Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone

Severtson, Stevan G.; Ellis, Matthew S.; Kurtz, Steven P.; Rosenblum, Andrew; Cicero, Theodore J.; Parrino, Mark W.; Gilbert, Michael; Buttram, Mance E.; Dasgupta, Nabarun; Bucher-Bartelson, Becki; Green, Jody L.; Dart, Richard C.

doi:10.1016/j.drugalcdep.2016.09.018

Cited by 44 publications

(47 citation statements)

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“…[24] Data from the website StreetRx.com, where users enter the price paid for drugs purchased on the street, show that IR oxycodone has a typical street price 30–35% higher per milligram than ER oxycodone as of 2015. [25]…”

Section: Discussionmentioning

confidence: 99%

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

et al. 2016

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BackgroundTherapeutic use and abuse of prescription opioids in the United States increased substantially between 1990 and 2010. The Centers for Disease Control estimated deaths related to pharmaceutical opioids reached nearly 19,000 in 2014. Of prescription opioids sold, 10% are extended release (ER) and 90% immediate release (IR). However, most regulations and interventions have focused on decreasing ER abuse. Our objective was to compare rates of abuse and diversion of ER and IR opioid analgesics over time using multiple surveillance programs.MethodsRates of abuse and diversion of ER and IR opioid formulations were compared using data from four surveillance programs in the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS®) System. Data were evaluated from 2009 through 2015, and Poisson regression used to compare IR and ER opioid cases over time.ResultsFrom 2009 to 2015, IR opioids were prescribed at a rate 12 to 16 times higher than ER. In the Poison Center Program, population-adjusted rates of Intentional Abuse for IR were 4.6 fold higher than ER opioids (p<0.001). In the Drug Diversion Program, population-adjusted rates of diversion were 6.1 fold higher for IR than ER opioids (p<0.001). In the Opioid Treatment Program, population-adjusted rates of endorsements for abuse were 1.6 fold higher for IR opioids than ER (p = 0.002). In the Survey of Key Informants' Patients Program, population-adjusted rates of endorsements for abuse were 1.5 fold higher for IR opioids than ER (p<0.001).ConclusionsBetween 2009 and 2015, IR opioids were prescribed at a much higher rate than ER opioids. Results from four surveillance programs show population-adjusted rates of prescription opioid abuse were markedly higher for IR than ER medications. For the greatest public health benefit, future interventions to decrease prescription opioid abuse should focus on both IR and ER formulations.

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Section: Discussionmentioning

confidence: 99%

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

et al. 2016

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“…Even opioids reformulated as crush-resistant tablets are still being manipulated before ingestion [3]. Despite sustained reductions in abuse and diversion of OxyContin in the first 5 years since its introduction [16], particularly for abuse via nonoral routes (e.g., injection, snorting) [3], oral abuse of OxyContin is still reported [3,7]. In a survey of oral abusers, 42% reported manipulation (e.g., chewing, dissolving in mouth) of crush-resistant tablet formulations prior to oral administration [3].…”

Section: Discussionmentioning

confidence: 99%

The Comparative Pharmacokinetics of Physical Manipulation by Crushing of Xtampza ^® ER Compared with OxyContin ^®

Brennan¹,

Kopecky

Marseilles

et al. 2017

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Aim:To further characterize the pharmacokinetics of Xtampza R ER. Subjects & methods:This was an openlabel, randomized, active-controlled, five-treatment, five-period, naltrexone-blocked, cross-over study. Healthy subjects received five equivalent oxycodone doses: Xtampza ER (intact or crushed), OxyContin R (intact or crushed) or immediate-release (IR) oxycodone (crushed). Blood samples were collected to assess oxycodone concentrations. Results: Crushed and intact Xtampza ER resulted in lower peak plasma concentrations compared with crushed oxycodone IR; crushed and intact Xtampza ER were bioequivalent. Crushed OxyContin exhibited a rapid increase in plasma oxycodone and was bioequivalent to crushed oxycodone IR. Conclusion: This second pharmacokinetic study demonstrated that Xtampza ER maintains its ER properties after crushing, unlike OxyContin, which failed to retain its ER properties after crushing.

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“…All patients with suspected substance use disorders should be referred for specialized care. Additional treatment considerations include utilization of crush‐resistant medications and mucosal analgesics …”

Section: Discussionmentioning

confidence: 99%

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

et al. 2017

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Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone

Abstract: Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.

Cited by 44 publications

References 18 publications

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

The Comparative Pharmacokinetics of Physical Manipulation by Crushing of Xtampza ^® ER Compared with OxyContin ^®

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

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Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone

Abstract: Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.

Cited by 44 publications

References 18 publications

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States

The Comparative Pharmacokinetics of Physical Manipulation by Crushing of Xtampza ® ER Compared with OxyContin ®

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review

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The Comparative Pharmacokinetics of Physical Manipulation by Crushing of Xtampza ^® ER Compared with OxyContin ^®