State-level variation in distribution of oxycodone and opioid-related deaths from 2000 to 2021: an ecological study of ARCOS and CDC WONDER data in the USA.
Level 4 - case-series / case-control
Ecological observational study analyzing aggregate state-level administrative and mortality data
PubMed 38453203 · doi:10.1136/bmjopen-2023-073765
What was done
This ecological observational study characterized US state-level oxycodone distribution and opioid-related mortality from 2000 to 2021. Distribution data by business type (pharmacies, hospitals, and practitioners) were obtained from Drug Enforcement Administration (DEA) ARCOS annual reports, converted to morphine milligram equivalents (MME) per capita, and normalized by population. Mortality data across specific opioid categories were retrieved from CDC WONDER.
What was found
Total oxycodone MME/person rose 280.13% from 2000 to 2010, followed by a 54.34% decline from 2010 to 2021. In the peak year (2010), a 15-fold difference existed between the highest- and lowest-distributing states. Pharmacies accounted for >94% of total MME/person distributed. Consistent, substantial elevations in combined MME/person occurred in Florida (2007–2011), Delaware (2003–2020), and Tennessee (2012–2021). Practitioner-distributed oxycodone in Florida was nearly 15-fold above the national state average from 2006 to 2010. Total opioid-related deaths rose 806% over the study period, primarily driven by heroin, other opioids, and other synthetic narcotics.
Why it matters
It maps long-term geographic and channel-specific trends in prescription opioid supply against the continuing overdose crisis, identifying states with extreme historical supply variations.
Limits
The ecological design precludes individual-level causal conclusions between supply and overdose deaths. Findings rely on administrative aggregate distribution metrics and death certificate coding without measuring illicit drug market dynamics or patient-level outcomes.
Cited by
- supports Opioid addiction and overdoses kill approximately 70,000 people per year in the United States.