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Caulkins JP, Tallaksen A, Taylor J, Kilmer B, Reuter P. The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104314. [PMID: 38183860 DOI: 10.1016/j.drugpo.2023.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s).
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Affiliation(s)
- Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Ave., Pittsburgh PA 15213, USA.
| | - Amund Tallaksen
- The Council of State Governments Justice Center, 22 Cortland St., Floor 22, New York, NY 10007, USA
| | - Jirka Taylor
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA
| | - Peter Reuter
- University of Maryland, 7251 Preinkert Drive, College Park, MD 20742, USA
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2
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Karamouzian M, Buxton JA, Hategeka C, Nosova E, Hayashi K, Milloy MJ, Kerr T. Shifts in substance use patterns among a cohort of people who use opioids after delisting of OxyContin in BC, Canada: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103852. [PMID: 36122483 PMCID: PMC9885984 DOI: 10.1016/j.drugpo.2022.103852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND OxyContin was delisted from Canadian provincial drug formularies in March 2012 and replaced with a reformulated tamper-resistant form of oxycodone (i.e., OxyNeo). We assessed if delisting of OxyContin was associated with changes in the use of unregulated opioids and other substances among people who use opioids (PWUO). METHODS Data were derived from two prospective cohort studies of people who use drugs in Vancouver, BC, Canada from 2006 to 2018. PWUO who had at least one follow-up visit before and after delisting of OxyContin were included. Outcomes of interest were self-reported regular (i.e., at least weekly) use of heroin, non-prescribed prescription opioids, cannabis, methamphetamine, crack cocaine, and powder cocaine during the previous six months. Using quasi-experimental interrupted time series, we fit generalized least squares models to assess participants' immediate and long-term substance use practices after the policy change. RESULTS We analyzed data from 1014 participants who contributed to 17457 visits during the study. Following the delisting of OxyContin, heroin use increased immediately by 5.17% (95% confidence intervals [CI]: 0.68 to 9.67) and over time by 0.47% (0.35 to 0.58) per month. Non-prescribed prescription opioid use increased immediately by 1.80% (0.10 to 3.50) and over time by 0.16% (0.12 to 0.19) per month. Cannabis use increased immediately by 4.37% (0.88 to 7.87) and over time by 0.11% (0.02 to 0.19) per month. Methamphetamine use did not increase immediately but increased over time by 0.10% (0.01 to 0.18) per month. Crack cocaine use decreased immediately by 6.13% (-10.94 to -1.69) but not significantly over time. Lastly, powder cocaine use did not increase immediately or over time. CONCLUSIONS Delisting of OxyContin in BC was not associated with a reduction in unregulated opioid use among PWUO. Our findings point to a shift in substance use patterns of PWUO post-intervention and further highlight the unintended consequences of supply-reduction interventions in addressing the opioid epidemic.
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Affiliation(s)
- Mohammad Karamouzian
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3; Centre on Drug Policy Evaluation, Saint Michael...s Hospital, Toronto, ON, CANADA, M5B 1T8.
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115,USA; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Ekaterina Nosova
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9
| | - Kanna Hayashi
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9
| | - M-J Milloy
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6
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Beachler DC, Hall K, Garg R, Banerjee G, Li L, Boulanger L, Yuce H, Walker AM. An Evaluation of the Effect of the OxyContin Reformulation on Unintentional Fatal and Nonfatal Overdose. Clin J Pain 2022; 38:396-404. [PMID: 35356897 PMCID: PMC9076252 DOI: 10.1097/ajp.0000000000001034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES OxyContin was reformulated with a polyethylene oxide matrix in August 2010 to reduce the potential for intravenous abuse and for abuse by insufflation. The objective of this study was to evaluate the impact of OxyContin's reformulation on overdose (OD) risk for individuals dispensed OxyContin in comparison to those dispensed other opioids under regular care. MATERIALS AND METHODS Three national insurance databases with National Death Index linkage identified OD in individuals with any dispensing of OxyContin or a primary comparator opioid (extended release morphine, transdermal fentanyl, or methadone) between July 2008 through September 2015. A difference-in-differences design was used to compare the pre-post reformulation changes in OD rates for OxyContin versus comparators. RESULTS A total of 297,836 individuals were dispensed OxyContin and 659,673 individuals were dispensed a primary comparator across the 3 databases. Overall, there was little or no difference in the temporal change in OD incidence in comparators versus OxyContin (Medicaid: adjusted ratio-of-rate-ratios (aRoRs) ranging from 0.90 to 1.05; MarketScan/HIRD: aRoR ranging from 1.10 to 1.22). However, restriction to person-time without concomitant opioid use revealed a modestly greater reduction in OD incidence over time during OxyContin use, as the aRoRs comparing the primary comparators to OxyContin ranged from 1.06 to 1.30 in Medicaid and from 1.64 to 1.85 in MarketScan/HIRD. DISCUSSION This study did not detect an overall effect of the OxyContin reformulation on OD in insured patients under regular medical care. There is a suggestion of a modestly reduced OxyContin-associated OD risk following the reformulation but only in commercially insured individuals receiving single-opioid regimens.
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Affiliation(s)
| | - Kelsey Hall
- Safety and Epidemiology, HealthCore Inc., Wilmington, DE
| | - Renu Garg
- Safety and Epidemiology, HealthCore Inc., Wilmington, DE
| | | | - Ling Li
- Safety and Epidemiology, HealthCore Inc., Wilmington, DE
| | | | - Huseyin Yuce
- Department of Mathematics, New For City College of Technology, The City University of New York, Brooklyn, NY
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The release of abuse-deterrent OxyContin and adolescent heroin use. Drug Alcohol Depend 2021; 229:109114. [PMID: 34638038 DOI: 10.1016/j.drugalcdep.2021.109114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the association between the abuse-deterrent reformulation of OxyContin and adolescent lifetime heroin use in the United States. METHODS The quasi-experimental study uses individual survey data from the 1999-2019 Youth Risk Behavior Surveillance System to examine whether the reformulation of OxyContin in August 2010 affected adolescent lifetime heroin use, exploiting heterogeneity in state-level rates of OxyContin misuse before the reformulation. Multiple regression analysis adjusted for state and year fixed effects, adolescent demographics, and time-varying state characteristics and policies. RESULTS The release of the abuse-deterrent reformulation of OxyContin was associated with a reduction in adolescents reporting ever using heroin. An adolescent in a state with a one percentage point higher state-level rate of pre-reformulation OxyContin misuse was 1.7% points less likely to report ever using heroin after the reformulation (95% confidence interval, [(CI) = -0.007, -0.027]). These effects are strongest for adolescent males (estimate: -0.028, [(CI) = -0.016, 0.040]) and non-whites (estimate: -0.021, [(CI) = -0.005, -0.037]). CONCLUSIONS These results suggest the release of abuse-deterrent OxyContin is associated with a decrease in the likelihood of adolescent lifetime heroin use in states with higher pre-reformulation rates of OxyContin misuse. Pharmaceutical innovations and policies that reduce the likelihood of prescription opioid misuse may be effective in reducing adolescent lifetime heroin use.
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Harder VS, Varni SE, Murray KA, Plante TB, Villanti AC, Wolfson DL, Maruti S, Fairfield KM. Prescription opioid policies and associations with opioid overdose and related adverse effects. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103306. [PMID: 34107447 PMCID: PMC8585674 DOI: 10.1016/j.drugpo.2021.103306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND United States (US) policies to mitigate the opioid epidemic focus on reducing access to prescription opioids to prevent overdoses. We examined the impact of state policies in Vermont (July 2017) and Maine (July 2016) on opioid overdoses and opioid-related adverse effects. METHODS Study population included patients 15 years and older in all-payer claims of Vermont (N = 597,683; Jan.2016-Dec.2018) and Maine (N = 1,370,960; Oct.2015-Dec.2017). We used interrupted time series analyses to assess the impact of opioid prescribing policies on monthly opioid overdose rate and opioid-related adverse effects rate. We used the International Classification of Disease-10-CM to identify overdoses (T40.0 × 1-T40.4 × 4, T40.601-T40.604, T40.691-T40.694) and adverse effects (T40.0 × 5, T40.2 × 5-T40.4 × 5, T40.605, T40.695). RESULTS Immediately after the policy, the level of Vermont's opioid overdose rate increased by 34% (95% confidence interval, CI: 1.09, 1.65) while the level of opioid-related adverse effects rate decreased by 29% (95% CI: 0.58, 0.87). In Maine, there was no level change in opioid overdose rate, but the slope of the adverse effects rate after the policy decreased by 3.5% (95% CI: 0.94, 0.99). These results varied within age and rurality subgroups in both states. CONCLUSION While the decrease in rate of adverse effects following the policy changes is promising, the increase in Vermont's opioid overdose rate may suggest there is an association between policy implementation and short-term risk to public health.
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Affiliation(s)
- Valerie S Harder
- University of Vermont, Larner College of Medicine, Department of Pediatrics, 1 South Prospect Street, Burlington VT, 05401, USA; University of Vermont, Larner College of Medicine, Department of Surgery, 111 Colchester Avenue, Burlington, VT 05401, USA.
| | - Susan E Varni
- University of Vermont, Larner College of Medicine, Department of Pediatrics, 1 South Prospect Street, Burlington VT, 05401, USA
| | - Kimberly A Murray
- Maine Medical Center Research Institute, Center for Outcomes Research and Evaluation, 509 Forest Avenue, Suite 200, Portland, Maine 04101, USA
| | - Timothy B Plante
- University of Vermont, Larner College of Medicine, Department of Medicine, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Andrea C Villanti
- University of Vermont, Larner College of Medicine, Department of Psychiatry, 1 South Prospect Street, Burlington VT, 05401, USA
| | - Daniel L Wolfson
- University of Vermont, Larner College of Medicine, Department of Surgery, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Sanchit Maruti
- University of Vermont, Larner College of Medicine, Department of Psychiatry, 1 South Prospect Street, Burlington VT, 05401, USA
| | - Kathleen M Fairfield
- Maine Medical Center, Department of Medicine, 22 Bramhall Street, Portland, Maine 04102, USA
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Wolff C, Dowd WN, Ali MM, McClellan C, Meinhofer A, Glos L, Mutter R, Rosenberg M, Schick A. The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation. Addict Behav 2020; 105:106268. [PMID: 32036188 DOI: 10.1016/j.addbeh.2019.106268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
The introduction of abuse-deterrent OxyContin in 2010 was intended to reduce its misuse by making it more tamper resistant. However, some studies have suggested that this reformulation might have had unintended consequences, such as increases in heroin-related deaths. We used the 2005-2014 cross-sectional U.S. National Survey on Drug Use and Health to explore the impact of this reformulation on intermediate outcomes that precede heroin-related deaths for individuals with a history of OxyContin misuse. Our study sample consisted of adults who misused any prescription pain reliever prior to the reformulation of OxyContin (n = 81,400). Those who misused OxyContin prior to the reformulation were considered the exposed group and those who misused other prescription pain relievers prior to the reformulation were considered the unexposed group. We employed multivariate logistic regression under a difference-in-differences framework to examine the effect of the reformulation on five dichotomous outcomes: prescription pain reliever misuse; prescription pain reliever use disorder; heroin use; heroin use disorder; and heroin initiation. We found a net reduction in the odds of prescription pain reliever misuse (OR:0.791, p < 0.001) and heroin initiation (OR:0.422, p = 0.011) after the reformulation for the exposed group relative to the unexposed group. We found no statistically significant effects of the reformulation on prescription pain reliever use disorder (OR: 0.934, p = 0.524), heroin use (OR: 1.014p = 0.941), and heroin use disorder (OR: 1.063, p = 0.804). Thus, the reformulation of OxyContin appears to have reduced prescription pain reliever misuse without contributing to relatively greater new heroin use among those who misused OxyContin prior to the reformulation.
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Novack LM, Carrasco KG, Tyler KA, Dombrowski K, Habecker P. Injection Opioid and Injection Methamphetamine Use in the Rural United States: A Systematic Review and Network Analysis. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619895247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The abuse of opioid and methamphetamine is a public health crisis in the United States, particularly in rural areas where injection drug use is common. This systematic review of rural injection drug use synthesized the research on injection of opioids and methamphetamine use and assessed the similarity of their research findings to the field of rural injection drug use in the United States. A citation network analysis was used to support the assessment of research similarity and provided a visualization of the field. This citation network analysis exposed a gap in the literature revealing that the state of research may not be fully applicable to the field in its entirety in the United States. In summary, this review provides a representative overview of the state of research in the field of injection drug use. Future research should conduct studies on rural drug use in areas of the country not represented in this review.
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Smith KE, Bunting AM, Walker R, Hall MT, Grundmann O, Castillo O. Non-Prescribed Buprenorphine Use Mediates the Relationship between Heroin Use and Kratom Use among a Sample of Polysubstance Users. J Psychoactive Drugs 2019; 51:311-322. [PMID: 30961450 PMCID: PMC10083077 DOI: 10.1080/02791072.2019.1597224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
In Asia, Mitragyna speciosa (e.g., "kratom") has been used to mitigate alcohol and drug dependence. Some preliminary findings suggest kratom's potential use as an informal harm-reduction method in the United States, such as an opioid substitute or as a means of lessening opioid withdrawal symptoms. To determine correlates of past-year kratom use among a sample of polysubstance users enrolled in residential recovery programs in Kentucky, an anonymous survey was completed by clients in April 2017. Logistic regression was used to identify significant associations with past-year kratom use. Of the final sample (N = 478), 10.4% reported past-year kratom use. Past-year heroin use, but not past-year prescription opioid (e.g., oxycodone, hydrocodone) use, was significantly associated with kratom use, such that individuals who reported past-year heroin use were 2.5 times more likely to also report past-year kratom use. Non-prescribed buprenorphine (i.e., Suboxone) use partially mediated the relationship between past-year heroin and kratom use by explaining 36% of the association between the two drugs. Though amphetamines were highly preferred, past-year use was negatively correlated with past-year kratom use. Rates of past-year kratom use were lower than rates of alcohol and illicit drug use. Kratom was not preferred over heroin or prescription opioids.
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Affiliation(s)
- Kirsten E. Smith
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | | | - Robert Walker
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Martin T. Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Olivia Castillo
- University of Miami School of Law, University of Miami, Coral Gables, FL, USA
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Peacock A, Larance B, Bruno R, Pearson SA, Buckley NA, Farrell M, Degenhardt L. Post-marketing studies of pharmaceutical opioid abuse-deterrent formulations: a framework for research design and reporting. Addiction 2019; 114:389-399. [PMID: 29989247 PMCID: PMC6599581 DOI: 10.1111/add.14380] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/12/2018] [Accepted: 07/04/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Opioid formulations with properties to deter abuse (abuse-deterrent formulations; ADFs) have been developed as one response to the prescription opioid 'epidemic'. As for all medicines, ADFs undergo evaluation of safety and efficacy prior to registration for marketing. However, reduced extra-medical use (the primary intended outcome of ADFs and reason for their introduction) can only be established in post-marketing observational studies, comparing them to opioid formulations without abuse-deterrent properties. This has implications for various features of study design and analysis. We discuss proposals for the design, conduct, governance and reporting of post-marketing studies on the effectiveness of pharmaceutical and opioid ADFs. METHODS A review of current guidance documents, public work-shops and forums and our own experience with post-marketing studies of ADFs. RESULTS AND CONCLUSIONS Research questions for post-marketing studies on ADFs of opioids should reasonably be framed around detecting any probable intended or unintended clinical and/or meaningful changes in specific aspects of extra-medical use (e.g. injection use) and harms. Outcomes reported by prevalence and frequency of occurrence and disaggregated by specific product and route of administration can illustrate the magnitude of ADF impact. We argue that a multi-faceted approach is required, using data from both general population and sentinel high-risk cohorts and from primary and secondary data sources. The comparator (historical non-ADF formulation of that opioid, equivalent current generic or similar opioid product), duration of monitoring and analytical approach require justification and should be sufficient to add weight to conclusions of causality. To maximize transparency, we recommend explicit declarations of funding and conflict of interest, establishment of an advisory committee, publication of study protocol and access to study results.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
- School of Medicine, University of Tasmania, TAS 7001, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
- School of Medicine, University of Tasmania, TAS 7001, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney NSW 2052 Australia
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Lipp A, Selt M, Ferenc D, Schollmeyer D, Waldvogel SR, Opatz T. Total Synthesis of (−)-Oxycodone via Anodic Aryl–Aryl Coupling. Org Lett 2019; 21:1828-1831. [DOI: 10.1021/acs.orglett.9b00419] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander Lipp
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Maximilian Selt
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Dorota Ferenc
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Dieter Schollmeyer
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Siegfried R. Waldvogel
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
| | - Till Opatz
- Institute of Organic Chemistry, Johannes Gutenberg University Mainz, Duesbergweg 10-14, 55128 Mainz, Germany
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Dasgupta N, Schwarz J, Hennessy S, Ertefaie A, Dart RC. Causal inference for evaluating prescription opioid abuse using trend-in-trend design. Pharmacoepidemiol Drug Saf 2019; 28:716-725. [PMID: 30714239 DOI: 10.1002/pds.4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE One response to the opioid crisis in the United States has been the development of opioid analgesics with properties intended to reduce non-oral use. Previous evaluations of abuse in the community have relied on population averaged interrupted time series Poisson models with utilization offsets. However, competing interventions and secular trends complicate interpretation of time-series analyses. An alternative research design, trend-in-trend, accounts for heterogeneity in per capita opioid dispensing and unmeasured time-varying confounding, which provides a causal evaluation, provided that underlying assumptions are met. METHODS Trend-in-trend can be modeled using a logistic regression framework. In logistic regression, exposure was any product-specific outpatient dispensing by three-digit ZIP code and calendar quarter, for 22 opioids. The outcome was any product-specific abuse case ascertained from poison centers and drug treatment programs, covering 94% of the US population, between July 2009 and December 2016. Product-specific odds ratios compared places without dispensing with places with any dispensing; the causal contrast represents the odds of product-specific abuse in the community given exposure. RESULTS Dispensing of new and low-volume opioids varied considerably across the country, with no region showing high of all products. Of 22 opioids analyzed, the three with approved labeling as intended to deter abuse ranked near the lowest in both absolute (population-adjusted rates: 1.7, 0.9, and 8.2 per million people per quarter, respectively) and relative measures (trend-in-trend ORs: 1.96, 1.79, 1.69, respectively). CONCLUSIONS Postmarketing studies of prescription opioid abuse may benefit by evolving from unadjusted surveillance rates to a causal inference approach.
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Affiliation(s)
- Nabarun Dasgupta
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.,Injury Prevention Research Center and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - John Schwarz
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Askhan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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13
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Bluthenthal RN, Chu D, Wenger LD, Bourgois P, Valente T, Kral AH. Differences in time to injection onset by drug in California: Implications for the emerging heroin epidemic. Drug Alcohol Depend 2018; 185:253-259. [PMID: 29477084 PMCID: PMC5889717 DOI: 10.1016/j.drugalcdep.2018.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heroin use is increasing in the US. Heroin use may predispose users towards injection routes of drug administration as compared to other illicit substances. OBJECTIVE To explore the relationship between heroin use and drug injection, we compared time from first use to first injection (referred to as time to injection onset by drug [TTIOD]) of heroin, methamphetamine/speed, cocaine, and crack cocaine among people who inject drugs (PWID). METHODS Age of first use and first injection by drug was collected from 776 PWID. Survival analyses were used to determine TTIOD and to examine demographic factors associated with TTIOD. Cox regression analysis was used to determine demographic factors associated with drug-specific injection onset. RESULTS The eventual injection onset rate by the drug was 99% for participants who used heroin, 85% for participants who used methamphetamine/speed, 80% for participants who used powder cocaine, and 38% for participants who used crack cocaine. Hazard ratios for injection use within one year of first use by drug were: 1.37 (median survival time [MST] = 0.61 years) for heroin, 0.66 (MST = 1.10 years) for methamphetamine/speed, 0.50 (MST = 2.93 years) for powder cocaine, and 0.12 (MST = 39.59 years) for crack cocaine. Demographic differences in TTIOD were found for each drug. Demographic differences were found for eventual injection by drug for all substances except heroin. CONCLUSION Among PWID, heroin use was associated with a more rapid transition to injection and a higher rate of eventual heroin injection regardless of demographics. More robust, innovative efforts to reduce heroin use and prevent injection initiation are urgently needed.
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Affiliation(s)
- Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, United States.
| | - Daniel Chu
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, United States
| | - Lynn D Wenger
- Behavioral and Urban Health Program, RTI International, 351 California St., San Francisco, CA, United States
| | - Philippe Bourgois
- Department of Psychiatry and Biobehavioral Sciences, UCLA Center for Social Medicine and the Humanities, Semel Institute, 760 Westwood Plaza, Los Angeles, CA, United States
| | - Thomas Valente
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, United States
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, 351 California St., San Francisco, CA, United States
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14
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Jauncey M, Livingston M, Salmon AM, Dietze P. The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:17-22. [DOI: 10.1016/j.drugpo.2017.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
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15
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Larance B, Dobbins T, Peacock A, Ali R, Bruno R, Lintzeris N, Farrell M, Degenhardt L. The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study. Lancet Psychiatry 2018; 5:155-166. [PMID: 29336948 DOI: 10.1016/s2215-0366(18)30003-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Escalation of pharmaceutical opioid use and harm in North America is well-documented, with similar issues emerging in Australia. One response is the development of tamper-resistant formulations of opioids. A potentially tamper-resistant formulation of controlled-release oxycodone was introduced in Australia in April, 2014, rapidly replacing the non-tamper-resistant formulation. Our study is the most systematic and comprehensive examination of the impact of a new opioid formulation to date, assessing the effect of tamper-resistant formulation of controlled-release oxycodone on population-level opioid use and opioid-related harm (ie, overdose, help-seeking, and treatment-seeking); and opioid use, tampering, and preference for the tamper-resistant formulation of controlled-release oxycodone compared with other drugs or formulations among sentinel populations likely to tamper with pharmaceutical opioids. METHODS We conducted interrupted time-series analyses of opioid sales data and multiple routinely collected health datasets, followed up a cohort of people who tamper with pharmaceutical opioids before and after the introduction of the tamper-resistant formulation of controlled-release oxycodone, and analysed annual surveys of people who inject drugs. Data were collected from several Australian states: New South Wales, South Australia, and Tasmania. Meta-analyses (weighted Z tests) were conducted to synthesise across data sources providing evidence for a given indicator. FINDINGS At the population level, we found reduced sales of higher strengths of controlled-release oxycodone and increased sales of other oxycodone formulations. No significant effect was observed among population-level indicators of opioid overdose, or help or treatment-seeking. Mortality data were not available for inclusion at the time of our study. Meta-analyses across sentinel populations (ie, prospective cohort, surveys of people who inject drugs, and clients of supervised injecting facilities or needle and syringe programmes) indicated reduced controlled-release oxycodone use via tampering (mainly injection), with no evidence of switching to heroin or other drug use. INTERPRETATION This formulation of controlled-release oxycodone reduced tampering with pharmaceutical opioids among people who inject drugs, but did not affect population-level opioid use or harm. FUNDING Mundipharma Australia, the Australian Government, and the National Health and Medical Research Council.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Robert Ali
- Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nicholas Lintzeris
- Sydney Medical School, Sydney University, Sydney, NSW, Australia; The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Global Health, School of Public Health, University of Washington, Washington, DC, USA
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16
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Vosburg SK, Haynes C, Besharat A, Green JL. Changes in drug use patterns reported on the web after the introduction of ADF OxyContin: findings from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System Web Monitoring Program. Pharmacoepidemiol Drug Saf 2017; 26:1044-1052. [DOI: 10.1002/pds.4248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/26/2017] [Accepted: 06/05/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Suzanne K. Vosburg
- Rocky Mountain Poison and Drug Center (RMPDC); A Division of Denver Health; 777 Bannock Street M/C 0180 Denver Colorado 80204 USA
| | - Colleen Haynes
- Rocky Mountain Poison and Drug Center (RMPDC); A Division of Denver Health; 777 Bannock Street M/C 0180 Denver Colorado 80204 USA
| | - Andrea Besharat
- Rocky Mountain Poison and Drug Center (RMPDC); A Division of Denver Health; 777 Bannock Street M/C 0180 Denver Colorado 80204 USA
| | - Jody L. Green
- Rocky Mountain Poison and Drug Center (RMPDC); A Division of Denver Health; 777 Bannock Street M/C 0180 Denver Colorado 80204 USA
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Abstract
OBJECTIVES To determine opioid-prescribing practices to the orthopaedic trauma (OT) population at one Level I trauma center. DESIGN A retrospective study of discharge prescriptions for adult patients with OT. Prescription details, injury burden, and patient demographics were abstracted for patients from initial injury through a 2-month follow-up. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Adult patients with OT admitted over a 30-day period (n = 110). INTERVENTION All discharge and follow-up opioid prescriptions were recorded. MAIN OUTCOME MEASUREMENTS Morphine milligram equivalents (MMEs) per day, number of opioid prescriptions, type/dose of medication prescribed. RESULTS One hundred thirty-five discharge prescriptions were written for 110 patients with orthopaedic injuries during the review period. All patients received opioids at the time of discharge. The MMEs prescribed at the time of discharge was 114 mg (54-300 mg) for a mean of 7.21 days (2-36.7 days). Although patients with preinjury risk factors were prescribed discharge opioids for a similar duration (7.00 days vs. 7.30 days, P = 0.81) than those without risk factors, they were prescribed significantly more MMEs than those without (130 vs. 108, P < 0.05) and were more likely to receive extended-release and long-acting opioids than those without (42.11% vs. 21.98%). CONCLUSIONS Pain management after OT continues to be opioid-centric despite involving a population at risk. Further focus on prescriber and patient education, risk evaluation with mitigation, guideline development, and comprehensive pain management strategies are warranted in the OT population. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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18
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Green JL, Bucher Bartelson B, Le Lait MC, Roland CL, Masters ET, Mardekian J, Bailey JE, Dart RC. Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration. Drug Alcohol Depend 2017; 175:140-145. [PMID: 28414990 DOI: 10.1016/j.drugalcdep.2017.01.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. METHODS This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. RESULTS While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. CONCLUSION Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.
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Affiliation(s)
- Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Becki Bucher Bartelson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - M Claire Le Lait
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Carl L Roland
- Pfizer Inc, 4222 Emperor Blvd., Suite 335, Durham, NC 27703 USA.
| | | | | | - J Elise Bailey
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
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19
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Jones MR, Carney MJ, Kaye RJ, Prabhakar A, Kaye AD. Drug Formulation Advances in Extended-Release Medications for Pain Control. Curr Pain Headache Rep 2017; 20:36. [PMID: 27084375 DOI: 10.1007/s11916-016-0565-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prescription opioid abusers frequently tamper with opioid tablets in order to either accelerate the delivery of the euphoria-inducing agent or to alter the route of delivery, such that it may be delivered intranasally or intravenously. As one strategy to combat the opioid epidemic in the USA, drug manufacturers have begun to explore formulations which resist such tampering by abusers. Techniques to prevent tampering consist of physical barriers to crushing, chewing, and drug extraction, or aversive or antagonistic agents, incorporated within the formulation itself. Recent years have seen the development of numerous extended-release opioid agents, which are described in this review. This article provides a comprehensive summary of the pharmacology, benefits, risks, and processes behind the development of currently available extended-release opioid drugs, as well as a glimpse into promising future formulations.
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Affiliation(s)
- Mark R Jones
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Rachel J Kaye
- Department of Biochemistry, Bowdoin College, Brunswick, ME, USA
| | - Amit Prabhakar
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA.
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20
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21
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Rahman Z, Zidan AS, Korang-Yeboah M, Yang Y, Siddiqui A, Shakleya D, Khan MA, Cruz C, Ashraf M. Effects of excipients and curing process on the abuse deterrent properties of directly compressed tablets. Int J Pharm 2017; 517:303-311. [DOI: 10.1016/j.ijpharm.2016.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/11/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022]
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22
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Severtson SG, Ellis MS, Kurtz SP, Rosenblum A, Cicero TJ, Parrino MW, Gilbert MK, Buttram ME, Dasgupta N, BucherBartelson B, Green JL, Dart RC. Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone. Drug Alcohol Depend 2016; 168:219-229. [PMID: 27716575 DOI: 10.1016/j.drugalcdep.2016.09.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/18/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The development of abuse deterrent formulations is one strategy for reducing prescription opioid misuse and abuse. A putative abuse deterrent formulation of oxycodone extended release (OxyContin®) was introduced in 2010. Early reports demonstrated reduced abuse and diversion, however, an analysis of social media found 32 feasible methods to circumvent the abuse deterrent mechanism. We measured trends of diversion, abuse and street price of OxyContin to assess the durability of the initial reduction in abuse. METHODS Data from the Poison Center Program, Drug Diversion Program, Opioid Treatment Program, Survey of Key Informant Patients Program and StreetRx program of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) System were used. The average quarterly rates of abuse and diversion for OxyContin were compared from before reformulation to the rate in second quarter 2015. Rates were adjusted for population using US Census data and drug availability. RESULTS OxyContin abuse and diversion declined significantly each quarter after reformulation and persisted for 5 years. The rate of abuse of other opioid analgesics increased initially and then decreased, but to lesser extent than OxyContin. Abuse through both oral and non-oral routes of self-administration declined following the reformulation. The geometric mean difference in the street price of reformulated OxyContin was 36% lower than the reformulated product in the year after reformulation. DISCUSSION Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.
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Affiliation(s)
| | - Matthew S Ellis
- Department of Psychiatry, Washington University School of Medicine, Washington University School of Medicine, Box 8134, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Department of Justice and Human Services, College of Humanities, Arts and Social Sciences, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL, 33138, USA.
| | - Andrew Rosenblum
- American Association for the Treatment of Opioid Dependence, New York, NY, USA.
| | - Theodore J Cicero
- Department of Psychiatry, Washington University School of Medicine, Washington University School of Medicine, Box 8134, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Mark W Parrino
- American Association for the Treatment of Opioid Dependence, New York, NY, USA.
| | | | - Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Department of Justice and Human Services, College of Humanities, Arts and Social Sciences, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL, 33138, USA.
| | - Nabarun Dasgupta
- Epidemico, Inc., 50 Milk St., 20th floor, Boston, MA, 02109, USA.
| | - Becki BucherBartelson
- Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA.
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA.
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23
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Hale ME, Moe D, Bond M, Gasior M, Malamut R. Abuse-deterrent formulations of prescription opioid analgesics in the management of chronic noncancer pain. Pain Manag 2016; 6:497-508. [DOI: 10.2217/pmt-2015-0005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Misuse, abuse and diversion of prescription opioid analgesics represent a global public health concern. The development of abuse-deterrent formulations (ADFs) of prescription opioid analgesics is an important step toward reducing abuse and diversion of these medications, as well as potentially limiting medical consequences when misused or administered in error. ADFs aim to hinder extraction of the active ingredient, prevent administration through alternative routes and/or make abuse of the manipulated product less attractive, less rewarding or aversive. However, opioid ADFs may still be abused via the intended route of administration by increasing the dose and/or dosing frequency. The science of abuse deterrence and the regulatory landscape are still relatively new and evolving. This paper reviews the current status of opioid ADFs, with particular focus on different approaches that can be used to deter abuse, regulatory considerations and implications for clinical management.
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Affiliation(s)
| | - Derek Moe
- CIMA Labs Inc., Brooklyn Park, MN, USA
| | - Mary Bond
- TEVA Pharmaceuticals, Frazer, PA, USA
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24
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Pergolizzi JV, Raffa RB, Zampogna G, Breve F, Colucci R, Schmidt WK, LeQuang JA. Comments and Suggestions from Pain Specialists Regarding the CDC's Proposed Opioid Guidelines. Pain Pract 2016; 16:794-808. [DOI: 10.1111/papr.12475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joseph V. Pergolizzi
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
- Department of Pharmacology; Temple University School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Robert B. Raffa
- Department of Pharmacology and Toxicology; University of Arizona College of Pharmacy; Tucson Arizona U.S.A
- Department of Pharmaceutical Sciences; Temple University School of Pharmacy; Philadelphia Pennsylvania U.S.A
| | - Gianpietro Zampogna
- NEMA Research, Inc.; Naples Florida U.S.A
- Department of Medicine; St. Vincent Charity Medical Center/Case Western Reserve University School of Medicine; Cleveland Ohio U.S.A
| | - Frank Breve
- Department of Pharmacy Practice; Temple University School of Pharmacy; Philadelphia Pennsylvania U.S.A
- Mid Atlantic PharmaTech Consultants, LLC; Ventnor City New Jersey U.S.A
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25
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Chilcoat HD, Coplan PM, Harikrishnan V, Alexander L. Decreased diversion by doctor-shopping for a reformulated extended release oxycodone product (OxyContin). Drug Alcohol Depend 2016; 165:221-8. [PMID: 27372220 DOI: 10.1016/j.drugalcdep.2016.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doctor-shopping (obtaining prescriptions from multiple prescribers/pharmacies) for opioid analgesics produces a supply for diversion and abuse, and represents a major public health issue. METHODS An open cohort study assessed changes in doctor-shopping in the U.S. for a brand extended release (ER) oxycodone product (OxyContin) and comparator opioids before (July, 2009 to June, 2010) versus after (January, 2011 to June, 2013) introduction of reformulated brand ER oxycodone with abuse-deterrent properties, using IMS LRx longitudinal data covering >150 million patients and 65% of retail U.S. prescriptions. RESULTS After its reformulation, the rate of doctor-shopping decreased 50% (for 2+ prescribers/3+ pharmacies) for brand ER oxycodone, but not for comparators. The largest decreases in rates occurred among young adults (73%), those paying with cash (61%) and those receiving the highest available dose (62%), with a 90% decrease when stratifying by all three characteristics. The magnitude of doctor-shopping reductions increased with increasing number of prescribers/pharmacies (e.g., 75% reduction for ≥2 prescribers/≥4 pharmacies). CONCLUSIONS The rate of doctor-shopping for brand ER oxycodone decreased substantially after its reformulation, which did not occur for other prescription opioids. The largest reductions in doctor-shopping occurred with characteristics associated with higher abuse risk such as youth, cash payment and high dose, and with more specific thresholds of doctor-shopping. A higher prescriber and/or pharmacy threshold also increased the magnitude of the decrease, suggesting that it better captured the effect of the reformulation on actual doctor-shoppers.
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Affiliation(s)
- Howard D Chilcoat
- Risk Management and Epidemiology, Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, CT, United States; Adjunct, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paul M Coplan
- Risk Management and Epidemiology, Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, CT, United States; Adjunct, Epidemiology Department, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Venkatesh Harikrishnan
- Risk Management and Epidemiology, Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, CT, United States
| | - Louis Alexander
- Risk Management and Epidemiology, Medical Affairs Strategic Research, Purdue Pharma L.P., Stamford, CT, United States
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26
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Coplan PM, Chilcoat HD, Butler SF, Sellers EM, Kadakia A, Harikrishnan V, Haddox JD, Dart RC. The effect of an abuse-deterrent opioid formulation (OxyContin) on opioid abuse-related outcomes in the postmarketing setting. Clin Pharmacol Ther 2016; 100:275-86. [PMID: 27170195 PMCID: PMC5102571 DOI: 10.1002/cpt.390] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/01/2016] [Accepted: 05/04/2016] [Indexed: 01/14/2023]
Abstract
An extended‐release opioid analgesic (OxyContin, OC) was reformulated with abuse‐deterrent properties to deter abuse. This report examines changes in abuse through oral and nonoral routes, doctor‐shopping, and fatalities in 10 studies 3.5 years after reformulation. Changes in OC abuse from 1 year before to 3 years after OC reformulation were calculated, adjusted for prescription changes. Abuse of OC decreased 48% in national poison center surveillance systems, decreased 32% in a national drug treatment system, and decreased 27% among individuals prescribed OC in claims databases. Doctor‐shopping for OC decreased 50%. Overdose fatalities reported to the manufacturer decreased 65%. Abuse of other opioids without abuse‐deterrent properties decreased 2 years later than OC and with less magnitude, suggesting OC decreases were not due to broader opioid interventions. Consistent with the formulation, decreases were larger for nonoral than oral abuse. Abuse‐deterrent opioids may mitigate abuse and overdose risks among chronic pain patients.
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Affiliation(s)
- P M Coplan
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, USA.,Adjunct, Epidemiology Department, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - H D Chilcoat
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S F Butler
- Inflexxion Inc., Newton, Massachusetts, USA
| | - E M Sellers
- DL Global Partners Inc, Toronto, Canada.,Pharmacology and Toxicology, Medicine and Psychiatry, University of Toronto, Toronto, Canada
| | - A Kadakia
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, USA
| | - V Harikrishnan
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, USA
| | - J D Haddox
- Department of Health Policy, Purdue Pharma L.P., Stamford, Connecticut, USA.,Department of Public Health & Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - R C Dart
- Rocky Mountain Poison & Drug Center, Denver, Colorado, USA.,Surgery and Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
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Webster LR, Kopecky EA, Smith MD, Fleming AB. A Randomized, Double-Blind, Double-Dummy Study to Evaluate the Intranasal Human Abuse Potential and Pharmacokinetics of a Novel Extended-Release Abuse-Deterrent Formulation of Oxycodone. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1112-30. [PMID: 26814256 PMCID: PMC4894244 DOI: 10.1093/pm/pnv020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/21/2015] [Accepted: 09/06/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Evaluate the human abuse potential (HAP) of an experimental, microsphere-in-capsule formulation of extended-release oxycodone (oxycodone DETERx®) (herein "DETERx"). DESIGN Randomized, double-blind, double-dummy, positive- and placebo-controlled, single-dose, four-phase, four-treatment, crossover study. SETTING Clinical research site. SUBJECTS There were 39 qualifying subjects (72% male, 85% white, mean age of 27 years) with 36 completing all four Double-blind Treatment Periods. METHODS The four phases encompassed: 1) Screening; 2) Drug Discrimination; 3) Double-blind Treatment; and 4) Follow-up. Drug Discrimination tests ensured that subjects could distinguish placebo from opioid. The four Double-blind Treatments compared DETERx-administered as either a crushed intranasal (IN) or an intact oral (PO) preparation-with immediate-release oxycodone IN (OXY-IR IN) and with an intact IN and PO placebo DETERx control. RESULTS For primary pharmacokinetic (PK) assessments, abuse quotient (Cmax/Tmax) was lower with DETERx IN than DETERx PO; both treatments were substantially lower than OXY-IR IN (6.24, 8.60, and 69.6 ng/mL/h, respectively). For drug liking, the primary subjective pharmacodynamic (PD) endpoint, both DETERx IN and DETERx PO produced significantly lower scores than OXY-IR IN (P ≤ 0.0001 for each); DETERx IN was less liked than DETERx PO (P ≤ 0.05), mirroring the PK relationships. Objectively assessed pupillometry corroborated the more rapid and significantly greater effect of OXY-IR IN than either DETERx IN or DETERx PO (P ≤ 0.007 for each). Overall safety profiles of DETERx and OXY-IR were comparable and both were well tolerated. CONCLUSIONS Pharmacokinetic and pharmacodynamic outcomes suggest that DETERx IN has relatively low HAP; continued research in larger populations is suggested.
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Affiliation(s)
- Lynn R Webster
- *Early Development Services, Scientific Affairs, PRA Health Sciences, Salt Lake City, Utah, USA;
| | | | - Michael D Smith
- *Early Development Services, Scientific Affairs, PRA Health Sciences, Salt Lake City, Utah, USA
| | - Alison B Fleming
- Product Development, Collegium Pharmaceutical Inc., Canton, Massachusetts, USA
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Janoff SL, Perrin NA, Coplan PM, Chilcoat HD, Campbell CI, Green CA. Protocol: changes in rates of opioid overdose and poisoning events in an integrated health system following the introduction of a formulation of OxyContin® with abuse-deterrent properties. BMC Pharmacol Toxicol 2016; 17:21. [PMID: 27177423 PMCID: PMC4867981 DOI: 10.1186/s40360-016-0064-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background Addiction, overdoses and deaths resulting from prescription opioids have increased dramatically over the last decade. In response, several manufacturers have developed formulations of opioids with abuse-deterrent properties. For many of these products, the Food and Drug Administration (FDA) recognized the formulation with labeling claims and mandated post-marketing studies to assess the abuse-deterrent effects. In response, we assess differences in rates of opioid-related overdoses and poisonings prior to and following the introduction of a formulation of OxyContin® with abuse-deterrent properties. Methods/Design To assess effects of this formulation, electronic medical record (EMR) data from Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Northern California (KPNC) are linked to state death data and compared to chart audits. Overdose and poisoning events will be categorized by intentionality and number of agents involved, including illicit drugs and alcohol. Using 6-month intervals over a 10-year period, trends will be compared in rates of opioid-related overdoses and poisoning events associated with OxyContin® to rates of events associated with other oxycodone and opioid formulations. Qualitative interviews with patients and relatives of deceased patients will be conducted to capture circumstances surrounding events. Discussion This study assesses and tracks changes in opioid-related overdoses and poisoning events prior to and following the introduction of OxyContin® with abuse-deterrent properties. Public health significance is high because these medications are designed to reduce abuse-related behaviors that lead to important adverse outcomes, including overdoses and deaths. Electronic supplementary material The online version of this article (doi:10.1186/s40360-016-0064-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shannon L Janoff
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Nancy A Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Paul M Coplan
- Purdue Pharma, L.P., One Stamford Forum, Stamford, CT 06901, USA
| | - Howard D Chilcoat
- Indivior Inc., 10710 Midlothian Turnpike, Suite 302, Richmond, VA 23235, USA
| | - Cynthia I Campbell
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Carla A Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
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Abstract
As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacological and nonpharmacological. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. We then explore the impact of buprenorphine abuse as well as discussing strategies for its reduction, including changes in policy, prescription and pharmacy monitoring, and continuing medical education for guiding and improving clinical practice.
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Graziani M, Nisticò R. Gender difference in prescription opioid abuse: A focus on oxycodone and hydrocodone. Pharmacol Res 2016; 108:31-38. [PMID: 27107788 DOI: 10.1016/j.phrs.2016.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/18/2022]
Abstract
Several data gathered in the last decade indicate an increase of abuse of prescription opioid drugs oxycodone (OXY) and hydrocodone (HYDRO) in women. However, to date there are no conclusive evidences investigating the gender-dependent abuse liability of prescription opioids. This study aims to supply a specific focus on women's data through a selective summary of the literature analyzing gender differences in the pharmacokinetic and pharmacodynamic dimension of OXY and HYDRO. Findings from this study suggest that the majority of OXY and HYDRO pharmacokinetic and pharmacodynamic effects do not differ according to gender, though confirming a significant difference in the incidence of adverse effects as demonstrated by the increased gastrointestinal adverse reactions in female subjects. Although the majority of recent clinical studies include an equal number of female and male subjects, the main outcome parameters do not relate specifically to gender differences. Due to the gender influence in activity of CYP3A4 and its crucial role in metabolism of both OXY than HYDRO, we suggest that assessing pharmacokinetic and pharmacodynamic interactions in clinical studies may be useful to clarify the effect of the higher CYP3A4 activity in female in relation to CYP2D6 genotype. Overall, considering the paucity of data regarding gender differences in European Union, this work highlights that impact of new abuse deterrent formulations should be assessed with a special focus on data concerning female subjects.
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Affiliation(s)
- Manuela Graziani
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy; Drug Addiction and Clinical Pharmacology Unit, University Hospital Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Robert Nisticò
- Department of Biology, University of Rome 'Tor Vergata', Rome, Italy
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L. Keast S, Owora A, Nesser N, Farmer K. Evaluation of Abuse-Deterrent or Tamper-Resistant Opioid Formulations on Overall Health Care Expenditures in a State Medicaid Program. J Manag Care Spec Pharm 2016; 22:347-56. [PMID: 27023688 PMCID: PMC10398165 DOI: 10.18553/jmcp.2016.22.4.347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The development of abuse-deterrent opioid prescription medications is a priority at the national level. Pharmaceutical manufacturers have begun marketing new formulations of currently available opioids that meet higher abuse resistance standards. Little information is available regarding the impact of these formulations on overall health care expenditures. OBJECTIVES To (a) examine the relationship between health care expenditures and use of brand abuse-deterrent or tamper-resistant (ADTR) extended-release opioids versus standard dosage form (SDF) extended-release opioids in a state Medicaid population, and (b) determine whether this relationship was influenced by member-specific characteristics. METHODS The study is a cross-sectional review of Oklahoma Medicaid members (aged ≥ 21 years) with at least 1 paid pharmacy claim for long-acting opioids between September 2013 and August 2014. Members who were adherent to extended-release opioid products were classified into ADTR and SDF opioid groups. The relationship between health care expenditures (prescription, medical, and overall) and opioid groups was examined using multiple linear regression models. The impact of member-specific characteristics (age, sex, race, urban classifications, and various comorbidities) on this relationship was examined. RESULTS Prescription spending ($9,265,554) accounted for 35% of overall health care expenditures ($26,304,693) among 938 members during the 12-month reference period. Total prescription expenditures were higher among ADTR than SDF user groups, and the difference in median expenditures between these 2 groups was larger among members with more comorbidities, as measured by the Charlson Comorbidity Index score. Overall, ADTR users had higher median total health care and medical expenditures, and the difference in median expenditures was dependent on whether a member had comorbidities of addiction or not (higher expenditures were observed among members with comorbidities of addiction). CONCLUSIONS The abuse and misuse of medically prescribed opioid products is a growing health epidemic. A variety of attempts have been made to reduce the potential of abuse and misuse of these products, including changes to product formulations. The results of this study indicate that both prescription spending and physician and pharmacy spending combined may be increased with the use of these new products because of higher pricing. Study findings also suggest that the use of ADTR opioids among members with comorbidities of addiction may be related to slightly lower overall health care and medical expenditures than those among members without comorbidities of addiction. Further research is required to answer questions regarding the comparative effectiveness of existing opioid prescription formulations. DISCLOSURES No outside funding supported this research. Nesser is employed by the Oklahoma Health Care Authority, and Keast is a contractual employee for the Oklahoma Health Care Authority. The authors declare no other conflicts of interest. Study design was primarily contributed by Keast, along with Nesser and Farmer. Keast took the lead in data collection, while data interpretation was primarily performed by Owora, along with Keast and assisted by Nesser and Farmer. The manuscript was written and revised by all authors equally.
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Assessing impact of formulation and process variables on in-vitro performance of directly compressed abuse deterrent formulations. Int J Pharm 2016; 502:138-50. [DOI: 10.1016/j.ijpharm.2016.02.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
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Novak SP, Bluthenthal R, Wenger L, Chu D, Kral AH. Initiation of Heroin and Prescription Opioid Pain Relievers by Birth Cohort. Am J Public Health 2015; 106:298-300. [PMID: 26691120 DOI: 10.2105/ajph.2015.302972] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined initiation patterns among different birth cohorts of people who used prescription opioids and heroin because of historical differences in drug use availability. We examined data from a community-based study of persons who inject drugs (n = 483) in California and a general population survey from the National Survey on Drug Use and Health (n = 1264) and found that individuals born after 1980 were more likely than were individuals born before 1980 to initiate opioids through nonmedical use of prescription opioids than heroin.
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Affiliation(s)
- Scott P Novak
- Scott P. Novak is with RTI International, Research Triangle Park, NC. Ricky Bluthenthal and Daniel Chu are with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Lynn Wenger and Alex H. Kral are with RTI International, San Francisco, CA
| | - Ricky Bluthenthal
- Scott P. Novak is with RTI International, Research Triangle Park, NC. Ricky Bluthenthal and Daniel Chu are with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Lynn Wenger and Alex H. Kral are with RTI International, San Francisco, CA
| | - Lynn Wenger
- Scott P. Novak is with RTI International, Research Triangle Park, NC. Ricky Bluthenthal and Daniel Chu are with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Lynn Wenger and Alex H. Kral are with RTI International, San Francisco, CA
| | - Daniel Chu
- Scott P. Novak is with RTI International, Research Triangle Park, NC. Ricky Bluthenthal and Daniel Chu are with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Lynn Wenger and Alex H. Kral are with RTI International, San Francisco, CA
| | - Alex H Kral
- Scott P. Novak is with RTI International, Research Triangle Park, NC. Ricky Bluthenthal and Daniel Chu are with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Lynn Wenger and Alex H. Kral are with RTI International, San Francisco, CA
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Gasior M, Bond M, Malamut R. Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations. Postgrad Med 2015; 128:85-96. [DOI: 10.1080/00325481.2016.1120642] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nguyen V, Raffa RB, Taylor R, Pergolizzi JV. The role of abuse-deterrent formulations in countering opioid misuse and abuse. J Clin Pharm Ther 2015; 40:629-34. [DOI: 10.1111/jcpt.12337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Affiliation(s)
- V. Nguyen
- Temple University School of Pharmacy; Philadelphia PA USA
| | - R. B. Raffa
- Temple University School of Pharmacy; Philadelphia PA USA
| | - R. Taylor
- NEMA Research; Bonita Springs FL USA
| | - J. V. Pergolizzi
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Pharmacology; Temple University School of Medicine; Philadelphia PA USA
- Association of Chronic Pain Patients; Houston TX USA
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Larance B, Lintzeris N, Bruno R, Peacock A, Cama E, Ali R, Kihas I, Hordern A, White N, Degenhardt L. The characteristics of a cohort who tamper with prescribed and diverted opioid medications. J Subst Abuse Treat 2015; 58:51-61. [DOI: 10.1016/j.jsat.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
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Peacock A, Degenhardt L, Larance B, Cama E, Lintzeris N, Ali R, Bruno R. A typology of people who tamper with pharmaceutical opioids: responses to introduction of a tamper-resistant formulation of controlled-release oxycodone. Pharmacoepidemiol Drug Saf 2015; 24:1321-33. [PMID: 26419615 DOI: 10.1002/pds.3883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 11/07/2022]
Abstract
PURPOSE In April 2014, a tamper-resistant controlled-release oxycodone formulation was released in Australia. We aimed to determine whether there are latent classes of people who tamper with pharmaceutical opioids based on frequency of opioid and illicit drug use, the demographic and clinical profiles of these groups, and if there were changes in use and harms following the introduction. METHODS A prospective cohort of 606 people who regularly tamper with pharmaceutical opioids was interviewed January to March 2014 (Wave 1) and May to August 2014 (Wave 2). Latent class analysis identified groups based on non-prescribed opioid, illicit drug and prescribed opioid substitution therapy (OST) use at Wave 1. Regression models examined whether group membership predicted use and harms at Wave 2. RESULTS Four groups were identified: frequent OST group (39%), mixed OST/heroin group (7%), infrequent pharmaceutical opioid and heroin group (44%) and frequent oxycodone group (25%). Compared with the frequent OST group, the infrequent pharmaceutical opioid/heroin group was more likely to report non-everyday pain and risky alcohol use, and the frequent oxycodone group had higher odds of homelessness. At Wave 2, oxycodone use decreased across groups (odds ratios (OR) ≤ 0.18, p < 0.001, particularly for the frequent oxycodone group: OR ≤ 0.05, p < 0.001), with reductions in days of use (g ≥ 0.35, p < 0.050). Non-prescribed pharmaceutical opioid use, illicit drug use and harms remained stable or decreased. CONCLUSIONS Despite heterogeneity among people who tamper with pharmaceutical opioids, the tamper-resistant formulation was followed by reductions in oxycodone tampering among high-frequency and low-frequency users. There was no evidence of increased use of other opioids or illicit drugs.
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Affiliation(s)
- Amy Peacock
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, Faculty of Medicine, Sydney University, Sydney, New South Wales, Australia.,The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Robert Ali
- University of Adelaide, Adelaide, South Australia, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
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Wong A, Macleod D, Robinson J, Koutsogiannis Z, Graudins A, Greene SL. Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally. Clin Toxicol (Phila) 2015; 53:815-8. [DOI: 10.3109/15563650.2015.1060486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Degenhardt L, Bruno R, Ali R, Lintzeris N, Farrell M, Larance B. The introduction of a potentially abuse deterrent oxycodone formulation: Early findings from the Australian National Opioid Medications Abuse Deterrence (NOMAD) study. Drug Alcohol Depend 2015; 151:56-67. [PMID: 25910850 DOI: 10.1016/j.drugalcdep.2015.02.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is increasing concern about tampering of pharmaceutical opioids. We describe early findings from an Australian study examining the potential impact of the April 2014 introduction of an abuse-deterrent sustained-release oxycodone formulation (Reformulated OxyContin(®)). METHODS Data on pharmaceutical opioid sales; drug use by people who inject drugs regularly (PWID); client visits to the Sydney Medically Supervised Injecting Centre (MSIC); and last drug injected by clients of inner-Sydney needle-syringe programmes (NSPs) were obtained, 2009-2014. A cohort of n=606 people tampering with pharmaceutical opioids was formed pre-April 2014, and followed up May-August 2014. RESULTS There were declines in pharmacy sales of 80mg OxyContin(®) post-introduction of the reformulated product, the dose most commonly diverted and injected by PWID. Reformulated OxyContin(®) was among the least commonly used and injected drugs among PWID. This was supported by Sydney NSP data. There was a dramatic reduction in MSIC visits for injection of OxyContin(®) post-introduction of the new formulation (from 62% of monthly visits pre-introduction to 5% of visits, August 2014). The NOMAD cohort confirmed a reduction in OxyContin(®) use/injection post-introduction. Reformulated OxyContin(®) was cheaper and less attractive for tampering than Original OxyContin(®). CONCLUSIONS These data suggest that, in the short term, introduction of an abuse-deterrent formulation of OxyContin(®) in Australia was associated with a reduction in injection of OxyContin(®), with no clear switch to other drugs. Reformulated OxyContin(®), in this short follow-up, does not appear to be considered as attractive for tampering.
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Affiliation(s)
| | | | | | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Australia
| | | | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Australia
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Smith RV, Lofwall MR, Havens JR. Abuse and diversion of gabapentin among nonmedical prescription opioid users in Appalachian Kentucky. Am J Psychiatry 2015; 172:487-8. [PMID: 25930135 PMCID: PMC4864031 DOI: 10.1176/appi.ajp.2014.14101272] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel V. Smith
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine,Department of Epidemiology, University of Kentucky College of Public Health
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine,Department of Psychiatry, University of Kentucky College of Medicine
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine,Department of Epidemiology, University of Kentucky College of Public Health
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Dasgupta N, Raymond D. Commentary on Degenhardt et al (2015): a new formulation for research. Addiction 2015; 110:238-9. [PMID: 25602043 DOI: 10.1111/add.12812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Nabarun Dasgupta
- Epidemiology and Public Health, University of North Carolina School of Public Health, Chapel Hill, NC, USA.
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Degenhardt L, Larance B, Bruno R, Lintzeris N, Ali R, Farrell M. Evaluating the potential impact of a reformulated version of oxycodone upon tampering, non-adherence and diversion of opioids: the National Opioid Medications Abuse Deterrence (NOMAD) study protocol. Addiction 2015; 110:226-37. [PMID: 25358480 DOI: 10.1111/add.12746] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/28/2014] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
AIMS A new oxycodone formulation (Reformulated OxyContin® was released in Australia, early 2014. It was developed as a tamper-resistant ('abuse-deterrent') formulation of the drug. We summarize methods used in the National Opioid Medication Abuse Deterrence (NOMAD) study, which will examine: (i) whether there is a reduction in extra-medical use (including via tampering) of OxyContin® following the introduction of Reformulated OxyContin®; (ii) potential changes in extra-medical use of non-abuse-deterrent forms of oxycodone, other pharmaceutical opioids and illicit drugs; (iii) whether methods of tampering with Reformulated OxyContin® become widespread over time; (iv) Reformulated OxyContin®'s attractiveness on the illicit market; and (v) sales, prescriptions and harms related to OxyContin® and other drugs. METHODS There are three major components. First, analyses of existing routine data sources such as: pharmaceutical sales; prescribing data; data on drug overdose deaths; and survey data on drug use in the general population and among people who inject drugs; secondly, specific data on OxyContin® collected through the Illicit Drug Reporting System; and thirdly, a prospective cohort of n = 606 people who regularly misuse or tamper with pharmaceutical opioids was formed prior to the introduction of Reformulated OxyContin®, followed-up twice post-release to examine potential changes after Reformulated OxyContin®'s introduction. DISCUSSION The study's strengths lie in varied data collections; interrupted time-series analysis; and prospective cohort. To our knowledge, this is one of the most comprehensive and transparently conducted studies conducted to date of the potential impact of an opioid medication upon use, tampering and diversion. Results have the potential to inform policymakers, clinicians, consumers and researchers alike.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
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Cone EJ, DePriest AZ, Heltsley R, Black DL, Mitchell JM, LoDico C, Flegel R. Prescription Opioids. III. Disposition of Oxycodone in Oral Fluid and Blood Following Controlled Single-Dose Administration. J Anal Toxicol 2015; 39:192-202. [DOI: 10.1093/jat/bku176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Gould HJ, Paul D. Hydrocodone extended-release: Pharmacodynamics, pharmacokinetics and behavioral pharmacology of a controversy. Pharmacol Res 2015; 91:99-103. [DOI: 10.1016/j.phrs.2014.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 01/30/2023]
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An update on oxycodone: lessons for death investigators in Australia. Forensic Sci Med Pathol 2014; 11:3-12. [DOI: 10.1007/s12024-014-9624-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
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Beauchamp GA, Winstanley EL, Ryan SA, Lyons MS. Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic. Am J Public Health 2014; 104:2023-9. [PMID: 25211712 PMCID: PMC4202970 DOI: 10.2105/ajph.2014.302147] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/04/2022]
Abstract
An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible.
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Affiliation(s)
- Gillian A Beauchamp
- Gillian A. Beauchamp, Shawn A. Ryan, and Michael S. Lyons are with the Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH. Erin L. Winstanley is with Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine and the James L. Winkle College of Pharmacy, University of Cincinnati
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47
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The US FDA Draft Guidance for Developing Abuse-Deterrent Opioid Analgesics: 2014 and Beyond. Pharmaceut Med 2014. [DOI: 10.1007/s40290-014-0067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sessler NE, Downing JM, Kale H, Chilcoat HD, Baumgartner TF, Coplan PM. Reductions in reported deaths following the introduction of extended-release oxycodone (OxyContin) with an abuse-deterrent formulation. Pharmacoepidemiol Drug Saf 2014; 23:1238-46. [PMID: 24916486 PMCID: PMC4282788 DOI: 10.1002/pds.3658] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 05/01/2014] [Accepted: 05/12/2014] [Indexed: 11/08/2022]
Abstract
Purpose Abuse of opioid analgesics for their psychoactive effects is associated with a large number of fatalities. The effect of making opioid tablets harder to crush/dissolve on opioid-related fatalities has not been assessed. The objective of this study was to assess the impact of introducing extended-release oxycodone (ERO [OxyContin®]) tablets containing physicochemical barriers to crushing/dissolving (reformulated ERO) on deaths reported to the manufacturer. Methods All spontaneous adverse event reports of death in the US reported to the manufacturer between 3Q2009 and 3Q2013 involving ERO were used. The mean numbers of deaths/quarter in the 3 years after reformulated ERO introduction were compared with the year before. Changes in the slope of trends in deaths were assessed using spline regression. Comparison groups consisted of non-fatal reports involving ERO and fatality reports involving ER morphine. Results Reports of death decreased 82% (95% CI: −89, −73) from the year before to the third year after (131 to 23 deaths per year) reformulation; overdose death reports decreased 87% (95% CI: −93, −78) and overdose deaths with mention of abuse-related behavior decreased 86% (95% CI:−92, −75). In contrast, non-fatal ERO reports did not decrease post-reformulation, and reported ER morphine fatalities remained unchanged. The ratio of ERO fatalities to all oxycodone fatalities decreased from 21% to 8% in the year pre-reformulation to the second year post-reformulation. Conclusions These findings, when considered in the context of previously published studies using other surveillance systems, suggest that the abuse-deterrent characteristics of reformulated ERO have decreased the fatalities associated with its misuse/abuse. © 2014 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Nelson E Sessler
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, CT, USA
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