01 Dec From most prescribed opioid in the US to (almost) discontinued: The demise of Demerol

MedicalResearch.com Interview with:

Lavinia Harrison

Lavinia Harrison
Geisinger Commonwealth School of Medicine
Scranton, PA  18509

MedicalResearch.com: What is the background for this study?

Response:   The opioid meperidine (Demerol) was widely prescribed in the United States (US) as an analgesic to treat moderate to severe pain. Meperidine was the most used opioid in the US in 1987 and was considered safer than other opioids during acute pancreatitis. Over the past two decades, meperidine has shifted from being frequently prescribed to being used only when patients are experiencing atypical reactions to opioids (e.g., morphine and hydromorphone); to removal from the World Health Organization’s essential medication list and receiving strong warnings against its use from many professional organizations including the American Geriatrics Society. The unfortunate Libby Zion (1965-1984) case increased concerns about serotonin syndrome with meperidine.

According to a prior pharmacoepidemiology report, the distribution of meperidine in the United States decreased by 95% between 2001 and 2019 [1]. The aim of the study was to include updated information (2020 and 2021) as well as examine the changes among Medicaid patients [2].

MedicalResearch.com: What are the main findings?

Response:Although the distribution of meperidine has continued to greatly decrease throughout the US, we also identified substantial regional differences. There was a 34-fold state-level difference in meperidine distribution between Arkansas (16.8 mg/10 persons) and Connecticut (0.5 mg/10 persons) in 2020. Meperidine distribution in 2020 was significantly elevated in Arkansas, Mississippi, and Alabama relative to the national average. In 2021, meperidine distribution was once again highest in Arkansas (16.7 mg/10 persons) and lowest in Connecticut (0.8 mg/10 persons). Similarly, the prescriptions of meperidine to Medicaid patients decreased by 74% between 2016 and 2021.

MedicalResearch.com: What should readers take away from your report?

Response: The main takeaway from this study is that there was a continued decrease in the overall distribution of meperidine in the past two decades, with a similar recent decline in prescribing to Medicaid patients. States in the south (Arkansas, Alabama, Mississippi, and Louisiana) may be at risk for inappropriate prescribing. This data may reflect plans to phase out the use of this opioid, especially in the many situations where safer and more preferred opioids are available. As more prescribers in the US and abroad become aware of meperidine’s inferiority to other opioids and its elevated risks for serotonin syndrome and neurotoxicity, this drug may soon become a relic of interest to only medical historians. 

MedicalResearch.com: Is there anything else you would like to add?

Response: This report was made possible by the comprehensive and timely information generously provided by the Drug Enforcement Administration. We continue to be surprised that other researchers and data journalists interested in controlled substances do not make use of this database [3].

Citations

1. Boyle et al. Declines and pronounced regional disparities in meperidine use in the United States. Pharmacology Research Perspectives 2021; 9:e00809. https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/prp2.809
2. Harrison et al. Pronounced declines in meperidine in the US: Is the end imminent? Pharmacy 2022, 10, 154. https://doi.org/10.3390/pharmacy10060154
3. Diversion Control Division, Drug Enforcement Administration. https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html

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Last Updated on December 1, 2022 by Marie Benz MD FAAD