Declines and pronounced state disparities in prescription opioid distribution in the United States

BackgroundThe United States (US) opioid epidemic is a persistent and pervasive public health emergency that now claims the lives of over 100,000 Americans per year. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain, and identified state-level differences between 2010 and 2019. Methods and FindingsData on opioid production quotas and distribution of ten prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) for 2010 to 2019 were obtained from the Drug Enforcement Administration. Total opioid production quotas increased substantially from 2010 to 2013 before decreasing 41.5% from 2013 (87.6 morphine mg equivalent metric tons) to 2019 (51.3). The peak year for distribution of all ten prescription opioids was between 2010 and 2013, except for codeine (2015). The largest quantities of opioid distribution were observed in Tennessee (520.70 morphine mg equivalent or MME per person) and Delaware (251.45) in 2011 and 2019. There was a 52.0% overall decrease in opioid distribution per capita from 2010 to 2019, with the largest decrease in Florida (-61.6%) and smallest in Texas (-18.6%). The highest to lowest state ratio of total opioid distribution, corrected for population, decreased from 5.25 in 2011 to 2.78 in 2019. The mean 95th/5th ratio was relatively consistent in 2011 (4.78 +0.70) compared to 2019 (5.64+0.98). Southern states had the highest per capita distribution for eight of the ten opioids in 2019. ConclusionsThis study found a sustained decline in distribution of ten prescription opioids during the last half-decade. Distribution was non-homogeneous at the state level. Analysis of state-level differences revealed a three-fold difference in the 95th:5th percentile ratio between states which was unchanged over the past decade. Production quotas did not correspond with the distribution, particularly in the 2010-2016 period. Future research focused on identifying factors contributing to the observed regional variability in opioid distribution could prove valuable to understanding, and potentially remediating, the pronounced disparities in prescription opioid-related harm in the US.