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Change in prescription opioid abuse after introduction of an abuse deterrent formulation

Theresa A. Cassidy, MPH, Emily C. McNaughton, MPH , Stephen F. Butler, PhD, Simon H. Budman, PhD

Presented at PAINWeek 2012

See our poster for “Change in prescription opioid abuse after introduction of an abuse deterrent formulation” here

Abstract

OBJECTIVE:

The reformulation of oxycodone hydrochloride controlled-release (CR) tablets in August 2010 created a natural experiment at a national scale, providing an opportunity to evaluate patterns of abuse of prescription opioids and other drugs before and after introduction of this abuse-deterrent formulation (ADF).

DESIGN:

Observational, cross-sectional study

SETTING:

Sentinel sample of adults assessed for substance abuse treatment within the NAVIPPRO® surveillance system

SUBJECTS:

Two hundred thirty-two thousand and eight hundred seventy-four adults at 437 facilities during January 1, 2008 through December 31, 2011.

METHODS:

Time-series analysis using logistic regression to estimate quarterly prevalence of past 30-day abuse (adjusted for covariates and prescription volume) and changes in abuse pre-and post-ADF introduction.

RESULTS:

Increases in abuse prevalence occurred for all prescription opioids as a class and for extended-release (ER) opioids. Significantly greater abuse of ER oxymorphone and buprenorphine occurred in the post-ADF period (relative risk [RR] = 2.91, 95% confidence interval [CI] = 2.59-3.27 and RR = 1.85, 95% CI = 1.74-1.96). Increases in abuse for these two compounds were significant among groups who reported abuse via preferential routes of administration (oral only, snorting only, injection only) post-ADF introduction.

CONCLUSIONS:

Replacement of a widely prescribed opioid formulation known for its abuse potential alone may have had little impact on overall rates of prescription opioids as a class. However, changes in abuse levels of certain opioids coinciding with ADF introduction suggest possible switching of abuse among this study sample to specific long-acting opioid analgesics. Additional follow-up studies will be important to monitor changing abuse patterns and their public health impact as new opioid formulations are developed and introduced to market.

See our poster for “Change in prescription opioid abuse after introduction of an abuse deterrent formulation” here