Analysis of State-level Variation in Distribution of Oxycodone and its Adverse Effect Profile in the US from 2000-2021

Abstract

ObjectivesCharacterize oxycodone’s distribution in the US by state and its adverse effect profile from 2000-2021.DesignObservationalSettingMore than 80,000 Americans died of an opioid overdose in 2021 as the United States (US) continues to struggle with an opioid crisis. Prescription opioids play a substantial role, introducing patients to opioids and providing a supply of drugs that can be redirected to those seeking to misuse them.MethodsThe Drug Enforcement Administration annual summary reports from the Automation of Reports and Consolidated Orders System (ARCOS) provided weights of oxycodone distributed per state by business type (pharmacies, hospitals, and practitioners). Weights were converted to Morphine Milligram Equivalents (MME) per capita and normalized for population.ResultsThere was a sharp 280.13% increase in total MME/person of oxycodone from 2000-2010, followed by a slower 54.34% decrease from 2010-2021. Florida (2007-11), Delaware (2003-20), and Tennessee (2012-21) displayed consistent and substantial elevations in combined MME/person compared to other states. In the peak year (2010), there was a 15-fold difference between the highest and lowest states. MME/person from only pharmacies, which constituted >94% of the total, showed similar results. Hospitals in Alaska (2000-01, 2008, 2010-21), Colorado (2008-21), and DC (2000-11) distributed substantially more MME/person over many years compared to other states. Florida stood out in practitioner-distributed oxycodone, with an elevation of almost 15-fold the average state from 2006-2010. The percentage of consumer reports in the FDA Adverse Drugs Events Reporting System (FAERS) increased from 6.3% (2001) to 95% (2021). Adverse effects distribution remained constant by age and sex, with higher average proportions in males (55%) and the 18-65 age group (79%).ConclusionsOxycodone distribution across the US showed marked differences between states and business types over time. Investigation of opioid policies in states of interest may provide insight for future actions to mitigate opioid misuse.Strengths and limitations of this studyARCOS is publicly accessible, comprehensive, and includes institutions that are unavailable in other commonly used databases (i.e. IQVIA).Diversion of oxycodone or whether the prescribed amounts were utilized cannot be determined from ARCOS data.FAERS data includes duplicates, incomplete results, and non-verifiable data which cannot be used to suggest causation between oxycodone and adverse events.These complementary results from two databases may not generalize to other countries with more restrictive oxycodone policies.