An Analysis of Oxycodone and Hydrocodone Distribution Trends in Delaware, Maryland, and Virginia Between 2006 and 2014

Abstract

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.

Dynamic Changes in the Distribution of Hydrocodone and Oxycodone in Florida from 2006 to 2021

“…Interestingly, Florida’s decline in opioid distribution after 2010 was not unique. Eufemio et al found the same timing of decline in Delaware, Maryland, and Virginia [ 30 ]. Although the authors believed this decline in oxycodone and hydrocodone to be due to stricter regulation as well, these three states implemented PDMPs at scattered points in time (Delaware in 2012, Maryland in 2018, Virginia in 2003) without much temporal correlation with the decline in opioids [ 45 , 46 , 47 ].…”

“…The anticipation of hydrocodone rescheduling may have contributed to providers choosing other less scrutinized pain relievers, like the previously uncontrolled, unscheduled tramadol [ 52 ]. This explanation is limited, however, as analyses in other states (Delaware, Maryland, and Viriginia) found that hydrocodone did increase from 2006 to 2010, although not as dramatically as oxycodone [ 30 ].…”

“…The standard ARCOS database, which reports on Schedule II and III substances with limited geographic resolution, has been used in some prior reports [ 11 , 25 , 26 , 27 , 28 , 29 ]. This report, which also includes the Washington Post ARCOS, adds to a more limited database of peer-reviewed investigations [ 30 , 31 ]. We analyzed this information for each county in Florida to compare easy-to-conceptualize areas of the state that may differ in population, urbanicity, demographics, and density of providers.…”

State-level variation in distribution of oxycodone and opioid-related deaths from 2000 to 2021: an ecological study of ARCOS and CDC WONDER data in the USA

“…There were stark differences in the patterns of change between states. Some, like Florida 16 or Delaware, 15 increased substantially leading up to 2010 and dropped off just as quickly. Others like Texas 14 or Illinois maintained consistently low distribution, and many states fell somewhere in between.…”

“…13 Here, we explore oxycodone distribution by state using the US Drug Enforcement Agency (DEA) ARCOS over a larger time frame than any previous studies, which included reports on prescription opioids in the US territories, Texas and throughout Delaware, Maryland and Virginia. [14][15][16] Past works frequently rely on the IQVIA database, which is limited by gaps in oxycodone, including data from Veteran's Affairs, Indian Health Services facilities, hospitals and independent pharmacies. 17 Using states as the geographical unit allows results to be interpreted in the context of laws and regulations which apply at that level.…”