Reductions and pronounced regional differences in morphine distribution in the United States

Background: Morphine is one of the oldest, most commonly prescribed, and widely used opioids in the United States (US). The potent analgesic properties of morphine have also been associated with the increase in misuse, addiction and opioid-related deaths in the US since the 1990s. Despite federal regulations, population-adjusted prescription opioid distribution varies markedly between states. The objective of this study was to describe the temporal pattern of morphine distribution nationally and between states. Methods: Drug weight and population data were obtained from Report 5 of the US Drug Enforcement Administrations Automation of Reports and Consolidated Orders System (ARCOS) to characterize patterns in the distribution of morphine from 2012 to 2020. Morphine distribution amounts were separated by state and business type and corrected for population. States outside a 95% confidence interval relative to the national average were considered statistically significant. Results: Pharmacies and hospitals distributed 24,200 kilograms of morphine in 2012. Tennessee (180.2 mg/person) was 4.7-fold higher than Texas (39.4 mg/person). National distribution decreased 56.4% to 10,723 kilograms in 2020. Tennessee (56.4 mg/person) was 3.8-fold higher than the District of Columbia (15.0 mg/person). The decline in Illinois (-40.9%) was significantly less than the national average (-56.8%) while that of Oregon (-71.1%) and Arizona (-70.4%) were significantly higher. Hospital decrease (-72.7%) from 2012-2020 was larger than that of pharmacies (-56.12%). Conclusions: The national 56% decline in the distribution of morphine in the last decade may be attributable to prioritization of the opioid crisis as a public concern, including subsequent growth of opioid misuse and treatment programs and decreased production quotas for opioids, including morphine. This decline also coincides with the national shortage of parenteral opioids resulting in greater prescriptions of alternative opioids such as nalbuphine and buprenorphine. Further research is necessary to understand the persistent four-fold regional difference between states.