An Analysis of Oxycodone and Hydrocodone Distribution Trends in Delaware, Maryland, & Virginia between 2006-2014

ObjectiveUnderstanding opioid use and distribution trends by geographic area is critical in addressing the ongoing opioid epidemic in the United States. This study is a county level analysis of oxycodone and hydrocodone use in Delaware, Maryland, and Virginia between 2006-2014. Materials and MethodsA retrospective analysis of oxycodone and hydrocodone distributed as collected by the Drug Enforcement Administrations (DEA) Washington Post Automation of Reports and Consolidated Orders System (ARCOS) in Delaware, Maryland, and Virginia. Raw drug weights in each county were adjusted to "daily average dose" (grams/county population/365). Purchasing data collected from ARCOS was used to compare distribution trends during this period. ResultsThere was a 57.59% in the weight of oxycodone and hydrocodone between 2006-2014. Oxycodone prescriptions increased by 75.50% and hydrocodone by 11.05%. Oxycodone increased across all three states between 2006-2010 and declined until 2014. Hydrocodone also increased but to a lesser extent than oxycodone. There was substantial variability in daily average dose of both opioids at the county level in all states. Pharmacies accounted for largest portion of oxycodone (69.17%) and hydrocodone (75.27%) purchased in the region. Hospitals accounted for 26.67% of oxycodone and 22.76% hydrocodone purchased. Practitioners and mid-level providers did not significantly contribute to this increase. ConclusionIn the states of Maryland, Delaware, and Virginia, the distribution of the prescription opioids oxycodone and hydrocodone increased by 57.59%. Daily average dose increased between 2006-2010 in all three states followed by a decline until 2014. Variability in daily average dose by county highlights the relationship between geography and likelihood of receiving high dose opioids. It may further allude to effects of targeted distribution by pharmaceutical manufacturers and prescribing habits of geographically distinct healthcare entities. Relationships between location and opioid usage should continue to be investigated to promote rational use of controlled substances.