24 Mar Dynamic changes and pronounced state-level differences in oxycodone in the USA: An observational study of ARCOS, Medicaid, and Medicare Drug databases
MedicalResearch.com Interview with:
Dr. Jay Solgama
Jay P. Solgama, MD
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA
MedicalResearch.com: What is the background for this study?
Response: The United States (U.S.) continues to face a severe opioid crisis, with nearly 80,000 opioid-related deaths reported in 2023. Prescription opioids play a central role in this epidemic, with a large proportion of misuse involving commonly prescribed pain relievers such as oxycodone. Prior research has shown that oxycodone (brand names OxyContin, Roxicodone, OxyIR, RoxyBond, and Percocet) is one of the most widely consumed and misused opioids in the U.S., with notable geographic variation in its distribution across states [1–3].
Against this backdrop, the present study aimed to comprehensively characterize oxycodone distribution across the U.S. from 2000 to 2023. Using three complementary data sources—the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS), Medicaid State Drug Utilization Data (M-SDUD), and the Medicare Part D Prescribers dataset (M-PDP)—we sought to evaluate national and state-level patterns, as well as identify strengths and weaknesses of each dataset [4,5]. The Medicaid program serves low-income and Medicare serves elderly patients.
MedicalResearch.com: What are the main findings?
Response: The investigation revealed substantial changes in oxycodone distribution across all three datasets. Within ARCOS, national distribution, measured in morphine milligram equivalents per person, increased sharply by approximately 280% from 2000 to a peak in 2010, followed by a gradual decline through 2023, though levels remained about 56% higher than in 2000. Pharmacies accounted for over 94% of total distribution, driving overall use, while hospitals and practitioners differed in the magnitude and timeline of change over the study years.
The Medicaid (M-SDUD) data showed a similar but slightly delayed pattern, with prescriptions and units of oxycodone peaking in 2012 (+218% and +183%, respectively). Over the full period (2000–2023), prescriptions decreased slightly (−8%) and units decreased by −17%. However, there were notable anomalies in early years for some states, highlighting limitations in the Medicaid dataset.
The Medicare Part D (M-PDP) data (2013–2022) showed more modest changes. Claims and 30-day fills per enrollee peaked around 2015 and declined by roughly 25–26% by 2021. When adjusted per beneficiary, claims instead peaked later (around 2020) and showed only small overall increases, underscoring the importance of population-specific measures.
Across all three datasets, substantial state-level variation was observed. States such as Florida, Delaware, and Tennessee consistently exhibited higher oxycodone distribution in ARCOS data, while Texas and Illinois remained among the lowest. Florida had policies where providers could directly dispense prescription opioids to patients without pharmacist involvement. Medicaid data similarly highlighted Delaware and Alaska as high-utilization states, while Medicare data showed lower utilization in places like the District of Columbia and North Dakota. These findings emphasize persistent geographic disparities seen across distinct data sources.
MedicalResearch.com: What should readers take away from your report?
Response: This study highlights the significant variability in oxycodone distribution across U.S. states and over time, reinforcing the complexity of the opioid epidemic. While overall distribution has declined since its peak around 2010, differences across states and healthcare systems remain pronounced. The findings also demonstrate that different data sources (ARCOS, Medicaid, and Medicare) capture distinct aspects of opioid use, underscoring the importance of using multiple datasets to obtain a more complete understanding of prescribing patterns.
These results suggest that regional prescribing practices, healthcare infrastructure, and policy interventions all likely contribute to observed disparities. Understanding these differences is critical for designing targeted and effective strategies to reduce opioid misuse while maintaining appropriate access to pain management.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should focus on identifying the underlying factors that drive state-level differences in oxycodone distribution, including policy variations, provider prescribing behaviors, and patient demographics and attitudes towards opioids. Additional studies could examine if regulatory interventions—such as preferred drug lists, prescription drug monitoring programs and prescribing limits [6]—meaningfully impact distribution trends over time.
Further work integrating multiple datasets, as done in this study, may also help clarify inconsistencies between sources and improve monitoring of opioid use. Expanding analyses to include outcomes such as misuse, addiction, and overdose could strengthen the connection between prescribing patterns and public health impacts.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study demonstrates the value of leveraging multiple publicly available data sources to better understand opioid distribution in the United States. ARCOS provides comprehensive national distribution data, while the Medicare datasets offer important insights into prescribing patterns among specific populations. Results from the Medicaid database should be viewed cautiously and only after careful examination of quarterly prescriptions over time to identify any implausible values.
Together, these resources can support more informed decision-making by clinicians and policymakers as the U.S. continues efforts to correct for past excesses while not overcorrecting. Continued use and refinement of these datasets will be essential for monitoring patterns, evaluating interventions, and guiding stewardship efforts to address the ongoing opioid crisis.
Publication:
Citations:
1. Key Substance Use and Mental Health Indicators in the United States: 2023 National Survey on Drug Use and Health.
2. Richards GC, et al. Global, regional, and national consumption of controlled opioids: a cross-sectional study of 214 countries and non-metropolitan territories. British Journal of Pain. 2022; 16(1):34-40.
3. Kibaly C, et al. Oxycodone in the opioid epidemic. Cellular and Molecular Neurobiology 2021; 41(5):899-926.
4. U.S. Department of Justice Drug Enforcement Administration. ARCOS Retail Drug Summary Reports.
5. Centers for Medicare & Medicaid Services. Medicaid State Drug Utilization Data and Medicare Part D Prescribers Data.
6. Davis CS, et al. Opioid prescribing laws are not associated with short-term declines in prescription opioid distribution. Pain Medicine 2020; 21(3):532-7.
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Last Updated on March 24, 2026 by Marie Benz MD FAAD