Abstract: Purpose: The opioid epidemic in the United States began with medical providers over-prescribing opioids. Florida, which led the country in opioid-prescribing physicians, was unique during this period because of its lax prescribing laws and high number of unregulated pain clinics. Here we address the difference in distribution rates of oxycodone and hydrocodone across Florida counties during the peak years of the opioid epidemic. Methods: Washington-Post and the United States Drug Enforcement Administration's Automation of Reports and Consolidated Orders System (ARCOS) databases provided longitudinal oxycodone and hydrocodone prescription data in grams per county (2006-2014) and statewide (2006-2021). Grams of oxycodone and hydrocodone were converted to morphine milligram equivalents (MME) for comparison. Results: There was a steep increase in oxycodone from 2006 to 2010, with subsequent decline. Hydrocodone distribution decreased slightly from 2006 to 2014. In peak year, 2010, the average MME per person across all counties in Florida was 729.4, a 120.6% increase from 2006. The three individual counties with the highest MME per person in 2010 were Hillsborough (2,271.3), Hernando (1,915.3), and Broward (1,726.9) and were significantly (p < .05) elevated relative to the average county. MME per person was highly correlated (r=0.91) with MME per pharmacy, therefore in most counties, both values rose together. Conclusion: The novel data demonstrated pronounced differences in opioid distribution, particularly oxycodone, between Florida counties during the height of the opioid epidemic. Legislative action taken between 2009 and 2011 aligns with the considerable decline in opioid distribution after 2010.

BJP was (2019-2021) part of an osteoarthritis research team supported by Pfizer and Eli Lilly. The other authors have no disclosures.

This study did not receive any funding

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