Background

Fentanyl and its derivatives are highly utilized opioid-based analgesics provided to patients in various formulations, but this agent has also been implicated in many overdoses when misused. The evolving opioid crisis has increased pressure on the healthcare industry to monitor opioid prescriptions. Different policies and procedures implemented to contain the crisis have impacted the utilization of some opioids.

Objective

A prior report identified three-fold differences between states in fentanyl use. This study explored fentanyl distribution patterns from 2010 to 2019.

Methods

The amount of fentanyl base distributed from 2010 to 2019 was obtained from the Drug Enforcement Administration. Sufentanil, alfentanil, and remifentanil were also analyzed from 2010 to 2017, the most recent year reported. Prescriptions, units, and reimbursement for 2010 and 2019 were obtained from Medicaid and fentanyl prescriber specialty from Medicare Part D.

Results

There was a 65.5% decrease in the overall milligrams of fentanyl per person distributed corrected for population. Ohio had the greatest decrease (−79.3%), while Mississippi saw the smallest (−44.5%). There was a 6.8-fold regional difference in the quantity of fentanyl distributed per person in 2010 from hospitals (South Dakota = 775.2, Alabama = 113.2 μg/person). The regional difference was also sizeable for pharmacies (6.2-fold, Mississippi = 1,025.3, Washington DC = 165.6). Medicaid reimbursement in 2019 was $165 million for over eight hundred-thousand prescriptions with the majority for generic (99.7%) and injectable (77.6%) formulations. Interventional pain management and anesthesia were over-represented, and hematology/oncology significantly under-represented for fentanyl prescriptions in Medicare.

Conclusion

The distribution of fentanyl-based substances decreased, although not uniformly, in the US over the last decade. Additionally, the most prescribed formulations of fentanyl have transitioned away from transdermal, potentially in an effort to regulate its availability. The considerable state-level disparities observed for fentanyl distribution from pharmacies and hospitals warrant further attention as there may be regional practices which are incongruent with evidence-based medicine.

中文翻译：

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分发的合法芬太尼明显下降，但不包括芬太尼衍生物

背景

芬太尼及其衍生物是高度使用的基于阿片类药物的镇痛剂，以各种配方提供给患者，但这种药物在误用时也与许多药物过量有关。不断演变的阿片类药物危机增加了医疗保健行业监测阿片类药物处方的压力。为遏制危机而实施的不同政策和程序影响了某些阿片类药物的使用。

客观的

先前的一份报告确定了芬太尼使用各州之间的三倍差异。本研究探讨了 2010 年至 2019 年芬太尼的分布模式。

方法

2010年至2019年分配的芬太尼碱量来自缉毒局。据报道，2010 年至 2017 年还对舒芬太尼、阿芬太尼和瑞芬太尼进行了分析。2010 年和 2019 年的处方、单位和报销从医疗补助和芬太尼处方专业从医疗保险 D 部分获得。

结果

根据人群分布，每人芬太尼的总毫克数减少了 65.5%。俄亥俄州的降幅最大（-79.3%），而密西西比州的降幅最小（-44.5%）。2010 年每人从医院分发的芬太尼数量存在 6.8 倍的地区差异（南达科他州 = 775.2，阿拉巴马州 = 113.2 微克/人）。药店的区域差异也很大（6.2 倍，密西西比 = 1,025.3，华盛顿特区 = 165.6）。2019 年，超过 80 万张处方的医疗补助报销为 1.65 亿美元，其中大部分为仿制药（99.7%）和注射剂（77.6%）。Medicare 中芬太尼处方的介入性疼痛管理和麻醉的比例过高，而血液学/肿瘤学的比例明显不足。

结论

在过去十年中，基于芬太尼的物质的分布在美国有所减少，但并不均匀。此外，最常用的芬太尼配方已从透皮过渡，可能是为了调节其可用性。在药房和医院的芬太尼分销方面观察到的州级显着差异值得进一步关注，因为可能存在与循证医学不一致的区域做法。