Abstract
BackgroundThe US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted.Materials and MethodsThis study was conducted to quantify prescription opioid use in Texas. Data was obtained from the publicly available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution. Data for 2006–2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined.ResultsThe change in morphine mg equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine.ConclusionsCollectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre-opioid epidemic prescription levels.
Highlights
Rates of opioid use and misuse in Texas are historically low compared to other states and regions of the country
Opioid overdoses are generally lower than other states with similar reporting quality; overdoses involving synthetic opioids other than methadone increased by 28.6% from 2015 to 2016 (Seth et al, 2018)
Counties in eastern and northern Texas had greater per capita prescription opioid use (Alexander et al, 2019)
Summary
Rates of opioid use and misuse in Texas are historically low compared to other states and regions of the country. Texas ranked 46th in the US for per capita morphine mg equivalents (MME, 578) for ten prescription opioids and was approximately one-quarter the highest state (Rhode Island = 2,624) (Piper et al, 2018). Texas had a similar ranking (45th) for buprenorphine and methadone for Opioid Use Disorder (OUD) treatment (Piper et al, 2018). Methadone use from Texas opioid treatment programs remained stable from 2011 to 2015 but buprenorphine quadrupled (Substance Abuse and Mental Health Services Administration, 2017). Data for 2006–2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. These findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to preopioid epidemic prescription levels
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