Declines and pronounced state-level variation in tapentadol use in the US

BackgroundTapentadol is an opioid approved for the treatment of moderate-to-severe pain in the United States (US). Tapentadol is unique as it is the only Schedule II prescription drug that has dual modes of action as it combines agonist activity at the {micro} opioid receptor with norepinephrine reuptake inhibition. This descriptive study characterized tapentadol use in the US. MethodsDrug distribution data from 2010 to 2020 were extracted for each state from the Drug Enforcement Administration. Use per state, corrected for population, was analyzed. The percentage of distribution channels (pharmacies, hospitals, and providers), the distributed amount of tapentadol, and the final adjusted quota of tapentadol were obtained. Data on tapentadol use as reported by the Medicare and Medicaid programs for 2010 to 2020 were also analyzed. ResultsThe distributed amount of tapentadol was 3.5 tons in 2020 and on average, the final adjusted production quota was 207.2% greater than the distributed amount between 2010 and 2020. Distributed tapentadol was 1.3% of all Schedule II opioids distributed in 2020. Tapentadol use decreased by -53.8% between 2012 and 2020 in the US whereas New Hampshire was the only state that had a positive change (+13.1%). There were minor changes in the amounts of tapentadol distributed via various distribution channels (Pharmacies = 98.0%, hospitals = 1.9% in 2020). Tapentadol prescribed by Nurse Practitioners experienced the largest increase of +8.7% among all specialties to 18.0%, the highest percentage of Medicare claims of tapentadol in 2019. Diabetes prevalence was significantly correlated with tapentadol distribution in 2012 (r(50) = .44, p < .01) and 2020 (r(50) = .28, p < .05). DiscussionThere has been a substantial decline over the past decade in tapentadol distribution and prescribing to Medicaid patients. The unusual tapentadol prescribing pattern in New Hampshire may warrant investigation regarding differing prescribers attitudes towards tapentadol or the employment of tapentadol as part of a step-down therapy for opioid addiction.