scholarly journals Methadone Distribution Trends from 2017-2019 in the United States

2020 ◽  
Author(s):  
John A. Furst ◽  
Nicholas J. Mynarski ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Rhode Island ◽  
Distribution Patterns ◽  
The United States ◽  
Opioid Use Disorder ◽  
Primary Objective ◽  
Treatment Programs ◽  
Opioid Use ◽  
Drug Enforcement ◽  
The Us

AbstractObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

scholarly journals Trends in Fentanyl and Fentanyl Derivative Utilization in the United States

2021 ◽  
Author(s):  
Raymond A. Stemrich ◽  
Jordan V. Weber ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Census Data ◽  
Distribution Patterns ◽  
The United States ◽  
Primary Objective ◽  
Opioid Prescription ◽  
Part D ◽  
The Us ◽  
Production And Distribution ◽  
Opioid Deaths

AbstractObjectiveThe primary objective of this study was to explore fentanyl and fentanyl derivative distribution patterns from 2010 and 2019 across the United States (US). This study builds upon previous literature that has analyzed the trends in opioid distribution and assesses changes in opioid prescription preferences.MethodsThe amount of fentanyl base distributed in the US from 2010-2019 was obtained from the Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS). Fentanyl derivatives (sufentanil, alfentanil, remifentanil) were also analyzed using ARCOS from 2010-2017, the most recent date reported. Census data from the American Community Survey was used to correct for population. Prescriptions, units, and reimbursement of fentanyl and fentanyl citrate formulations for 2010 and 2019 were obtained from Medicaid and prescriber specialty in Medicare Part D.ResultsTotal grams of fentanyl distributed in the US from 2010 to 2019 decreased by 63%. Correspondingly, there was a 65% decrease in the milligrams per person distributed when correcting for population. From a regional perspective, Ohio had the greatest decrease (−79.3%) while Mississippi saw the smallest (−44.5%). Medicaid reimbursement in 2019 was $165 million for over eight hundred-thousand prescriptions with the majority to generic (99.7%) and injectable (77.6%) formulations. Interventional pain management and anesthesia were over-represented, and hematology/oncology under-represented for fentanyl in Medicare.ConclusionThe production and distribution of fentanyl-based substances has decreased, although not uniformly, in the US over the last decade. Additionally, the most prescribed formulations of fentanyl have transitioned away from transdermal, potentially in an effort to regulate its availability. Although impactful, the overdose deaths attributed to synthetic opioid deaths continue to increase highlighting the need for public health interventions beyond the pharmaceutical and medical communities.

scholarly journals Rise and Regional Disparities in Buprenorphine Utilization in the United States

2019 ◽  
Author(s):  
Amir Azar R. Pashmineh ◽  
Alexandra Cruz-Mullane ◽  
Jaclyn C. Podd ◽  
Warren S. Lam ◽  
Suhail H. Kaleem ◽  
...  
Keyword(s):  
United States ◽  
Partial Agonist ◽  
Strong Association ◽  
The United States ◽  
Regional Disparities ◽  
Opioid Use ◽  
Policy Changes ◽  
Drug Enforcement ◽  
Drug Enforcement Administration ◽  
The Us

AbstractAimsBuprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution.MeasurementsBuprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined.FindingsBuprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018.ConclusionsAlthough buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

The opioid epidemic

2017 ◽  
Vol 52 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Nitin Chopra ◽  
Lauren H Marasa
Keyword(s):  
United States ◽  
Treatment Options ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Significant Family History ◽  
History Of ◽  
Number Of Treatment

Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.

Adverse effects of regulation on buprenorphine prescribing and its impact on the treatment of opioid use disorder

2021 ◽  
Vol 17 (7) ◽  
pp. 133-139
Author(s):  
Daniel M. Strickland, MD, FACOG ◽  
John Sorboro, MD, DABPN, FASAM
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Federal Law ◽  
Opioid Use ◽  
The Us ◽  
Main Driver ◽  
The Face ◽  
State Oversight ◽  
Overdose Deaths

Problem: Drug addiction and misuse is a medical and societal problem that has exacted a heavy toll on the United States, and, indeed, the world. In the United States, opioids are currently the main driver of drug overdose deaths. Despite the proven safety and efficacy of medically assisted therapy (MAT) using buprenorphine for the treatment of opioid use disorder (OUD), as well as the fact that its use is regulated by US Federal Law, many states have enacted separate and often burdensome regulations that restrict the prescribing of buprenorphine beyond those required by the US Drug Enforcement Agency (DEA) under the provisions of the DATA 2000 Act, and unnecessarily reduce the availability of effective treatment of OUD in those states.Purpose: The purpose of this article is to review the pharmacology of both buprenorphine (and naloxone as an additive) and the risks associated with the misuse of buprenorphine products and to consider if such additional state oversight and restrictions improves or is deleterious to public safety in the face of this national epidemic.Conclusion: We conclude that the placing of unnecessary and unscientific restraints on the treatment of patients with OUD is inconsistent with the principles of harm reduction, and such restraints should be removed unless/until they can be supported by real evidence. 

scholarly journals Cross-state variation in opioid use disorder among a privately insured nonelderly population in the United States

2020 ◽  
Author(s):  
Bibo Jiang ◽  
Li Wang ◽  
Douglas Leslie
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Prescription Drug Monitoring Programs ◽  
The Us ◽  
State Variation ◽  
Demographic Patterns ◽  
Privately Insured

Abstract Background: Although cross-state variation of the opioid epidemic in the United States are well documented in general, little are known about the epidemic in privately insured individuals. Objectives: To describe cross-state variation in Opioid Use Disorder (OUD) among privately insured individuals in the US for the years 2005-2015 and investigate demographic differences of OUD patients between a group of hard-hit states and the rest states. Methods: The MarketScan Commercial Claims and Encounters database was used to calculate prevalence of opioid use disorder for the 50 states in the US, respectively. We analyzed level and change of OUD prevalence in each state from 2005 to 2015 and identified the states which were affected most by the epidemic. One-sided exact fisher test was used to analyze demographic difference of the epidemic in the hard-hit states and the remaining states. Results: Cross-state variations of the opioid epidemic among privately insured population were substantial, both in terms of severity and acceleration of the epidemic. Demographic patterns of the epidemic were similar across states. The 18-34 age group was the most affected group with the highest prevalence. The 55-64 group experienced the most rapid increase of OUD prevalence, especially in states that suffered most in the epidemic. Conclusions: Results can assist policy makers to design better clinical and policy interventions on the opioid epidemic, especially on privately insured individuals. Drastic increase of OUD prevalence among the 55-64 group might indicate the need to improve prescription drug monitoring programs for chronic pain, especially in states more affected by the epidemic.

scholarly journals 1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S717-S718
Author(s):  
Michael Lowry ◽  
Christina Fiske ◽  
Peter F Rebeiro
Keyword(s):  
United States ◽  
Substance Use ◽  
Bacterial Infections ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Discharge Data ◽  
Serious Infections ◽  
The Us

Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p&lt; 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures

scholarly journals Opioid distribution trends (2006–2017) in the US Territories

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6272 ◽  
Author(s):  
Fedor F. Cabrera ◽  
Erik R. Gamarra ◽  
Tiffany E. Garcia ◽  
Ashanti D. Littlejohn ◽  
Poul A. Chinga ◽  
...  
Keyword(s):  
Puerto Rico ◽  
Oral Morphine ◽  
Distribution Patterns ◽  
The United States ◽  
Virgin Islands ◽  
Treatment Programs ◽  
Drug Enforcement ◽  
The Us ◽  
Per Capita ◽  
Distribution Trends

BackgroundThe US mainland is experiencing an epidemic of opioid overdoses. Unfortunately, the US Territories (Guam, Puerto Rico, and the Virgin Islands) have often been overlooked in opioid pharmacoepidemiology research. This study examined common prescription opioids over the last decade.MethodsThe United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) was used to report on ten medical opioids: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone, by weight from 2006 to 2017. Florida and Hawaii were selected as comparison areas.ResultsPuerto Rico had the greatest Territorial oral morphine mg equivalent (MME) per capita (421.5) which was significantly higher (p< .005) than the Virgin Islands (139.2) and Guam (118.9) but significantly lower than that of Hawaii (794.6) or Florida (1,509.8). Methadone was the largest opioid by MMEs in 2017 in most municipalities, accounting for 41.1% of the total in the Virgin Islands, 37.9% in Florida, 36.6% in Hawaii but 80.8% in Puerto Rico. Puerto Rico and Florida showed pronounced differences in the distribution patterns by pharmacies, hospitals, and narcotic treatment programs for opioids.ConclusionsContinued monitoring of the US Territories is needed to provide a balance between appropriate access to these important agents for cancer related and acute pain while also minimizing diversion and avoiding the opioid epidemic which has adversely impacted the US mainland.

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