John Boyle, BS Department of Medical Education Geisinger Commonwealth School of Medicine

Declines, but pronounced regional differences, in meperidine (Demorol) use Interview with:

John Boyle, BS Department of Medical Education Geisinger Commonwealth School of Medicine

John Boyle

John Boyle, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine What is the background for this study?

Response:  Meperidine is an opioid analgesic which has been approved for use since the 1940s for moderate to severe pain. During the 1990s, concerns about adverse effects (e.g., serotonin syndrome) and CYP450 drug interactions (e.g., 3A4 inhibition of other metabolism of other common medications) were raised and by 2003 it was removed from the WHO’s List of Essential Medicines.

Despite increased awareness of adverse effects, meperidine is still used in the United States. It was the goal of this study1 to uncover pharmaepidemiological trends in its use. What are the main findings?

Response:  Although there was a marked decline in meperidine distribution in the United States as reported by the Drug Enforcement Administration’s Automated Reports and Consolidated Orders System (ARCOS)2 database, significant regional disparities also were identified. Our analysis revealed a four-state region (Arkansas, Alabama, Oklahoma, and Mississippi) with significantly greater use than the rest of the country. This region accounted for 13.8% of the meperidine distributed in 2019 despite only containing 4.5% of the US population. What should readers take away from your report?

Response: The main takeaway of the study is that while meperidine use continues to decrease, there are areas which are “hot spots”. Significant variation in the use of this opioid as identified by our study warrants further research about safe and appropriate use. There is also a need to identify specific situations that are driving meperidine use, which will help tailor education. For example, is meperidine being used as a first line analgesic or is it being used preferentially in cases of acute pancreatitis? Each of these is not a recommended use, but provider audience and educational strategies would vary accordingly. Is there anything else you would like to add?

Response: To date, this is the only national pharmaepidemiological study of meperidine that exists in the United States. It may serve as a starting point to continue to monitor meperidine use. We also encourage other public health researchers and journalists interested in controlled substances to make use of the publically available ARCOS database2.


  1. Boyle et al. Declines and pronounced regional disparities in meperidine use in the United States. Pharmacology Research Perspectives 2021; 9:e00809.
  2. Diversion Control Division, Drug Enforcement Administration.



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Last Updated on June 25, 2021 by Marie Benz MD FAAD