Changes in Prevalence of Prescription Opioid Abuse after Introduction of an Abuse-Deterrent Opioid Formulation

Cassidy, Theresa A.; DasMahapatra, Pronabesh; Black, Ryan A.; Wieman, M.; Butler, Stephen F.

doi:10.1111/pme.12295

Cited by 76 publications

(51 citation statements)

References 25 publications

(40 reference statements)

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“…However, in 2011, the dispensing of opioids declined sharply, driven by new national opioid dispensing guidelines (NOUGG, 2010), and by the delisting of OxyContin from most provincial drug formularies in 2012 (INCB, 2013). Despite these changes, some research suggests that abuse of prescription opioids as a class has not decreased, but instead shifted to other prescription opioids such as extended-release oxymorphone (Cassidy et al, 2014). …”

Section: Discussionmentioning

confidence: 99%

Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Mitra

Wood

Nguyen

et al. 2015

Drug and Alcohol Dependence

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Background Non-fatal drug overdose is a major cause of morbidity among people who use drugs, although few studies have examined this risk among street-involved youth. We sought to determine the risk factors associated with non-fatal overdose among Canadian street-involved youth who reported illicit drug use. Methods Using data from a prospective cohort of street-involved youth in Vancouver, Canada, we identified youth without a history of overdose and employed Cox regression analyses to determine factors associated with time to non-fatal overdose between September 2005 and May 2012. Results Among 615 participants, 98 (15.9%) reported a non-fatal overdose event during follow-up, resulting in an incidence density of 7.67 cases per 100 person-years. In multivariate Cox regression analyses, binge drug use (adjusted hazard ratio [AHR] = 1.85; 95% confidence interval [CI] = 1.20 – 2.84), non-injection crystal methamphetamine use (AHR = 1.70; 95% CI = 1.12 – 2.58), non-injection prescription opiate use (AHR = 2.56; 95% CI = 1.36 – 4.82), injection prescription opiate use (AHR = 2.49; 95% CI = 1.40 – 4.45) and injection heroin use (AHR = 1.85; 95% CI = 1.14 – 3.00) were positively associated with time to non-fatal overdose. Social, behavioural and demographic factors were not significantly associated with time to non-fatal overdose event. Conclusions Rates of non-fatal overdose were high among street-involved youth. Drug use patterns, in particular prescription opiate use, were associated with overdose. These findings underscore the importance of addiction treatment and prevention efforts aimed at reducing the risk of overdose among youth.

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Section: Discussionmentioning

confidence: 99%

Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Mitra

Wood

Nguyen

et al. 2015

Drug and Alcohol Dependence

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“…However, these benefits have been accompanied by a significant increase in abuse of other opioids, most notably heroin, in some studies. [112,[116][117][118]122] Epidemiological data showing the potential impact of other abuse-deterrent opioid analgesic formulations on rates of prescription opioid abuse and diversion are not yet available.…”

Section: Differences In Routes Of Abuse Between Populationsmentioning

confidence: 99%

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Gąsior

Bond

Malamut

2015

Postgraduate Medicine

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Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking and vaping) and injection. However, reported routes of abuse vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations 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 even aversive. There are currently five opioid analgesics with a Food and Drug Administration abuse-deterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.

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“…Because IR/ER OC/APAP is a unique, original analgesic, epidemiologic comparisons with marketed opioids will be more complicated than for OC CR and oxymorphone ER, which were bioequivalent reformulations of marketed products. It is also important to note that the reformulation of ER OC to resist crushing and extraction was followed by a migration of abusers to more easily manipulated formulations, including IR single-entity OC and IR FDC OC tablets 37,38 . Thus, as stipulated by the FDA, extensive postmarketing data will ultimately be required to demonstrate whether IR/ER OC/APAP tablets have less potential for abuse than IR OC/APAP tablets now that IR/ER OC/APAP has become commercially available.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the tamper-resistant properties of biphasic immediate-release/extended-release oxycodone/acetaminophen tablets

Eisenhauer

Matchett

Heasley

et al. 2015

Drug Development and Industrial Pharmacy

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Changes in Prevalence of Prescription Opioid Abuse after Introduction of an Abuse-Deterrent Opioid Formulation

Cited by 76 publications

References 25 publications

Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Evaluation of the tamper-resistant properties of biphasic immediate-release/extended-release oxycodone/acetaminophen tablets

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