MedicalResearch.com Interview with:
Brian J. Piper, PhD, MS
Assistant Professor of Neuroscience
Department of Basic Sciences,
Geisinger Commonwealth School of Medicine,
Scranton PA 18509
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The US is experiencing an opioid crisis. There were 63,800 drug overdose deaths in 2016 which is three-fold higher than in 1999. Drug overdose deaths involving synthetic opioids like fentanyl increased 27-fold. Overdoses may even have contributed to decreases in the US lifespan. Emergency Room visits involving opioids have also shown recent increases, particularly in the Southwest and Western US. The US accounts for less than 5% of the world’s population but consumed over two-thirds (69.1%) of the world’s supply of six opioids (fentanyl: 30.1%, methadone: 48.1%, morphine: 51.2%, hydromorphone: 53.0%, oxycodone: 73.1% and hydrocodone: 99.7%) in 2014.
The goal of this study was to examine changes in medical use of ten opioids within the United States, and US Territories, from 2006 to 2016 as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS). Prior estimates of the Morphine Mg Equivalent (MME), per person in the US (640), although much higher than most other developed countries, may be an underestimate because of a federal regulation (42 CFR Part 2) that prevents reporting methadone from narcotic treatment programs.
We discovered that prescription opioid use peaked in 2011 (389.5 metric ton MMEs) and has been rapidly declining (346.5 in 2016). Relative to 2011, there were decreases in hydrocodone (–28.4%); oxymorphone (–28.0%); fentanyl (–21.4%); morphine (–18.9%); oxycodone (–13.8%); and meperidine (–58.0%). However, there was a pronounced increase in buprenorphine (75.2%). Similar changes were observed from 2015 to 2016 with a statistically significant reduction in all opioids except buprenorphine which was increased. There were substantial geographical variations in rates with a seven fold difference between the highest Morphine Milligram Equivalents in 2016 (Rhode Island = 2,624 mg/person) relative to Puerto Rico (351 mg/person).
Two drugs used in treating an opioid use disorder (methadone and buprenorphine) accounted for over-half (52%) of the total MME in 2016.
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