From Peak to Plunge: A Multi-Database Analysis of State-Level Disparities in Hydromorphone Use in the US.

BACKGROUND: Hydromorphone is a semi-synthetic opioid agonist and a hydrogenated ketone of morphine. This study examined hydromorphone use in the United States (US) using three databases. METHODS: The distribution of hydromorphone in the US (in grams) was provided by the US Drug Enforcement Administration's Automated Reports and Consolidated Orders System (ARCOS) by state, zip code, and business type (pharmacies, hospitals, providers, etc.). Hydromorphone prescription claims were also examined using the Medicaid and Medicare Part D programs from 2010 to 2023. RESULTS: Hydromorphone increased by +30.6% by 2013, followed by a decrease of -55.9% by 2023 in ARCOS. Medicaid prescriptions increased by +39.6% by 2015 and decreased by -48.9% by 2023. Medicare Part D claims increased by +8.5% by 2015 and decreased by -31.9% by 2023. There were also pronounced regional disparities in hydromorphone use identified in ARCOS (158.7-fold), Medicaid (17.5-fold), and Medicare Part D (13.7-fold). CONCLUSIONS: Hydromorphone use in the US has decreased substantially from 2010 to 2023. Additionally, these findings highlight considerable regional disparities, which may inform targeted opioid stewardship initiatives and guide policymakers to ensure safe and equitable opioid prescribing practices.