Opioid Abuse Drops, Then Levels Off
About a third of patients successfully defeated the abuse-deterrence mechanism.
Making an abuse-deterrent formulation of OxyContin (oxycodone ) diminished abuse in the short term, but the reductions eventually hit a plateau, researchers found.
In a survey of patients being treated for opioid abuse, there was a significant reduction in past-month OxyContin abuse after the abuse-deterrent formulation came on the market (45% versus 26%, P<0.001), according to Theodore Cicero, PhD, and Matthew Ellis, MPE, of Washington University in St. Louis, Mo.
But the decline eventually plateaued, remaining in the range of 25% to 30% a few years thereafter, they reported online in JAMA Psychiatry.
Cicero said the findings imply that while supply-side issues are important, addressing only these “will not solve the opioid abuse problem unless efforts are made to reduce the demand for these drugs.”
When it was introduced in the mid-1990s, extended-release OxyContin was marketed as harder to abuse because of its timed-release technology. But those set on abusing the drug were able to foil that mechanism and release all of the opioid at once.
More than a decade later, in 2010, OxyContin maker Purdue Pharma replaced its original drug with an abuse-deterrent formulation that made it harder to crush or dissolve the drug, with the hope that it might reduce abuse.
Early work showed that the new formulation did reduce abuse in the short term. But to track longer-term trends, Cicero and colleagues looked at data from the Survey of Key Informants’ Patients (SKIP) program, which is part of the RADARS surveillance system.
It included 10,784 patients who’d been diagnosed with opioid use disorder and subsequently admitted to a drug treatment program. These patients completed an anonymous survey of opioid abuse patterns from January 2009 to June 2014, and there was an 82% response rate.
The survey showed that the reformulation was associated with a significant reduction in past-month abuse (45% in January to June 2009 versus 26% in July to December 2012, P<0.001), which was tied to a migration to other opioids, particularly heroin, Cicero said.
But the reduction eventually leveled off — from 2012 to 2014, about 27% of patients reported past-month abuse of OxyContin.
In more in-depth interviews, the researchers found that the plateau reflects three trends. First, 43% of patients reported transitioning from non-oral routes of administration to oral use.
About a third of patients successfully defeated the abuse-deterrent mechanism and were able to continue inhaling or injecting the drug.
The FDA has long been trying to address questions about the role of abuse-deterrent technologies with opioids. It released a draft guidance in January 2013 and held a 2-day meeting last fall on that guidance. It’s still not clear when the final rules will be released.
The study implied that even though abuse-deterrent formulations curtail abuse to an extent “their effectiveness has clear limits, resulting in a significant level of residual abuse,” he wrote. Thus, he called for efforts not only on the supply side of the issue, but on the demand side.
That includes better educational efforts to prevent abuse in the first place, along with better access to treatment programs, the authors wrote.
Cicero disclosed serving as consultant on the scientific advisory board for RADARS, which is funded through a grant from the Denver Health and Hospital Authority that collects subscription fees from 14 pharmaceutical companies.
Ellis disclosed no relevant relationships with industry.
Filed under: General Problems
Its been a while since someone has asked me… “hey, man. you got any OC’s? I’m allergic to OP’s.” yeah, good times.