| Abstract |
Michael E Schatman,1,2 Erica L Wegrzyn3 1Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Ma, USA; 3Department of Pharmacy, Stratton VA Medical Center, Albany, NY, USACorrespondence: Michael E Schatman Tel +1 425 647-4880Email Michael.Schatman@tufts.edu As a means of mitigating the now concluded prescription opioid crisis in the United States, the Drug Enforcement Administration (DEA) has, in its infinite wisdom, embarked on a campaign of annually reducing the Aggregate Production Quota (APQ) of opioids each year since 2017. According to the DEA, they began reducing the APQ because there was no longer the need for a 25% “buffer” of excess opioids due to decreases in prescribing each year.1 In 2017, production of almost every opioid manufactured in the United States was reduced by at least 25%.1 In 2018, APQs of opioids – including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, meperidine, and fentanyl – were reduced by 20% compared to 2017 production.2 For 2019, DEA reduced APQs only of “more commonly prescribed schedule II opioids, including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, and fentanyl”.3 The 2020 production decreases affected 5 commonly-used opioids: Oxycodone production was decreased by 9%, hydrocodone by 19%, hydromorphone by 25%, fentanyl by 31%, and oxymorphone by 55%.4 Given, in response to the need for increased availability of opioids associated with the COVID-19 crisis, DEA made small adjustments (increases of 10–15%) in production APQs in April of 2020 of analgesics including codeine, fentanyl, hydromorphone, and morphine.5 Unfortunately, this action was too little, too late. Hospitals that had already been sounding the alarm for the past several years regarding routine shortages of parenteral opioids suddenly were faced with inadequate supplies essential for treating patients on ventilators amidst COVID-19, with the need for IV formulations increasing more than twofold.6
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