Dynamic Changes in Prescription Opioids from 2006 to 2017 in Texas

Abstract

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.

Declining National Codeine Distribution in United States Hospitals and Pharmacies from 2011 to 2019

“…According to ARCOS, the spike in codeine distribution for Texas began increasing largely in 2015 and continued to climb with each successive year. The precipitous rise in Texas has been recognized in another prior study (28). A possible explanation for the pronounced regional disparity in Texas, Oklahoma, and Arkansas could be a result from the cultural roots of codeine consumption.…”

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

“…11 The objective of this report was to quantify the trends in licit cocaine distribution in the United States using DEA data from 2002-2017, and to determine the usage of medical cocaine in the Medicaid and Medicare part D programs from 2013-2017. Based on research with other controlled substances, [12][13][14][15][16][17] we hypothesized that cocaine use may be declining and vary regionally across the US. The 9041L encompasses various formulations of cocaine hydrochloride including as a monotherapy (4% or 10%) or with adrenaline (Supplemental Table 1).…”

“…This comprehensive data source captures medical and research use and cocaine distribution as an internal standard for analytical chemistry procedures. ARCOS is based on manufacturers and distributors reporting their controlled substances transactions to the DEA and has been employed in prior pharmacoepidemiology reports of opioids [12][13][14][15][16] and stimulants. 17 Medical use of cocaine was also obtained from the Medicare and Medicaid programs…”