13 Oct New Geisinger Study finds steep decline in hydromorphone use in America over the last decade

MedicalResearch.com Interview with:

Krisha S. Patel

Krisha S. Patel
Center For Pharmacy Innovation and Outcomes
Geisinger College Health Sciences
Scranton, PA

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

Response: Hydromorphone is a powerful opioid medication approved for treating moderate to severe acute pain, as well as chronic pain that doesn’t respond to other treatments. One brand name is Dilaudid. It is much more potent than morphine, about 5 to 10 times stronger, and crosses the blood-brain barrier more efficiently. Hydromorphone comes in several forms, including oral powders, solutions, immediate- and extended-release tablets, and injectable options like intravenous, intramuscular, and subcutaneous.

Like morphine, hydromorphone primarily targets the mu-opioid receptors, with some activity at delta receptors. Its higher fat solubility gives it a faster onset of action than morphine, though not as rapid as fentanyl. Due to its potency and risk for misuse and overdose, hydromorphone is typically prescribed only when other pain management options have failed. According to the RADARS StreetRx Program, in 2023, the black-market value of a 1 mg immediate-release tablet was about $15,000 annually, with extended-release tablets reaching $62,000 for a full-years supply.

While previous studies have explored regional differences in the use of opioids like morphine, oxycodone, and codeine, hydromorphone has not been examined. This study aims to fill that gap by analyzing state-level and temporal trends in hydromorphone use across the US from 2010 to 2023. It draws on data from three major sources: the Drug Enforcement Administration’s Automated Reports and Consolidated Orders System (ARCOS), Medicaid, and Medicare Part D. By comparing these datasets, this report also explores how hydromorphone distribution and prescribing patterns have evolved over time.

MedicalResearch.com: What are the main findings?

Response: This new investigation identified regional disparities in hydromorphone use across the US from 2010 to 2023. ARCOS data showed a 30.6% increase in distribution through 2013, followed by a 55.9% decline by 2023. Medicaid prescriptions rose 39.6% by 2015, then dropped 48.9% by 2023. Similarly, Medicare Part D claims increased 8.5% by 2015 before decreasing 31.9% by 2023. Our findings also highlighted pronounced state-level disparities in hydromorphone use identified in ARCOS (158.7 fold), Medicaid (17.5 fold), and in Medicare Part D (13.7 fold).

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

Response: Firstly, there has been a substantial decrease in hydromorphone use in the US over the past decade. This suggests the loss of its popularity among the opioids as well as other competing pharmacotherapies becoming more popular.

Secondly, our findings showcase the regional disparities in hydromorphone use in the US, with there being a substantial difference between some states. In 2023, Vermont had the highest milligrams per person (47.6) whereas Alabama had the lowest (0.3), highlighting an almost one-hundred and sixty fold difference between the two states. This substantial disparity highlights the need for regionally tailored interventions and policies to account for the demographic and geographical differences. Due possibly to the increasing Centers of Disease control and Preventions overdose prevention programs that reduce the accessibility to opioids, the decline in hydromorphone use was expected.

MedicalResearch.com: What recommendations do you have for future results of this study?

Response: This investigation employed three freely available complementary databases. We continue to be surprised that other public health investigators or data journalists do not regularly make use of ARCOS. Future research should also explore individual-level patient data to better understand disparities beyond the broader state-level trends identified in this report. Examining patient-specific factors could provide deeper insights into how demographic and geographic differences influence access to hydromorphone and other healthcare services. Moving forward, it is essential that interventions and policies are tailored to regional needs, taking into account variations in population characteristics, healthcare infrastructure, and prescribing practices. Such targeted approaches can help ensure more equitable access to pain management and support ongoing efforts to address the opioid crisis more effectively.

Citation:

Krisha S. Patel et al. From peak to plunge: A multi-database analysis of state-level disparities in hydromorphone use in the US. Pharmacy 2025; https://www.mdpi.com/2226-4787/13/5/147

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Last Updated on October 13, 2025 by Marie Benz MD FAAD