Background Tapentadol is a molecule incorporating mu opioid receptor agonism and norepinephrine reuptake inhibition to provide analgesia, with the potential for a lower incidence of gastrointestinal side effects than full mu opioid agonists. Postmarketing surveillance of tapentadol as an active pharmaceutical ingredient has consistently revealed low levels of abuse and diversion. Objective The purpose of the present study was to further characterize the abuse liability of tapentadol extended-release (ER) by evaluating the prevalence of past 30-day tapentadol ER abuse and reported routes of administration as compared with ER opioids with Food and Drug Administration (FDA) abuse-deterrent labeling (“ADF opioids”) and ER opioids without FDA abuse-deterrent labeling (“non-ADF opioids”). Methods Data were collected from January 2014 through December 2017 from 776 centers located in 43 states throughout the United States using the Addiction Severity Index–Multimedia Version (ASI-MV), an instrument that is integral to the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO, Inflexxion, an IBH Company, Costa Mesa, CA, USA). Results Tapentadol ER had lower rates of past 30-day abuse than ADF ER and non-ADF ER opioid comparators, both at a population level and when adjusted for drug utilization. Tapentadol ER was primarily abused orally, although it was also abused through alternate routes of administration. Cumulative rates of tapentadol ER abuse by alternative routes of administration were lower than both ADF and non-ADF ER opioid comparators, although large confidence intervals resulting from the small sample size of reported tapentadol ER use limit firm conclusions. Conclusions In summary, tapentadol ER was found to have lower rates of both past 30-day abuse and use via alternate routes of administration, specifically snorting and smoking, than ADF and non-ADF ER comparators.
Background The prevalence of abuse, diversion, and web-based endorsement of tapentadol (extended-release [ER], immediate-release [IR]) has been characterized as low compared with other prescription opioids. Little is known about individual experience with tapentadol nonmedical use (NMU). Objective This study aims to pilot web-based survey technologies to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used, and impressions of tapentadol products (Nucynta and Nucynta ER). Methods Recruitment flyers and banner advertisements were placed on the Bluelight website [DragonByte Technologies Ltd] with a link to a web-based survey (Qualtrics) designed to query about individuals’ lifetime tapentadol NMU. This web-based survey was followed by an interactive web-based chat (Cryptocat) with respondents who were willing to be contacted. Respondents were queried about sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued or discontinued use. Desirability and attractiveness for NMU was rated. Results Web-based recruitment successfully attracted difficult-to-find study participants. A total of 78 participants reported that tapentadol was obtained from friends and family (ER 11/30, 37%; IR 18/67, 27%), the internet (ER 11/30, 37%; IR 12/67, 18%) or participants’ own prescriptions from a doctor (ER 9/30, 30%; IR 17/67, 25%). It was used nonmedically for pain relief (ER 18/30, 60%; IR 33/67, 49%) and multiple psychotropic effects, including relaxation (ER 13/30, 43%; IR 29/67, 43%), reduction in depression or anxiety (ER 7/30, 23%; IR 30/67, 45%), or getting high (ER 12/30, 40%; IR 33/67, 49%). Tapentadol was primarily swallowed (ER 22/30, 73%; IR 55/67, 82%), although snorting (ER 2/30, 7%; IR 8/67, 12%) and injection (ER 2/30, 7%; IR 5/67, 8%) were also reported. The preferred dose for NMU was 100 mg (both ER and IR). The participants reported tapentadol use with benzodiazepines (ER 12/21, 57%; IR 28/47, 60%). Most participants had discontinued tapentadol NMU at the time of survey completion (ER 22/30, 73%; IR 55/67, 82%). Reasons for discontinued ER NMU included side effects (10/22, 46%) and lack of effective treatment (10/22, 46%). Reasons for discontinued IR NMU included lack of access (26/55, 47%) and better NMU options (IR 21/55, 38%). Few individuals were willing to divulge identifying information about themselves for the interactive chat (8/78, 10%), demonstrating the strength of anonymous, web-based surveys. Interactive chat supported the survey findings. A subgroup of participants (4/78, 5%) reported hallucinogenic side effects with high doses. Conclusions Web-based surveys can successfully recruit individuals who report drug NMU and those who are difficult to find. Tapentadol NMU appears to occur primarily for pain relief and for its psychotropic effects. Although it was liked by some, tapentadol did not receive a robust pattern of endorsement for NMU.
This study examined patterns of hydrocodone combination product (HCP) abuse and their potential role in abuse progression of prescription opioids and other drugs. An Internet survey was administered to 472 adult opioid users in the United States who used HCPs nonmedically. Alternate routes (33%) and concomitant drug use (45%) were indicated more frequently during respondent’s most recent HCP nonmedical use compared with their initial use (20% and 24%, respectively). Those initiating HCP nonmedical use during adolescence used alternate routes (e.g., chewing, snorting) throughout their lifetime more frequently (69.5%) compared with those older when initiating HCP nonmedical use (51.0%). A different abuse pattern was observed from first to most recent HCP use, starting with oral administration of intact tablets followed by use of alternate routes and concomitant use of illicit drugs, sometimes use of heroin. These data may inform future public health interventions, including the potential development of abuse-deterrent immediate-release opioids.
BACKGROUND The prevalence of abuse, diversion and even online endorsement of tapentadol (extended-release [ER] and immediate-release [IR]) has been characterized as low compared to other prescription opioids. However, little has been published about the experience of tapentadol non-medical use (NMU). OBJECTIVE To address this gap, the present study sought to pilot online survey technologies, specifically, the programs Qualtrics and Cryptocat, to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used and impressions of tapentadol products (Nucynta® and Nucynta ER®). METHODS A recruitment flyer and banner advertisement were placed on the Bluelight.org website with a link to an online survey (Qualtrics) designed to identify and query individuals about their lifetime tapentadol NMU. This web-based survey was followed by an interactive, online chat (Cryptocat) with survey participants who were willing to be contacted. Participants were queried about: sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued/discontinued use; desirability/attractiveness for NMU was rated. RESULTS Web-based, online recruitment successfully attracted difficult-to-find study participants. Participants (n=78) reported that tapentadol was obtained from friends and family (ER=36.7%, IR=26.9%), the internet (ER=36.7%, IR=17.9%) or participants’ own prescriptions from one doctor (ER=30.0%, IR=25.4%). It was used non-medically for pain relief (ER=60.0%, IR=49.3%) and multiple psychotropic effects including relaxation (ER=43.3%, IR=43.3%), reduction in depression or anxiety (ER=23.3%, IR=44.8%), or getting high (ER=40.0%, IR=49.3%). Tapentadol was primarily swallowed whole (ER=73.3%, IR=82.1%), although snorting (ER=6.7%, IR=11.9%) and injecting (ER=6.7%, IR=7.5%) were reported. Preferred dose strength for NMU was 100 milligrams (both ER and IR). Participants reported tapentadol use with benzodiazepines (ER=57.1%, IR=59.6%). Most participants had discontinued tapentadol NMU by the time of survey completion (ER=73.3%, IR=82.1%). Reasons for discontinued ER use included side effects (45.5%) and lack of effective high (45.5%). Reasons for discontinued IR use included lack of access (47.3%) and better NMU options (IR=38.2%). Far fewer individuals were willing to divulge any identifying information about themselves for the interactive chat (n=8), demonstrating the strength of anonymous, web-based surveys. The interactive chat largely supported the survey findings. A subgroup of participants (n=4) reported hallucinogenic side effects at high doses. CONCLUSIONS Web-based, online surveys can successfully recruit individuals who report drug NMU, and those who are particularly difficult to find. In this pilot study, tapentadol NMU appeared to occur primarily for pain relief or psychotropic effects. Even though it was liked by some, this study did not find that tapentadol received a robust pattern of endorsement for NMU. CLINICALTRIAL N/A
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