Background: Little information has been published on opioid prescribing practices in the United States as a whole for any year since 2005, despite increased use and increased overdoses. The objective of this study was to describe trends in prescribing rates and prescription sizes for commonly used opioids over the past decade.
Methods: We used 2 data systems. Vector One: National (VONA; data obtained for the period 2000-2009) is a service that can estimate the number of prescriptions dispensed by retail pharmacies. The Automation of Reports and Consolidated Orders System (ARCOS; data obtained for the period 2000-2010) is a mandatory reporting system that allows the US Drug Enforcement Administration to monitor certain controlled substances from the point of manufacture to the point of sale. ARCOS data represent the amount of controlled substances legitimately distributed at the retail level. We calculated crude prescription rates of various opioids from VONA data, total drug amounts distributed (as milligrams per 100 persons) from ARCOS data and morphine milligram equivalents (MME) per prescription by combining data from these 2 sources.
Results: The number of opioid prescriptions per 100 persons increased by 35.2%, from 61.9 to 83.7, during the period 2000-2009. The distribution of opioids to US pharmacies, in milligrams per 100 persons, increased by at least 100% for all selected opioids during the period 2000-2010. The average size of an oxycodone prescription increased by 69.7% (from 923 MME to 1566 MME) during the same period, while the average size of a hydrocodone prescription increased by 69.4% (from 170 MME to 288 MME). The increase for fentanyl was smaller (20.9%) (from 4804 MME to 5809 MME).
Interpretation: The rate of opioid prescribing, the amount of opioids distributed and the average prescription size all increased markedly in the United States over the past decade. Rates of death from opioid overdose also have increased steadily through 2008 and have likely continued to increase in subsequent years. Effective measures to prevent prescription drug overdoses have yet to be identified and employed.