Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study (Preprint)

Abstract

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