Author Interviews, Pain Research / 24.03.2026
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:
[caption id="attachment_72890" align="alignleft" width="195"] Dr. Jay Solgama[/caption]
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.
Dr. Jay Solgama[/caption]
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.
Dr. Piper[/caption]
Brian J. Piper, PhD
Department of Medical Education
Center for Pharmacy Innovation & Outcomes
Geisinger College of Health Sciences
Scranton, PA 18509
MedicalResearch.com: What is the background for this study?
Dr. Piper: Tapentadol has an unusual mechanism of action. This opioid is similar to morphine in that it activates mu, the main opiate receptor which is important for pain. This drug also acts similar to an antidepressant like duloxetine (Cymbalta) with equal ability to block both the norepinephrine and the serotonin transporters (Figure 1). The combination of opioid and monoaminergic activity may influence both therapeutic and side effect profiles.
[caption id="attachment_68512" align="aligncenter" width="192"]
Figure 1. Biological mechanism of action of the atypical opioid tapentadol involves binding to the mu opiate receptor, blocking the norepinephrine transporter (NET), and blocking the serotonin transporter (SERT) [1].[/caption]Tapentadol is approved in the US for moderate to severe acute pain, moderate to severe chronic pain, and neuropathic pain associated with diabetic peripheral neuropathy. However, tapentadol is not generally considered first-line for any of these indications. Although this agent has a high potential for abuse and is classified as a Schedule II substance, a manufacturer of extended release tapentadol (Grunenthal) has conducted a misinformation campaign claiming tapentadol has a “minimum potential of abuse”, does not cause respiratory depression (a well-known opioid effect), does not cause any euphoric feelings, has no street value, and is not an opioid [2]. Prior pharmacoepidemiological studies have examined the use patterns of other prescription opioids that can be misused like oxycodone [3], fentanyl [4], meperidine [5] and methadone [6] but there is limited national information about the use of tapentadol.
Elena Stains
Medical Student
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA
MedicalResearch.com: What is the background for this study?
Response: Opioid use has been an increasing problem since the early 2000s in the United States (US) with a surge around 2010. Twenty-five percent of those having abused pain relievers in 2013 and 2014 got those drugs from physicians1. Physicians are particularly well-known for fueling the opioid crisis in Florida in the 2000s. Of the United States’ top 100 opioid prescribing physicians in 2010, an astounding 98 were prescribing in Florida2. Florida taking the main stage of the opioid crisis can be attributed to several factors, including ability of physicians to dispense opioids directly from their offices to patients (i.e. without pharmacists) and the presence of many infamous “pill mills” in the state3–6.
The researchers at Geisinger Commonwealth School of Medicine aimed to analyze the amount of hydrocodone (including brand names of Vicodin and Lortab) and oxycodone (OxyContin and Percocet) distributed in Florida from 2006 to 2021, paying close attention to the peak year of the opioid crisis, 2010. The team used the Washington Post and the US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) databases to compile this compelling information.
Leana Pande[/caption]
MedicalResearch.com Interview with:
Leana Pande
Touro College of Osteopathic Medicine
MedicalResearch.com: What is the background for this study?
Response: Buprenorphine is not a new drug. It was developed in the 1960s with the intent of providing the benefits of opioids, without the addictive side effects. Unlike many prescription opioids,1 use of this Schedule III drug is increasing.2 It is often characterized as a partial agonist at the mu-opioid receptor (Figure-Right). Buprenorphine is available in many routes of administration and also with (brand name Suboxone) or without naloxone. Buprenorphine is a first-line pharmacotherapy for pregnant women with OUD.3 This review was completed in order for the benefits, and risks, of buprenorphine to be more fully appreciated and inform utilization for both opioid use disorder (OUD) and the treatment of pain.
Edward Liu[/caption]
Edward Liu, BA
Second year medical student
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA
Medicalresearch.com: What is the background for this study?
Response: The United States’ opioid epidemic continues to rise because of increasing opioid use and availability, contributing to prescription opioid misuse, mortality, and rising cost.1 The worsening health and economic impact of opioid use disorder in the US warrants further attention on the adverse effects and distribution pattern of commonly prescribed opioids like oxycodone (OxyContin), fentanyl (Duragesic), and morphine (MS-Contin). Using the Automated Reports and Consolidated Ordering System (ARCOS) database,2 a comprehensive data collection system of pharmacies and hospitals distribution of Schedule II and III controlled substances in the US with the FDA Adverse Event Reporting System (FAERS)3 has never been done before. This approach may provide a more complete picture of the risks of prescription opioids which can include drowsiness, nausea, and potentially fatal respiratory depression. 
Alden Mileto, BA
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA
MedicalResearch.com: What is the background for this study?
Response: The drug buprenorphine is a partial opioid agonist, originally developed in the 1960s as an alternative to the stronger full opioid mu receptor agonists like morphine. Today, the drug is sometimes used for pain, but is more often used as a treatment for Opioid Use Disorder (OUD). Since the 2002 federal approval for buprenorphine use in treatment of OUD, there has been an increase in buprenorphine prescription across all states.
However recent studies have showed a disproportionate increase in buprenorphine prescriptions to rural/ less populated areas in comparison to urban/densely populated areas. The objective of this study [1] was to analyze the trends in buprenorphine distribution, overall and by three-digit zip codes, in Pennsylvania from 2010-2020.
Dr. Harris[/caption]
MedicalResearch.com Interview with:
Rebecca Arden Harris, MD, MSc
Assistant Professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania
Senior Fellow, Leonard Davis Institute of Health Economics
Perelman School of Medicine, University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: The impact of the nationwide overdose epidemic on Black women has received little attention from policy-makers, researchers, or the press.
MedicalResearch.com: What are the main findings?
Response: Over the 7-year study period, preventable overdose deaths among Black women resulted in nearly 0.75 million years of life lost (YLL). Women aged 25-34 have suffered a rising proportion of this burden.
Dr. Thakrar[/caption]
Ashish Thakrar, MD
Internal Medicine & Addiction Medicine
National Clinician Scholars Program
University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: About 1.8 million Americans are currently incarcerated, more than any other country in the world per capita. Of those 1.8 million, about 1 in 7 suffers from opioid addiction, putting them at high risk of overdose and death, particularly in the weeks following release.
Opioid use disorder is a treatable condition, particularly with the medications buprenorphine or methadone, but historically, prisons and jails have not offered treatment. Over the past five years, a few states and municipalities have enacted policies to provide access for OUD treatment. We examined whether these policies were actually improving access to treatment. 
Background: To identify individual-level factors associated with COVID-19-related impacts on recovery in 216 participants originally enrolled in the SUBLOCADE® (buprenorphine extended-release) clinical program.
Within the fifteen-month study 216 participants, during the period of September 2021 through January 2021, were asked how the COVID-19 crisis affected their recovery from substance use, utilizing self-reported measures.
Dr. Kovács[/caption]
Balázs Kovács PhD
Associate Professor of Organizational Behavior
Yale School of Management
MedicalResearch.com: What is the background for this study?
Response: Our study looks at the association between the prevalence of legal cannabis stores, called “dispensaries”, and opioid-related mortality rates in the U.S. We find that higher cannabis dispensary counts are associated with reduced opioid-related mortality rates. We find this relationship holds for both medical dispensaries, which only serve patients who have a state-approved medical card or doctor’s recommendation, as well as for recreational dispensaries, which sell to adults 21 years and older. The statistical associations we find appears most pronounced with the class of opioids that includes fentanyl and its analogs. 
Dr. Desai[/caption]
Nimesh D. Desai, MD, PhD
Director, Thoracic Aortic Surgery Research Program
Associate Professor of Surgery
Hospital of the University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Dr. Chase Brown: Opioid use in the United States is a public health emergency. We know that opioids prescribed after general surgery operations to patients who never received them within the year prior to their surgery are at increased risk for continuing to take opioids months later. However, this has not been studied in patients undergoing cardiac surgery, who often times have more severe post-operative pain.
Our goal in this study was to determine how many patients after cardiac surgery and are opioid naive are continuing to take opioids within 90-180 days after their surgery. 
