DEA Philadelphia Division

• 13 pages
• January 2015

(U) Over the last decade, the states of Pennsylvania and Delaware have experienced a sharp increase in prescription opioid abuse and related overdoses, many resulting in death. In an effort to identify potential sources and demonstrate the availability of these abused pharmaceuticals, the DEA Philadelphia Division Intelligence Program conducted a review and analysis of oxycodone, hydrocodone, and buprenorphine orders by registrants in Pennsylvania and Delaware for the years 2010-2013.

(U) As of 2010 (latest figures available), Pennsylvania and Delaware had the 14th and 10th highest drug overdose mortality rates in the United States, with 15.3 and 16.6 per 100,000 people suffering drug overdose fatalities (respectively). The number of drug overdose deaths, a majority of which were from prescription drugs, increased by 89 percent in Pennsylvania and by 50 percent in Delaware since 1999.

(U) Reports from the law enforcement, public health, and regulatory communities indicate that prescription drugs within Schedules II, III, and IV are readily available and sought throughout Pennsylvania and Delaware. These commonly abused licit drugs are available on the street in both wholesale (hundred dosage units (DUs)) and retail (a few DUs) quantities. Intelligence and investigations indicate the most commonly diverted and abused prescription opioids include the pain relievers oxycodone and hydrocodone, as well as buprenorphine. Buprenorphine (Subutex® and Suboxone®) reduces or eliminates opioid withdrawal symptoms, including drug cravings, without producing the “high” or dangerous side effects of heroin and other opioids. Intelligence indicates that as heroin and opioid abuse increases, abusers increasingly seek buprenorphine to ease withdrawal symptoms until the abuser has the funds or means to acquire their primary drug of choice.

(U) The analysis conducted by the DEA Philadelphia Division Intelligence Program in this report focused on registrant ordering totals, the number of registrants ordering, and the average number of DUs by registrant, for the aforementioned drugs. This information was obtained from the DEA Office of Diversion Control’s Automated Reports and Consolidated Orders System (ARCOS).

(U) Oxycodone

(U) Pennsylvania ranked first in the country for the total number of oxycodone DUs ordered in 2013 (319 million); from 2010-2012, Pennsylvania ranked second behind Florida in this category. In 2013, Delaware ranked 39th (28 million), a decrease in ranking from 2010 (35th), 2011 (36th), and 2012 (37th). See Figure 1 for full state rankings and order totals.

(U) Although nationwide oxycodone orders decreased slightly in 2013 (from 5 billion to 4.9 billion DUs), Pennsylvania’s slight decrease in oxycodone orders over 2012 still resulted in the number one ranking in 2013. Of note, in 2013, Florida had 4,933 registrants ordering oxycodone, as compared to 3,477 in Pennsylvania, an almost 30 percent difference, yet Pennsylvania’s oxycodone orders exceeded Florida’s by approximately 200,000 DUs.

(U) Of the 319 million oxycodone DUs ordered in Pennsylvania in 2013, 297 million were ordered by pharmacies, 20 million by hospitals, and 1.3 million by physicians. Of note, of the 1.3 million DUs ordered by physicians, a single physician accounted for 124,000 DUs (~10 percent). This distribution was similar for the previous years analyzed (2010-2012).

(U) In Delaware, the 28 million oxycodone DUs ordered in 2013 were distributed to pharmacies (26 million), hospitals (1.9 million), and physicians (10,000). Of note, the pharmacy and hospital orders remained similar from 2010-2012, however, physician orders dropped substantially from 2011 (417,000 DUs) to 2013 due to the enactment of strict physician dispensing legislation in Delaware in 2012.

(U) Of the 74,201 registrants ordering oxycodone in the United States in 2013, Pennsylvania had 3,477 registrants, resulting in a ranking of 5th; Delaware had 238 registrants, resulting in a ranking of 46th. These rankings and number of registrants were stable across the analyzed time period (2010-2013). See Figure 2 for the full state rankings and registrant totals.

(U) Analysis of oxycodone orders per registrant revealed that Pennsylvania averaged 91,844 DUs per registrant in 2013 (ranking 16th); Delaware averaged 121,394 DUs per registrant (ranking 2nd). These rankings were relatively stable across the analyzed time period (2010-2013), with Delaware holding the number one ranking from 2010-2012 for average DUs per registrant. See Figure 3 for the full state rankings and registrant averages.

(U) Hydrocodone

(U) Of the 8.4 billion DUs of hydrocodone ordered in the United States in 2013, Pennsylvania registrants ordered 244 million (ranking 12th); Delaware ordered 8.9 million (ranking 49th). These rankings were relatively stable across the analyzed time period (2010-2013). See Figure 4 for full state rankings and order totals.

(U) The distribution of hydrocodone DUs ordered in Pennsylvania in 2013 included 236 million by pharmacies, 5.4 million by hospitals, and 2.5 million by physicians. Delaware orders included 8.5 million by pharmacies, 290,000 by hospitals, and 64,000 by physicians. The distribution was relatively stable across the analyzed time period (2010-2013) with the corresponding decrease in physician orders in Delaware in 2013 referenced in the oxycodone section, above.

(U) Of the 101,955 registrants ordering hydrocodone nationwide in 2013, Pennsylvania had 4,605 registrants (ranking 5th); Delaware had 293 registrants (ranking 46th). These rankings were stable across the analyzed time period (2010-2013). See Figure 5 for full state rankings and registrant totals.

(U) Analysis of hydrocodone orders per registrant revealed that Pennsylvania averaged 53,064 DUs per registrant (ranking 39th) in 2013; Delaware averaged 30,395 DUs per registrant (ranking 48th). These rankings were relatively stable across the analyzed time period (2010-2013). See Figure 6 for the full state rankings and registrant averages.

(U) Buprenorphine

(U) Of the 310 million DUs of buprenorphine ordered in the United States in 2013, Pennsylvania registrants accounted for 22 million DUs (ranking 2nd); Delaware registrants ordered 1.1 million DUs (ranking 41st). These rankings were stable across the analyzed time period (2010-2013). However, unlike oxycodone and hydrocodone DU orders, which decreased over the analyzed time period, buprenorphine orders increased by 45 percent from 2010 to 2013 in Pennsylvania and by 32 percent in Delaware. This is an obvious and identifiable link to the well-documented increase in heroin abuse in Pennsylvania and Delaware during the same time period. See Figure 7 for full state rankings and order totals.

(U) Of the 22 million buprenorphine DUs ordered in Pennsylvania in 2013, 21 million were ordered by pharmacies, 748,104 DUs by hospitals, 11,486 DUs by physicians, and 12,330 DUs by narcotics treatment programs. This breakdown remained relatively stable across the analyzed period (2010-2013), however, the number of DUs ordered by narcotics treatment programs increased 189 percent from 2010 to 2013. Of the 1.1 million DUs ordered in Delaware in 2013, 1,030,844 DUs were ordered by pharmacies, 53,348 DUs by hospitals, 462 DUs by physicians, and 94,620 DUs by narcotics treatment programs. This distribution remained relatively stable across the analyzed time period (2010-2013), however, the number of dosage units ordered by narcotics treatment programs increased 383 percent from 2010 to 2013.

(U) Of the 60,701 registrants ordering buprenorphine in the United States in 2013, Pennsylvania had 2,922 (ranking 5th); Delaware had 216 (ranking 44th). These rankings were stable across the analyzed time period (2010-2013), while the number of registrants ordering buprenorphine increased slightly from 2010 to 2013 in both states. See Figure 8 for full state rankings and registrant totals.

(U) Analysis of buprenorphine orders per registrant revealed that Pennsylvania averaged 7,613 DUs per registrant (ranking 13th); Delaware averaged 5,459 DUs per registrant (ranking 21st). These rankings remained stable across the analyzed time period (2010-2013), however, the average number of DUs ordered by each registrant increased in both Pennsylvania (31 percent) and Delaware (16 percent) from 2010 to 2013. See Figure 9 for full state rankings and registrant averages.

(U) Outlook

(U) Treatment, medical examiner, and law enforcement data point to a clear and chilling advancement in prescription drug availability and abuse, most notably opioids, throughout Pennsylvania and Delaware. Exacerbating the problem, the pathway from prescription drug abuse to heroin abuse is no longer an anecdotal consideration; intelligence supports that it is a reality in Pennsylvania and Delaware, imitating the nationwide trend. As a result, the epidemic of prescription drug abuse continues unabated in Pennsylvania and Delaware, with annual increases in related overdose deaths. The abundance of prescription opioids ordered by registrants, as detailed in this report, represent one of the sources of these abused narcotics. Moving forward, educating registrants and community members on the dangers of prescription drug abuse is an essential component of an effective demand reduction strategy against prescription drug abuse. Effective prescription monitoring programs, training for medical professionals on addiction, and aggressive law enforcement efforts are also necessary to effectively stem the supply of diverted pharmaceutical controlled substances.

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