No Overall Dip in Opioid Abuse With Reformulated Oxycodone

Laird Harrison

September 13, 2012

September 13, 2012 (Las Vegas, Nevada) — The introduction of a tamper-resistant formulation of controlled-release oxycodone hydrochloride (OxyContin, Purdue) may have prompted abusers to switch to other prescription opioids, a new study suggests.

Overall abuse of opioids remained fairly constant after August 2010 when Purdue Pharma of Stamford, Connecticut, introduced a formulation of OxyContin that is more difficult to snort, smoke, chew, and inject, researchers report.

"What we are seeing is a shift toward abuse of certain products," first author Theresa A. Cassidy, MPH, director of scientific development at the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO), told Medscape Medical News.

The researchers' results were presented here at PAINWeek, a conference for pain specialists.

Other Opioids

Purdue researchers reported previously that abuse of their product has declined after the reformulation.

To see what happened with other opioids, Cassidy and colleagues from Inflexxion, a drug abuse research center in Newton, Massachusetts, collected data from a sample of adults assessed for substance abuse at centers in the United States by using NAVIPPRO.

The Inflexxion researchers reviewed data from 122,606 individuals from 347 facilities and 32 states from July 1, 2009, through December 31, 2011. They made quarterly estimates of substance abuse within the past 30 days among the total study sample.

For prescription opioids, they defined abuse as any nonmedical use of a prescription opioid product.

They found that proportion of those surveyed who were abusing extended-release prescription opioids increased from 10.21% before the introduction of the tamper-resistant formulation to 12.30% afterward (R2 = 0.5978).

They also found an increase in single-entity immediate-release oxycodone from 1.79% before the tamper-resistant product was introduced to 2.56% afterward.

Abuse of original oxymorphone extended release increased from 0.33% to 1.01%.

They also documented increases in other opioids by specific routes of administration. For abuse via injection, abuse of single-entity oxycodone immediate release increased by 22.4% (P < .0001). Abuse of original oxymorphone extended release increased by 11.0% (P < .0001) in this population.

Among those who snort prescription opioids, abuse of single-entity oxycodone immediate release increased 18.0% (P < .0001) and original oxymorphone extended release increased 9.4% (P < .0001).

The researchers found no change in abuse for morphine extended-release products or illegal substances, such as heroin, cocaine, and amphetamine. Another recent study, however, suggested that introduction of the tamper-resistant formulation of oxycodone was accompanied by a surge in the use of heroin in the same time period.

Consistent Findings

This study's findings were consistent with some other papers presented at the same meeting and came as no surprise to Mel Pohl, MD, medical director of the Las Vegas Recovery Center in Nevada, who specializes in treating people with both pain and addiction.

"This really underlines the bigger problem," he told Medscape Medical News. "If addicts want to use drugs and if they can't use one, they will find another. That's what in my clinical practice has happened."

Making drugs harder to abuse is only one of the measures that must be taken to address the problem, he said. Other steps include reducing the supply, law enforcement, prescription monitoring, and treating drug addiction.

In his own center, Dr. Pohl uses alternatives to pharmaceuticals such as counseling, massage, yoga, and physical therapy to treat patients' pain.

Ms. Cassidy is an employee of Inflexxion, which contracts with pharmaceutical companies. Dr. Pohl has disclosed no relevant financial relationships.

PAINWeek. Abstract 5. Presented September 6, 2012.