.48) physicians accounted for the longest while family medicine (0.69) and internal medicine (0.40) accounted for the shortest TDS per provider. Conclusion: Use of meperidine has been declining over the last two-decades. Meperidine distribution varied on a geographical level with south/south-central, and more obese, states showing appreciably greater distribution per person. Primary care doctors continue to account for the majority of meperidine daily supply, but specialists like interventional pain management were the most likely to prescribe meperidine to Medicare patients. Increasing knowledge of meperidines undesirable adverse effects (e.g. seizures) and serious drug-drug interactions likely are responsible for these pronounced reductions.
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