Disparities in Opioid Distribution in Puerto Rico and the Continental United States (2018-2023).

Objective: The objective of this study was to analyze and compare the distribution patterns of fentanyl, morphine, meperidine, and codeine in the continental US compared to Puerto Rico from 2018-2023. Attention was given to meperidine due to its extensive adverse effect profile and irreversible central nervous system toxicity.

Methods: Data was collected from Automation of Reports and Consolidated Orders Systems (ARCOS). The dataset included annual distribution data for meperidine, fentanyl, morphine, and codeine in the US and Puerto Rico. Population data was collected from US Census data and the American Community Survey. Data analyses were conducted using Microsoft Excel Version 2410. For each opioid, the mean distribution and standard deviation (SD) were calculated for the continental US. The mean distribution in Puerto Rico was compared to the US mean distribution with a 95% confidence interval. ANOVA tests were performed to assess differences in distribution of each opioid across years (2018, 2020, and 2022) within the continental US. All descriptive statistics and ANOVA calculations were conducted with statistical significance determined at p < 0.05.

Results: From 2018 to 2023, meperidine distribution declined in both regions but decreased more sharply in the continental US (82.6%) compared to Puerto Rico (43.5%). Distribution levels exceeded six standard deviations above the US mean in 2023. Fentanyl and morphine distributions were consistently lower in Puerto Rico than in the continental US.

Conclusion: There was a disproportionately high distribution of meperidine in Puerto Rico compared to the continental US across the years studied.