Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions from 2006 to 2019

Pharmacology Res & Perspec

Nichols

et al. 2021

Self Cite

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.

Section: Analysis Of Medicare Data Revealed That Between 2013 and 2017mentioning

confidence: 99%

Section: Analysis Of Medicare Data Revealed That Between 2013 and 2017mentioning

confidence: 99%

Declines and pronounced regional disparities in meperidine use in the United States

Boyle

Pharmacology Res & Perspec

Nichols

et al. 2021

Self Cite

“…There are some strengths and limitations to this study. ARCOS is a comprehensive and publically available data source frequently used in research [18, 22, 32]. While meperidine is used for acute pain in non-humans, use by veterinarians is very modest [22, 33].…”

Section: Discussionmentioning

confidence: 99%

“…ARCOS is a comprehensive and publically available data source frequently used in research [18, 22, 32]. While meperidine is used for acute pain in non-humans, use by veterinarians is very modest [22, 33]. Although mereridine is always considered inappropriate for older adults (Supplemental Table 1), the version of the Medicare dataset we employed does not allow us to determine how many of the million TDS meperidine recipients were older (≥ age 65) versus disabled.…”

Section: Discussionmentioning

confidence: 99%

“…ARCOS retail distribution was reported for the total and by three categories: hospitals, pharmacies and practitioners. Teaching institutions, a category used for non-human use, was not displayed separately due to minute and sporadic volumes and is available elsewhere [22]. The mass of meperidine distributed each year as reported by ARCOS was corrected with US Census Bureau population estimates.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Declines, and Pronounced Regional Disparities, in Meperidine Use in the United States

Boyle

Nichols

et al. 2020

Preprint

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.

Analysis of Adverse Drug Events of Opioids in the United States

Liu¹,

Piper

2022

Preprint

The United States (US) is going through an opioid crisis with annual increases in opioid-related mortality. Our study analyzed the adverse drugs events (ADEs) for eleven prescription opioids when correcting for distribution, and their ratios for three periods: 2006-2010, 2011-2016, and 2017-2021 in the US. The opioids included buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol. The Food and Drug Administration Adverse Event Reporting System (FAERS) database consists of reports by MedWatch adverse event forms submitted by healthcare professionals and others (N=667,969), whereas the Automation of Reports and Consolidated Orders System (ARCOS) reports on medically used controlled substances. Oral morphine milligram equivalents (MMEs) were calculated by conversion relative to morphine. The relative ADEs of the select opioids calculated from FAERs, opioid distribution from ARCOS, and the FAERs to ARCOS ratios were analyzed for the eleven opioids. Oxycodone reports peaked in the third period and showed consistently high ADEs. Codeine and meperidine accounted less than five percent of ADEs. The ARCOS distributions were relatively constant over time, but methadone consistently accounted for the largest portion of the total distribution. The FAERS to ARCOS ratios generally increased over time, with meperidine (60.6), oxymorphone (11.1), tapentadol 10.3, and hydromorphone (7.9) most over-represented for ADEs in the third period. Oxymorphone had a 542.2% increase in ratio between the second and third period should be noted. Methadone was under-represented (< .20) in all three periods. These findings indicate the need to further monitor and address the ADEs of select opioids.SignificancePrescription opioid use in the US is among the highest in the world. This study analyzed both FAERs and ARCOS databases to understand the adverse drugs events. This investigation identified which opioids were overrepresented (e.g. meperidine) and underrepresented (e.g. methadone) for adverse effects relative to the prevalence of use to inform healthcare policies and change the way physicians view and prescribe these opioids.