Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States

Armbuster, Y. C.; Banas, B. N.; Feickert, K. D.; England, Stephanie E; Moyer, E. J.; Christie, Emily; Chughtai, Sana; Giuliani, Tanya J; Halden, Rolf U.; Graham, Jove; McCall, Kenneth L.; Piper, Brian J.

doi:10.1177/87551225211035563

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…Meperidine now primarily serves as an option for patients who may have special considerations such as allergies to morphine or those that cannot use fentanyl or other alternatives. Although it may still be a bit premature, it is tempting to speculate whether meperidine will remain a rarely used Schedule II substance like cocaine [16] or methamphetamine [17] or join the ranks of heroin and propoxyphene that were discontinued in the US.…”

Section: Discussionmentioning

confidence: 99%

Pronounced Declines in Meperidine in the US: Is the End Imminent?

Harrison¹,

Arnet²,

Ramos³

et al. 2022

Preprint

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Background: Once a widely used analgesic in the United States (US), meperidine offered an alternative to other opioids as a pain reliever. However, within the last two decades, meperidine has gone from a drug to be utilized only when patients exhibit atypical reactions to opioids (e.g., morphine and hydromorphone) to being taken off the World Health Organization List of Essential Medications and receiving strong recommendations for the overall avoidance. The aim of this study was to identify changes in meperidine distribution in the US and regional disparities as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (DEA ARCOS) and Medicaid. Methods: Data related to the meperidine distribution was obtained through ARCOS (2001 –2021) and Medicaid public use files (2016 –2021). Heat maps were used to visualize regional disparities in distribution by state. States outside a 95% confidence interval were statistically significant. Results: Meperidine distribution between 2001 and 2021 decreased by 97.4% (R=.-97, P &lt; .0001). There was a 34-fold state-level difference in meperidine distribution between Arkansas (16.8 mg/10 persons) and Connecticut (0.5 mg/ 10 persons) in 2020. Meperidine distribution in 2020 was elevated in Arkansas, Mississippi, and Alabama. In 2021, Meperidine distribution was highest in Arkansas ( 1.67 /10 persons) and lowest in Connecticut (0.08 /10 persons). Total prescriptions of meperidine as reported by Medicaid decreased by 73.8% (R= -0.67, P = 0.045) between 2016 and 2021. Conclusion: We observed a decrease in the overall distribution of meperidine in the past two decades with similar recent declines in prescribing to Medicaid enrollees. The shortage of some parenteral formulations is an important contributor to these declines. This data may reflect plans to phase out the use of this opioid, especially in the many situations where preferred opioids are available.

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Section: Discussionmentioning

confidence: 99%

Pronounced Declines in Meperidine in the US: Is the End Imminent?

Harrison¹,

Arnet²,

Ramos³

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Meperidine now primarily serves as an option for patients who may have special considerations, such as allergies to morphine or those that cannot use fentanyl or other alternatives. Although it may still be a bit premature, it is tempting to speculate whether meperidine will remain a rarely used Schedule II substance like cocaine [ 26 ] or methamphetamine [ 27 ], or join the ranks of heroin and propoxyphene which were discontinued in the US.…”

Section: Discussionmentioning

confidence: 99%

Pronounced Declines in Meperidine in the US: Is the End Imminent?

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background: Once a widely used analgesic in the United States (US), meperidine offered an alternative opioid to other opioids as a pain reliever and was widely assumed to be safer with acute pancreatitis. However, within the last two decades meperidine, has gone from a frequently used drug to being used only when patients exhibit atypical reactions to opioids (e.g., morphine and hydromorphone), to being taken off the World Health Organization List of Essential Medications and receiving strong recommendations for overall avoidance. The aim of this study was to identify changes in meperidine distribution in the US, and regional disparities as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (DEA ARCOS) and Medicaid. Methods: Data related to meperidine distribution was obtained through ARCOS (2001–2021) and Medicaid public use files (2016–2021). Heat maps were used to visualize regional disparities in distribution by state. States outside a 95% confidence interval were statistically significant. Results: Meperidine distribution between 2001 and 2021 decreased by 97.4% (R = −0.97, p < 0.0001). There was a 34-fold state-level difference in meperidine distribution between Arkansas (16.8 mg/10 persons) and Connecticut (0.5 mg/10 persons) in 2020. Meperidine distribution in 2020 was elevated in Arkansas, Mississippi, and Alabama. In 2021, meperidine distribution was highest in Arkansas (16.7 mg/10 persons) and lowest in Connecticut (0.8 mg/10 persons). Total prescriptions of meperidine as reported by Medicaid decreased by 73.8% (R = −0.67, p = 0.045) between 2016 and 2021. Conclusion: We observed a decrease in the overall distribution of meperidine in the past two decades, with a similar recent decline in prescribing it to Medicaid enrollees. The shortage of some parenteral formulations is an important contributor to these declines, however, the most likely explanation for this global decline in use is related to an increased recognition of safety concerns related to important drug interactions and a neurotoxic metabolite. This data may reflect plans to phase out the use of this opioid, especially in the many situations where safer and more preferred opioids are available.

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Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States

Cited by 2 publications

References 29 publications

Pronounced Declines in Meperidine in the US: Is the End Imminent?

Pronounced Declines in Meperidine in the US: Is the End Imminent?

Pronounced Declines in Meperidine in the US: Is the End Imminent?

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