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.
Tapentadol immediate-release (NUCYNTA) was launched in June 2009 with the extended-release product (Nucyntaâ ER) released in August 2011. Tapentadol is a centrally-acting analgesic with mopioid receptor agonistic and norepinephrine reuptake inhibition activities. In an effort to deter abuse, particularly through unintended routes of administration, the extended-release tablets were manufactured using Intacâ technology to be difficult to crush for intranasal abuse and difficult to solubilize for intravenous abuse. Cases classified in the Intentional Exposure category in the Poison Center Program of the Research Abuse, Diversion, and Addition-Related Surveillance (RADARSâ) System were analyzed and used to test whether the proportion of cases reporting use via injection or inhalation is lower for extended-release tapentadol than for immediate release (IR) tapentadol. Between the launch of the extended-release product and June 2015, there were 303 Intentional Exposures involving ER tapentadol and 217 Intentional Exposures involving IR tapentadol. Of the 303 ER tapentadol intentional exposures, 178 (58.8%) were classified as Suspected Suicides and 47 (15.5%) were Intentional Abuse exposures. Of all ER tapentadol exposures, 5 (1.7%) of the 303 exposures reported use via injection or inhalation, all of which were Intentional Abuse exposures. Of the 217 IR tapentadol cases classified as Intentional Exposure, 55.8% were Suspected Suicide exposures and 14.3% were Intentional Abuse exposures. Ten (4.6%) of these exposures reported use via injection or inhalation. Of these, 8 were Intentional Abuse exposures, 1 was Suspected Suicide, and 1 was Intentional Misuse. The proportion of tapentadol ER exposures mentioning injection or inhalation use is significantly lower than the proportion of IR tapentadol exposures (c 2 =3.95, p=0.047). Though intentional exposures still exist, extended-release tapentadol is associated with fewer incidents of injection or inhalation use in cases reported to the RADARS System poison centers.
had > 2 opioid prescriptions, we identified beneficiaries with high-dose use (> 120 daily morphine milligram equivalents for ≥ 90 consecutive days) and multiple providers (≥ 4 prescribers and ≥ 4 pharmacies) each year; and concurrent benzodiazepine use (≥ 30 cumulative days) from 2013-2015 when Part D began coverage for benzodiazepines. We obtained adjusted annual rates of high-risk measures across 306 hospital referral regions (HRRs) using multivariable logistic regression and examined the association between these measures and overdose risk(claimbased) in the subsequent year using Cox proportional regression, adjusting for sociodemographic, health status, and access-to-care factors. ReSultS: Adjusted annual rates of high-dose use (~9%), having multiple providers(~5%), and concurrent benzodiazepine use (~34%) remained stable over five years. In 2015, the ratio of 75th-to-25th percentile rates of high-risk measures across HRRs were 1.80 for high-dose use, 1.87 for having multiple providers, and 1.33 for concurrent benzodiazepine use. The top 3 HRRs with the highest rate of: high-dose use were Sarasota, FL(17.2%), Sun City, AZ(17.2%) and Clearwater, FL(16.9%); multiple providers were Slidell, LA(14.0%), Muskegon, MI(12.5%), and Bryan, TX(12.0%); and concurrent benzodiazepine use were Dearborn, MI(58.0%), Miami, FL(55.4%), and Spartanburg, SC(55.1%). These measures were associated with subsequent overdose risk for high-dose (hazard ratio [HR]= 2.19, 95%CI= 1.86-2.57); multiple providers (HR= 1.58,; and concurrent benzodiazepine use (HR= 1.82, 95%CI= 1.58-2.10). ConCluSionS: High-risk opioid use measures were associated with overdose risk among disabled Medicare beneficiaries. Areas and individuals with prevalent high-risk opioid use may benefit from targeted interventions (e.g.,lock-in programs) to prevent overdose. MH4
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