Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene

Abstract

IMPORTANCEIn the second half of 2010, abuse-deterrent extended-release oxycodone hydrochloride (OxyContin; Purdue Pharma) was introduced and propoxyphene was withdrawn from the US market. The effect of these pharmaceutical market changes on opioid dispensing and overdose rates is unknown.OBJECTIVE To evaluate the association between 2 temporally proximate changes in the opioid market and opioid dispensing and overdose rates. DESIGN, SETTING, AND PARTICIPANTS Claims from a large national US health insurer were analyzed, using an interrupted time series study design. Participants included an open cohort of 31.3 million commercially insured members aged 18 to 64 years between January 1, 2003, and December 31, 2012, with median follow-up of 20 months (last follow-up, December 31, 2012). EXPOSURES Introduction of abuse-deterrent OxyContin (resistant to crushing or dissolving) on August 9, 2010, and market withdrawal of propoxyphene on November 19, 2010.MAIN OUTCOMES AND MEASURES Standardized opioid dispensing rates and prescription opioid and heroin overdose rates were the primary outcomes. We used segmented regression to analyze changes in outcomes from 30 quarters before to 8 quarters after the 2 interventions.RESULTS Two years after the opioid market changes, total opioid dispensing decreased by 19% from the expected rate (absolute change, −32.2 mg morphine-equivalent dose per member per quarter [95% CI, −38.1 to −26.3]). By opioid subtype, the absolute change in dispensing by milligrams of morphine-equivalent dose per member per quarter at 2 years was −11.3 (95% CI, −12.4 to −10.1) for extended-release oxycodone, 3.26 (95% CI, 1.40 to 5.12) for other long-acting opioids, −8.19 (95% CI, −9.30 to −7.08) for propoxyphene, and −16.2 (95% CI, −18.8 to −13.5) for other immediate-release opioids. Two years after the market changes, the estimated overdose rate attributed to prescription opioids decreased by 20% (absolute change, −1.10 per 100 000 members per quarter [95% CI, −1.47 to −0.74]), but heroin overdose increased by 23% (absolute change, 0.26 per 100 000 members per quarter [95% CI, −0.01 to 0.53]). CONCLUSIONS AND RELEVANCEOpioid dispensing and prescription opioid overdoses decreased substantially after 2 major changes in the pharmaceutical market in late 2010. Pharmaceutical market interventions may have value in combatting the prescription opioid overdose epidemic, but heroin overdose rates continue to increase. Complementary strategies to identify and treat opioid abuse and addiction are urgently needed.

Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis

“…Recently, 2 large studies from the US also showed significant reductions in the quantity of long-acting oxycodone dispensed following the introduction of a tamper-deterrent formulation. 18,19 In contrast to our findings, the authors reported no corresponding rise in the quantity of other long-acting opioids dispensed. These differences may be at least partially explained by changes in the public funding of OxyNeo in Canada, which may have led more patients to switch from oxycodone to an alternative opioid.…”

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

“…[94][95][96][97][98][99] A growing body of evidence suggests that introduction of the abuse-deterrent formulation of oxycodone has been associated with decreased rates of abuse and diversion of this opioid analgesic in the USA. [101,[110][111][112][113][114][115][116][117][118][119]. Cost savings have also been reported to be associated with reductions in abuse following the introduction of the abuse-deterrent reformulation of oxycodone in the USA.…”

“…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.…”

Health Impact Assessment of the Proposed Opioid Prior Authorization Policy in the State of Utah, USA

“…Prescription drug users frequently move onto heroin, an illegal and powerful opioid, because it is much less expensive and often easier to get; studies have shown almost half of young heroin users start with abusing prescription opioids [27,28]. A study reporting the effects of introducing an abuse-deterrent opioid showed that opioid dispensing dropped 19% and prescription opioid overdoses dropped 20%; however, heroin overdose rose 23% as a result [29]. Reducing the supply of opioids without addressing their demand can result in people turning to heroin and other harmful drugs [23,29].…”

“…A study reporting the effects of introducing an abuse-deterrent opioid showed that opioid dispensing dropped 19% and prescription opioid overdoses dropped 20%; however, heroin overdose rose 23% as a result [29]. Reducing the supply of opioids without addressing their demand can result in people turning to heroin and other harmful drugs [23,29].…”