most_medicated_header

According to the National Survey on Drug Use and Health, over 54 million people have used prescription medication non-medically – effectively more than 20 percent of the population aged 12 and older.

When our doctor puts pen to paper and hands us a prescription, there’s a trust in their knowledge of our symptoms and recommendation of the best treatment plan. Still, some of the most commonly used prescriptions can carry the potential for addiction when not taken as directed or when used for long-term pain management. Medical professionals may diagnose a true need to use controlled substances to help manage pain or other conditions and to provide federal oversight, these shipments are monitored by the Drug Enforcement Administration’s (DEA) system ARCOS (Automation of Reports and Consolidated Orders System). However, despite these efforts, millions of people can use these drugs in ways other than intended or prescribed.

To understand how widely available these drugs have become, we studied data from the DEA to determine where in the U.S. substances like oxycodone, Adderall, and GHB are ending up; which drugs are the most commonly prescribed; and to what extent deaths are linked to their misuse. Is your neighborhood home to some of the largest distributions of these prescriptions? Continue reading to see how prescription drugs may be covertly affecting your community.

Controlled Substances in Your Neighborhood

Billions of grams of the pharmaceutical drugs are distributed across the country, and while some may be prescribed by a physician and used as intended, some simply aren’t.

Use our interactive map to see the controlled substances distributed where you live. You’ll be able to see the breakdown by substance, as well as the total grams and dosages to get a better sense of how much of these substances are floating around your neighborhood. You might be surprised to learn how many millions of pills of controlled substances, ranging from amphetamines to methadone and oxycodone, have been prescribed in your area.

Substance Distribution Across the U.S.

prescription_drug_hot_spots

We looked at the areas across the country that had the highest distribution of controlled substances ranging from oxycodone, fentanyl, and Adderall, among others.

Phoenix, Arizona, had the highest distribution of oxycodone with over 1.3 million grams in 2015. While these pills may have been prescribed legally, the DEA has concluded that almost 2 million Americans have taken oxycodone illegally, making it one of the most misused prescription drugs in the country. The National Institute on Drug Abuse has also indicated that between 2 and 5 percent of children between eighth grade and high school have taken oxycodone recreationally.

Ritalin and Adderall had the highest distribution in St. Louis, Missouri, with over 581,000 grams in 2015. Adderall’s recreational use is widely documented (among young adults especially). According to studies, individuals using Adderall without a prescription in college are three times more likely to try marijuana, eight times more likely to use cocaine, and five times more likely to use painkillers non-medically.

Fentanyl, which carries a much higher risk for overdose,was most commonly distributed around mid-island New York with over 4,000 grams in 2015. The DEA has reported that one-quarter of a milligram of fentanyl can be a lethal dosage, making it 80 to 100 times stronger than morphine. From 2014 to 2015, the death rate from fentanyl (which had over 433,000 grams distributed in 2015) rose 72.2 percent.

The Most Prescribed Substances, by Grams

prescribed_controlled_substances_grams

Which substances are the most widely circulated in the United States? Our research revealed that oxycodone was the most prescribed substance in 2015. As a potent opioid pain reliever, oxycodone is typically used to treat chronic pain and can be extremely habit-forming. We found that prescriptions for over 57 million grams of oxycodone were written for Americans after a major surgery, to manage conditions like back pain, or to combat pain caused by cancer. t The prevalence of painkillers is quite high — further studies have shown that 60 percent of Americans have filled a prescription for opioid painkillers like oxycodone at some point in their life. Research has also identified painkillers, like oxycodone, as a gateway to heroin use. As the rate of prescription opioid abuse rises across the U.S., rates of heroin usage have nearly doubled since 2007.

Hydrocodone, another opioid pain medication, had almost 33 million grams prescribed, and GHB (gamma hydroxybutyrate) – a central nervous depressant used to treat sleep disorders – had over 25 million grams prescribed. GHB is commonly referred to as a “date rape drug” and is often diluted with alcohol to create an increased sense of euphoria. GHB is also prescribed in grams with the standard adult dosage at 4.5, while many other pharmaceutical drugs are measured in milligrams, which is why in mass alone it is one of the most abundant controlled substances though it is infrequently prescribed. If combined with alcohol, it can take over seven hours for the effects of GHB to fully wear off.

In total, over 220 million grams of the top 10 most commonly prescribed substances were dispensed to Americans in 2015.

The Most Prescribed Substances, by Dose

prescribed_controlled_substances_doses

So what does 220 million grams mean in terms of the number of pills or doses being prescribed? To better understand how much of each medication was distributed in 2015, we used the average recommended dosage for an adult, converted it from milligrams to grams, and divided this by the total prescription amount in grams to determine how many pills were prescribed that year.

Oxycodone had over 11 billion pills prescribed. In 2013, doctors wrote nearly 250 million individual opioid prescriptions for drugs like oxycodone (and hydrocodone) – enough for every adult in the U.S. to have their own bottle. When converted into the number of pills prescribed, Adderall rose to the second highest amount of prescribed medication, with over 7 billion pills in 2015. Adderall, a central nervous system stimulant, may also become habit-forming and is commonly used in the treatment of attention deficit hyperactivity disorder (ADHD). Historically, Adderall is used by young adults as a stimulant to help them through school and as they transition into professional careers. Amphetamines like Adderall can have negative side effects such as insomnia, loss of appetite, and emotional liability. Between 2005 and 2010, the number of hospital visits for nonmedical use of ADHD stimulants rose from just over 5,000 to more than 15,000 — it’s clear that Adderall misuse is a growing problem.

Death by Prescribed Substances

overprescribed_and_overdosed

Unfortunately, misuse of substances like Adderall may be contributing to a larger problem — many controlled substances have been linked to a high number of deaths in the U.S.

In 2015, controlled opioid narcotics were the most commonly distributed prescription medication; they were also the cause of the highest number of prescription-related deaths in the same year. With almost 136 million grams of various medications (including oxycodone, hydrocodone, morphine, and others) prescribed in 2015, over 16,200 people died from misuse of these substances. Some of these deaths may be due to recreational ingestion of these drugs and others may be from accidental misuse. As it turns out, prescription drug misuse may be underestimated  — over half of respondents from a survey conducted by Recovery Brands, admitted they did not understand the “take as needed” label attached to pharmaceutical drugs, indicating that patients may be incorrectly taking their prescription drugs, resulting in a higher potential for accidental overdose.

Psychostimulants (including amphetamines and methamphetamines), barbiturates (including amobarbital and pentobarbital), and methadone were all more widely distributed in 2015; however, each accounted for fewer deaths than lesser-dispersed synthetic narcotics like fentanyl.

Fewer than 8 million grams of synthetic opioids were distributed in 2015;  however, they accounted for almost 10,000 deaths. Why do these drugs carry such a high risk of overdose? While other drugs are commonly measured in grams, synthetic opioids like fentanyl are measured in micrograms due to the drug’s potency. This report from STAT pictures just how little fentanyl is required for a deadly result.

Rates of Opioid Distribution Across the U.S.

american_opioid_distribution

In 2015, more than 73 percent of all drug-related overdoses in the U.S. involved opioid use. That’s an average of 91 deaths every day. We found that certain states had a higher controlled distribution of opioids than other substances.

According to data from the DEA, Tennessee had a higher rate of opioid distribution in 2015 than any other state in the country, with over 69,000 grams per 100,000 residents. In fact, in 2015, there were almost 8 million prescriptions written for opioids in Tennessee, more than there are residents in the state. In 2015, almost 1,500 people died from drug misuse in Tennessee, nearly 72 percent of which were related to opioids.

Oklahoma had the second highest rate of controlled substance distribution with over 67,000 grams of opioids for every 100,000 residents. Oklahoma currently leads the nation in the misuse of prescription painkillers, which has also resulted in an increase in heroin-related deaths.

Other states like Arkansas, West Virginia, and Alabama each had over 60,000 grams of opioids distributed across the state for every 100,000 residents.

Opioid Distribution, by State and Grams

opioid_crisis_and_solution

In response to the opioid crisis in the U.S., we’ve compared the distribution of opioids in cities with some of the highest concentrations of methadone and suboxone distribution – drugs used to help treat the symptoms of withdrawal from opioids. Of the top 10 states for opioid distribution per 100,000 residents, Arkansas, Tennessee, Kentucky, and West Virginia ranked the highest.

Tennessee had the highest concentration of opioids, and certain sections of Nashville had the highest presence of opioid distribution in the state with over 38 million grams in the 370 ZIP code area alone. Chattanooga (almost 33 million grams) and Knoxville, Tennessee, also had some of the state’s highest saturation of opioid distribution. Knoxville, which is two-thirds the size of Nashville, had nearly the same number of overdose fatalities in 2015.

On the other hand, methadone and suboxone distribution levels weren’t nearly as high in Nashville, where opioid use was the strongest in Tennessee. Methadone and suboxone are opioid medications that can help those suffering from opioid addiction as they go through the symptoms of withdrawal and has been a preferred medication for the detoxification process for years. The distribution of these drugs spiked in Knoxville and Memphis, indicating these areas may be getting more support for opioid addiction than those in other parts of the state.

Similarly, Little Rock, Arkansas, had some of the highest rates of opioid distribution by grams, but some relatively low rates of methadone and suboxone. Of the states with the highest distribution of opioids throughout their cities, West Virginia had the highest ratio of methadone and suboxone distribution compared to opioids, meaning those in West Virginia potentially addicted or going through withdrawal have the most access to medication meant to help that process. West Virginia has the highest rate of death from drug overdoses across the country, and pharmaceutical painkillers like opioids are at the heart of this drug misuse crisis in West Virginia today.

Conclusion

The volume of the substances we studied reflect legal distribution documented by the DEA;   however, it’s no secret that many of these drugs are misused or illegally distributed after a doctor prescribes them to a patient.

If you or someone you love has issues with controlled substances like oxycodone or Adderall, help is here for you. Visit us at DrugAbuse.com to find support and resources. Visit online to find information about the withdrawal process and treatment options for specific substances so you can find the specialized help you need.

Methodology

We analyzed the Drug Enforcement Administration’s retail drug reports from 2006 to 2015 by drug type and location for controlled substances. Because of the large volume of controlled substances monitored, the DEA uses grams as the unit of mass, instead of milligrams. For the interactive map, we used retail drug distribution by three digit ZIP code for 2015.  In order to calculate the number of doses of each controlled substance, we found the usual adult dosage in milligrams. We then converted that dosage to grams and divided the total number of grams for each zip code. Deaths related to drugs were taken from http://wonder.cdc.gov.

Sources

https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/

https://www.deadiversion.usdoj.gov/schedules/orangebook/d_cs_drugcode.pdf

http://wonder.cdc.gov

20160831_Fair Use_RB_drug-abuse.com (1)