Pharmacoepidemiology of Oxycodone in the USA: An Observational Study of ARCOS, Medicaid, and Medicare Drug Databases

The US continues to battle an opioid crisis, substantially influenced by prescription opioids, with nearly 80 000 opioid-related deaths in 2023. This study aims to characterize oxycodone's distribution in the United States (US) from 2000 to 2023 using three data sources. Morphine Milligram Equivalents (MME) of oxycodone were calculated from the Drug Enforcement Administration annual summary reports from the Automation of Reports and Consolidated Orders System (ARCOS); the number of units and prescriptions of oxycodone per enrollee were calculated using the Medicaid State Drug Utilization Data (M-SDUD); and the number of claims and 30-day fills per enrollee and per beneficiary with a claim for oxycodone were calculated from the Medicare Part D Prescribers (M-PDP) dataset. Oxycodone MME per person in ARCOS rose +280% from 2000 to 2010 before declining, ending at +56% over the full period. At the 2010 peak, Florida, Delaware, and Tennessee showed high distributions of oxycodone, while Texas and Illinois had lower amounts compared to most states. Delaware again stood out in the Medicaid data with higher numbers of units and prescriptions, along with Alaska, Arizona, Maine, and Maryland. This data also had some anomalies in the number of prescriptions in the 2000s. The Medicare data covered 2013-2022, with the District of Columbia and North Dakota standing out with lower numbers of claims and 30-day fills per beneficiary compared to other states. Oxycodone distribution varied substantially between states over time. Each dataset provided complementary insights, highlighting the importance of multi-source monitoring for assessing opioid distribution trends and informing public policy.