Declines, but Pronounced Regional Variation, in Tapentadol Use in the US

Background: Tapentadol is an atypical opioid with a dual mechanism as a mu agonist and norepinephrine reuptake inhibitor. This study characterized tapentadol use in the United States (US) using three databases. Methods: Drug distribution from 2010-2020 were extracted from the Drug Enforcement Administration’s (DEA) Automated Reports and Consolidated Orders System (ARCOS). Use per region (mg/person) and business activity (i.e., pharmacy). Tapentadol prescription claims from the Medicare and Medicaid programs for 2010-2020 were also examined. Results: The distributed amount of tapentadol was 3.5 tons in 2020. Distribution was over twice as high in southern (South Atlantic=29.0 mg/person, East South Central=28.8) relative to Pacific (12.9) or New England (12.8) states. Tapentadol use decreased nationally between 2012 and 2020 by -53.8%. Adult diabetes prevalence was significantly associated with tapentadol distribution in 2012 (r(50) = +.44, p < .01) and 2020 (r(50) = +.28, p < .05). Tapentadol prescribing to Medicaid patients declined -55.2% from the peak year, 2011, until 2020. Tapentadol prescribed by Nurse Practitioners accounted for over one-sixth (18.0%) of 2019 Medicare. Conclusions: There has been a substantial decline over the past decade in tapentadol distribution and prescribing. However, the substantial regional differences may warrant further attention by opioid stewardship programs.