Trends in the Distribution of Selected Opioids by State US 1999-2011Opioids by State, US, 1999 2011

Christopher M. Jones, PharmD, MPHLCDR, US Public Health Service

Division of Unintentional Injury PreventionNational Center for Injury Prevention and Control

1

Centers for Disease Control and PreventionNational Center for Injury Prevention and Control

Division of Unintentional Injury Prevention

Drug overdose death rates continue to increaseUS, 1980-2010

25

Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose)

20

atio

n

15

10

0,0

00

po

pu

l

5

10

Dea

ths

per

1

01980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

2

NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data

Year

Number of drug overdose deaths involving opioid pain relievers and other drugsopioid pain relievers and other drugs

US, 1999-2010

18,000Any opioid analgesic

14,000

16,000

s

Any opioid analgesic

Specified drug(s) other than opioid

8,000

10,000

12,000

ber

of d

eath

other than opioid analgesic

Only non-specified drug(s)

4,000

6,000

Nu

mb g( )

0

2,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

3

CDC/NCHS, National Vital Statistics System

Rates of opioid overdose deaths, sales and treatment admissions increased in parallel, admissions increased in parallel,

US, 1999-2010Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000

6

7

8

4

5

6

Rat

e

2

3

0

1

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Year

4

National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS

Year

Current Analysis

National and state sales of oxycodone, hydrocodone, y , y ,methadone from 1999 through 2011

B d DEA’ A t ti f R t d Based on DEA’s Automation of Reports and Consolidated Orders System (ARCOS) data

5

ARCOS

DEA database

Quarterly mandatory reporting system for Quarterly mandatory reporting system for manufacturers and distributors

Tallies cumulative sale of certain licit controlled substances in grams

Reflects the amount of drug legitimately distributed in the U.S. the U.S.

Used to monitor controlled substances from the point of manufacture to the point of sale.

Public health uses to monitor trends

6

Distribution rate of selected opioids in grams, US, 1999-2011 ARCOS1999-2011, ARCOS

HYDROCODONE METHADONE OXYCODONE

2,000

2,500

1,500

2,000

00

0 p

erso

ns

1,000

Gra

ms

per

10

,0

500

G

7

01999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Distribution of hydrocodone, 2011, ARCOSDistribution of hydrocodone, 2011, ARCOS

860549

1359

1425

10301000

1135

685

996

1337

957

876

20641691

2100

1071823

88377812.11156

1118872

25271575

3199NH 498VT 549MA 406RI 892

2306

1623

1100

2806

11302662

1414

88377812.12839

32521025

1575 CT 479NJ 351DE 515MD 433DC 1892112 2664

17822021

1068

930

189-899 900-1399Grams per 10,000 population719

930

1400-3252

Percent change in distribution of hydrocodone by state, 1999-2011, ARCOSstate, 1999 2011, ARCOS

600

500

300

400

Per

cen

t

200

P

0

100

D D C MI N K

S S A N O K E R V T V IL Y M N WI Y D V

T HI E H X Y

AL A A Z A A C H A R A RI T K A O D

EC

T FL D NJ C

9

ND SD S M TN K M I A

MN

MO

O M A NV

M WV I KY

NM IN W WY ID V H N OH TX

NY

A LA GA

A PA

CA

N NH

VA

O WA R U A MA

CO D C F MD N D

Distribution of methadone 2011, ARCOSDistribution of methadone 2011, ARCOS

133263

240

554

459401

87

156

129

236

113

116

299317

284

169196

181176227

213191

193154

340NH 311VT 389MA 218RI 129

101

195

142

458

241204

190

181176260

139252213

154 CT 138NJ 131DE 219MD 210DC 88283

106224

333

352

87-179 180-239Grams per 10,000 population210

352

240-554

Percent change in distribution of methadone 1999-2011, ARCOS,

1,400

1,000

1,200

800

Per

cen

t

400

600

P

0

200

11

0

IAM

N NE

MI

MS

OH

SD WI

IN VT

OR

SC DE HI

TN FL ME ID OK

MO CA

WA LA PA AL

NJ IL KY RI

CO

WY

TX

AZ

KS

MD

ND

MT

NH

NV

NY

WV

VA

NM NC

UT

GA

AR

CT

MA

AK

DC

Distribution of oxycodone 2011, ARCOSDistribution of oxycodone 2011, ARCOS

9891241

1924

2569

20122985

499

1892

895

1170

1086

866

12631325

1599

15342057

172622462294

25722875

29212425

3705NH 2705VT 1940MA 2174RI 2338

1140

1657

2530

1879

22692207

1930

172622462524

19083690

3152

2425 CT 2658NJ 3169DE 6122MD 2961DC 13531891

4571711

4832

1921

457-1789 1800-2299Grams per 10,000 population1782

1921

2300-6122

Percent change in distribution of oxycodone by state, 1999-2011, ARCOSstate, 1999 2011, ARCOS

1,200

1,000

600

800

Per

cen

t

400

P

200

13

0

TN DE

NY FL NV

UT NJ

OK

CO CA

NM H

IK

S ID OR

AZ LA RI WI

GA

NC

AR

OH KY

WY

AL IL IN SD MT

MN SC IA

MO

MD PA M

IM

SW

VN

D CT

VA

ME

NH

WA

MA VT

NE

DC TX AK

Conclusions

Rising trends in opioid use portend increasing rates of drug overdosesdrug overdoses

Data available to states to track prescription drug sales and overdoses vary widely

ARCOS data are consistent across states and can be used to track distribution and compare states

PDMPs and insurance claims data can also be used to PDMPs and insurance claims data can also be used to identify and address opioid abuse by patients, as well as inappropriate prescribing by providers

These data can also be used to track the impact of various state-level interventions

14

Thank YoThank You

Christopher M. Jones, PharmD, MPHcjones@cdc.gov

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.