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Statewide opioid sales to hospitals and pharmacies

ARCOS data capture distribution of drugs to hospitals and pharmacies reported to the Drug Enforcement Administration. Data are presented in typical daily doses, described in detail at the bottom of the page.

All opioids can be used for pain, while methadone and buprenorphine can also be used in the treatment of opioid use disorder. Fentanyl here refers only to fentanyl itself, used most commonly in surgery or chronic pain management, and not any of the many fentanyl analogues, only some of which are legal. The different lines for methadone reflect the apparent addition after 2005 of methadone distributed to opiate treatment programs (OTPs) to methadone totals reported in ARCOS. The all Rx opioids series starts in 2005 because buprenorphine did not appear in ARCOS before then. That series assumes meperidine, missing until 2008, had essentially 0 distribution before then. The common opioid pain Rx series sums across all prescription opioids presented except methadone and buprenorphine, which is occasionally used for pain but mostly as a medication for opioid use disorder. Data are missing for some of the components in 2000 and 2002. These data represent the legal distribution of pharmaceutical opioids in the State. These opioids could subsequently be used as prescribed or beyond what was prescribed, go unused, or be illegally sold, given away, or stolen.

To see less common drugs in more detail, turn off aggregate series (e.g., all Rx opioids, which sums all the opioids shown) or more common series e.g., (hydrocodone) by clicking the series name(s) in the legend below the chart.

Data source: US Drug Enforcement Agency. Split in methadone series reflects ARCOS apparently including opiate treatment programs (OTPs) in distribution data beginning in 2006. All Rx opiates begins in 2005 due to prior inconsistent reporting of component drugs shown in ARCOS data.

Comparison with treatment admissions, deaths, and crime lab cases

To account for population change over time, we present the data for opiate distribution as doses per person in Washington (doses pp), here with rates (per 100,000 residents) of publicly-funded first-time treatment admissions, deaths, and crime lab cases associated with prescription-type and other opioids for comparison.

Data sources: Center for Health Statistics, Washington State Department of Health (deaths), Division of Behavioral Health and Recovery, Washington State Department of Social and Health Services (admissions, OTP caseloads), Forensic Laboratory Services Bureau, Washington State Patrol (cases), US Drug Enforcement Agency (ARCOS sales to hospitals and pharmacies in Washington state), Washington State Office of Financial Management (population). 2020 death data are preliminary. Split in methadone series reflects ARCOS apparently including opiate treatment programs (OTPs) in distribution data beginning in 2006. All Rx opiates begins in 2005 due to prior inconsistent reporting of component drugs shown in ARCOS data.

Conversion from grams to daily doses and morphine equivalance

ARCOS is a DEA database for monitoring the flow of controlled prescription substances from manufacture up to the point of sale or dispensing. The data are generated from manufacturers and distributors, and reflect the amount of drugs legitimately distributed to (but not at) the retail level (i.e. to hospitals and pharmacies). Geography is assigned based upon the registration of the purchasing retail outlet.

For comparison across what to the body can be very different drugs, we convert weights to usual daily doses by dividing total grams reported by a usual grams per daily dose value (from the World Health Organization). For example, 100 grams of meperidine, divided by 0.4 g/dose (400mg/dose), results in 250 doses. The dosage information puts very potent drugs (e.g., fentanyl, 1.2 mg per day) on similar footing as less potent prescription-type opiates (e.g., codeine, 100 mg per day) in terms of usual daily dosage. Where multiple dosage equivalents are available, we use the most common route, usually oral. Note, of course, that individual doctors and users may select different dosages. Morphine equivalence is a different way to compare potency, provided for reference.

Drugmg per daily dosemorphine equivalence ratio
meperidine (a.k.a. pethidine)4000.1
fentanyl base1.275
Defined daily doses are from the World Health Organization Collaborating Centre for Drug Statistics Methodology and reflect "the assumed average maintenance dose per day for a drug used for its main indication in adults." Table is not for prescribing purposes. Morphine-equivalent weight ratios are from the Washington State Agency Medical Directors' Group and the federal Centers for Medicare & Medicaid Services. Methadone conversion to morphine assumes a dose of 25 mg.