Objectives Meperidine, once viewed as relatively safe, is now discouraged in clinical settings due to its associated risks. Previous studies have identified a significant decrease in meperidine distribution across the US from 2000 to 2021. Regional disparities accompanied this decline. The goal of this study was to investigate if the decrease in meperidine distribution has continued in recent years: 2019 to 2023; and if regional variations persist. This investigation also aimed to identify correlates of meperidine distribution, including adult obesity prevalence and annual income, to provide insight into the regional variation.

Design Retrospective observational study utilizing data from the Automation of Reports and Consolidated Orders System (ARCOS) Drug Retail Summary Reports by the Drug Enforcement Administration (DEA), the CDC, and the US Census Bureau.

Setting USA, including Puerto Rico

Participants US population

Primary and secondary outcome measures The primary outcome was the meperidine distribution across the US between 2019 and 2023. Secondary outcomes included associations between meperidine distribution and adult obesity prevalence and median household income.

Results Total meperidine distribution across the US dropped by 57.8% from 2019 to 2023. A substantial geographic variation was found with southern states accounting for the 2nd, 3rd, and 4th highest in meperidine use capita in 2023, only behind Puerto Rico. In contrast, northeastern states accounted for four of the five lowest states. A significant relationship was found between annual income and meperidine distribution in 2022 (r(49) = -.38, p < .005). A trend was observed between adult obesity prevalence and meperidine distribution (r(52) = +.24, p = .078).

Conclusion Our study revealed a continued decrease in meperidine distribution and continued presence of geographical variation from 2019 to 2023. Furthermore, a novel relationship was identified between meperidine distribution and annual income.

Strengths and Weaknesses Strengths

The ARCOS database is comprehensive for meperidine distribution in every year/location used in this study.

This study reports on the pronounced state level differences in meperidine use and the association with other variables which include annual income and adult obesity prevalence by location.

Weaknesses

The Automation of Reports and Consolidated Orders System database lacks information on formulations and the number of prescriptions.

Further study should examine spending on meperidine by Medicaid, Medicare, or private insurance agencies.

Brian J. Piper was (2019-2021) a member of an osteoarthritis research team that was supported by Eli Lilly and Pfizer. All other authors have no competing interests.

This study was funded by the Geisinger College of Health and Sciences Summer Research Immersion Program.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

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All data analyzed in this study is available through the following public archives: ARCOS, US Census Bureau, and the CDC.

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