Abstract
BackgroundThe US mainland is experiencing an epidemic of opioid overdoses. Unfortunately, the US Territories (Guam, Puerto Rico, and the Virgin Islands) have often been overlooked in opioid pharmacoepidemiology research. This study examined common prescription opioids over the last decade.MethodsThe United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) was used to report on ten medical opioids: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone, by weight from 2006 to 2017. Florida and Hawaii were selected as comparison areas.ResultsPuerto Rico had the greatest Territorial oral morphine mg equivalent (MME) per capita (421.5) which was significantly higher (p < .005) than the Virgin Islands (139.2) and Guam (118.9) but significantly lower than that of Hawaii (794.6) or Florida (1,509.8). Methadone was the largest opioid by MMEs in 2017 in most municipalities, accounting for 41.1% of the total in the Virgin Islands, 37.9% in Florida, 36.6% in Hawaii but 80.8% in Puerto Rico. Puerto Rico and Florida showed pronounced differences in the distribution patterns by pharmacies, hospitals, and narcotic treatment programs for opioids.ConclusionsContinued monitoring of the US Territories is needed to provide a balance between appropriate access to these important agents for cancer related and acute pain while also minimizing diversion and avoiding the opioid epidemic which has adversely impacted the US mainland.
Highlights
Increasing rates of opioid prescriptions and overdoses in the past decade and a half have led epidemiologists and lawmakers to refer to the current situation as an opioid epidemic
The present study aimed to investigate the temporal pattern in opioid distribution in the United States (US) Territories of Guam, Puerto Rico, the Virgin Islands, and American Samoa
This study identified dynamic changes in prescription opioids from 2006 to 2017 in the US Territories of Guam, Puerto Rico, American Samoa and the Virgin Islands and the quantities distributed by business activity relative to Florida and Hawaii
Summary
Increasing rates of opioid prescriptions and overdoses in the past decade and a half have led epidemiologists and lawmakers to refer to the current situation as an opioid epidemic. Lawmakers and healthcare administrators have developed several strategies to address opioid misuse These include removing pain as the fifth vital sign and the implementation of prescription take back and drug disposal programs. All states (except Missouri), the District of Columbia, and Guam have operational PDMPs (Prescription Drug Monitoring Program Training and Technical Assistance Center, 2018; President’s Commission on Combatting Drug Addiction and the Opioid Crisis, 2017). Puerto Rico had the greatest Territorial oral morphine mg equivalent (MME) per capita (421.5) which was significantly higher (p < .005) than the Virgin Islands (139.2) and Guam (118.9) but significantly lower than that of Hawaii (794.6) or Florida (1,509.8). Methadone was the largest opioid by MMEs in 2017 in most municipalities, accounting for 41.1% of the total in the Virgin Islands, 37.9% in Florida, 36.6% in Hawaii but 80.8% in Puerto Rico. Continued monitoring of the US Territories is needed to provide a balance between appropriate access to these important agents for cancer related and acute pain while minimizing diversion and avoiding the opioid epidemic which has adversely impacted the US mainland
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