Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
BMJ Open. 2024 Mar 7;14(3):e073765. doi: 10.1136/bmjopen-2023-073765.
This study aims to characterise oxycodone's distribution and opioid-related overdoses in the USA by state from 2000 to 2021.
This is an observational study.
More than 80 000 Americans died of an opioid overdose in 2021 as the USA continues to struggle with an opioid crisis. Prescription opioids play a substantial role, introducing patients to opioids and providing a supply of drugs that can be redirected to those seeking to misuse them.
The Drug Enforcement Administration annual summary reports from the Automation of Reports and Consolidated Orders System provided weights of oxycodone distributed per state by business type (pharmacies, hospitals and practitioners). Weights were converted to morphine milligram equivalents (MME) per capita and normalised for population. The Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research provided mortality data for heroin, other opioids, methadone, other synthetic narcotics and other/unspecified narcotics.
There was a sharp 280.13% increase in total MME/person of oxycodone from 2000 to 2010, followed by a slower 54.34% decrease from 2010 to 2021. Florida (2007-2011), Delaware (2003-2020) and Tennessee (2012-2021) displayed consistent and substantial elevations in combined MME/person compared with other states. In the peak year (2010), there was a 15-fold difference between the highest and lowest states. MME/person from only pharmacies, which constituted >94% of the total, showed similar results. Hospitals in Alaska (2000-2001, 2008, 2010-2021), Colorado (2008-2021) and DC (2000-2011) distributed substantially more MME/person over many years compared with other states. Florida stood out in practitioner-distributed oxycodone, with an elevation of almost 15-fold the average state from 2006 to 2010. Opioid-related deaths increased +806% from 2000 to 2021, largely driven by heroin, other opioids and other synthetic narcotics.
Oxycodone distribution across the USA showed marked differences between states and business types over time. Investigation of opioid policies in states of interest may provide insight for future actions to mitigate opioid misuse.
本研究旨在通过各州 2000 年至 2021 年的数据，描述美国奥施康定的分布情况和与阿片类药物相关的过量用药情况。
这是一项观察性研究。
2021 年，美国有超过 8 万美国人死于阿片类药物过量，该国仍在努力应对阿片类药物危机。处方阿片类药物在其中发挥了重要作用，使患者接触到阿片类药物，并提供了可供那些试图滥用药物的人重新调配的药物供应。
药物管制局年度综合报告系统的自动报告提供了各州按商业类型（药店、医院和医生）分布的奥施康定重量。重量已转换为吗啡毫克当量（MME）/每千人，并根据人口进行了标准化。疾病控制与预防中心广泛在线流行病学研究数据提供了海洛因、其他阿片类药物、美沙酮、其他合成麻醉剂和其他/未指定麻醉剂的死亡率数据。
从 2000 年到 2010 年，奥施康定的总 MME/人均增长了 280.13%，随后从 2010 年到 2021 年又下降了 54.34%。佛罗里达州（2007-2011 年）、特拉华州（2003-2020 年）和田纳西州（2012-2021 年）的 MME/人均综合水平持续且显著升高，与其他州相比。在高峰年份（2010 年），最高和最低州之间存在 15 倍的差异。仅占总数 94%以上的来自药店的 MME/人均也显示出了类似的结果。阿拉斯加（2000-2001 年、2008 年、2010-2021 年）、科罗拉多州（2008-2021 年）和哥伦比亚特区（2000-2011 年）的医院在多年来分发的 MME/人均数量上明显高于其他州。佛罗里达州在医生分发的奥施康定方面表现突出，从 2006 年到 2010 年，其平均水平上升了近 15 倍。2000 年至 2021 年，阿片类药物相关死亡人数增加了 806%，主要是由海洛因、其他阿片类药物和其他合成麻醉剂引起的。
美国奥施康定的分布在各州和各商业类型之间存在显著差异，且这种差异随时间而变化。对感兴趣的州的阿片类药物政策进行调查，可能为减轻阿片类药物滥用提供未来行动的见解。
