An analysis of buprenorphine distribution patterns among pharmacies and hospitals in the United States from 2019-2023
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Background
Opioid Use Disorder (OUD) is a debilitating condition characterized by the overuse of prescription opioid medications and the development of physical and/or psychological dependence. Consequences of this condition include chronic impairment, distress, and later life-altering health conditions such as overdose, all of which have been highlighted by the prominence of OUD in the United States in recent years. Buprenorphine is a standard OUD treatment and commonly used for pain management. Understanding changes in distribution patterns across the US is vital for continuing to improve outcomes for OUD patients.
Methods
This study analyzed changes in buprenorphine distribution among pharmacies and hospitals from 2019-2023 to determine temporal patterns and identify state level disparities. The Drug Enforcement Administrations’ Automated Reports and Consolidated Ordering System (ARCOS), US Census Bureau Population Estimates databases, and mortality rates (CDC WONDER) were analyzed. Data were corrected for population to identify patterns of buprenorphine distribution in the US from 2021-2022 and 2022-2023 through examining percent changes in milligrams per 100 population at national and state level.
Results
The year-to-year percent change of national buprenorphine distribution from pharmacies has remained positive but changed from 12.2% increase from 2019-2020 to a four percent increase every year from 2020-2023. From 2021-2022, there was a +4.9% increase in total grams of buprenorphine distributed to pharmacies and a 95% CI [-5.1, 14.9], with District of Columbia, South Dakota, and Nebraska outside of the 95% CI. Distribution to hospitals increased by 10.2% [-32.3, 52.7] during 2021-2022, with Hawaii, New Hampshire and Delaware being outside of 95% CI. From 2022-2023, there was an increase of +5.7% and 95% CI [-3.5, 14.9] in pharmacy distribution, with states including Washington, Rhode Island and Kansas remaining outside of the 95% CI. Hospital distribution has decreased from twenty percent between 2019-2020 to eighteen percent between 2022-2023. Changes in mortality data from 2022-2023 showed no associations with trends in buprenorphine distribution for those years.
Conclusion
Following increases in buprenorphine distribution during the COVID pandemic, a consistent increase has continued year-over-year in most states and the country overall by both pharmacies and hospitals. Some states (e.g. Rhode Island, Georgia, Washington D.C.) have not followed this pattern. Notably, Hawaii went from the most negative percent change in hospital distribution to the most positive change in the timeframe analyzed. This may offer opportunities to analyze more specific impacts of the increased buprenorphine distribution on populations and their outcomes associated with OUD.
