Tamper-resistant oxycodone does not affect overall opioid use, harm
Although a formulation of tamper-resistant, controlled-release oxycodone tablets reduced misuse of pharmaceutical opioids among people who inject drugs, they did not impact population-level opioid use or harm, according to research published in Lancet Psychiatry.
“Links have ... been made between the introduction of the tamper-resistant formulation of controlled-release oxycodone in the U.S.A. and increases in heroin use and harm,” Briony Larance, PhD, from the National Drug and Alcohol Research Centre at the University of New South Wales, Australia, and colleagues wrote. “It is difficult to attribute positive or negative changes in extra-medical use and opioid-related harm to the introduction of tamper-resistant formulation of controlled-release oxycodone in the U.S.A. because of the multitude of government-initiated responses to the pharmaceutical opioid problem that occurred during the same period.”
In 2014, a potentially tamper-resistant formulation of controlled-release oxycodone was introduced in Australia. In this study, researchers examined the impact of this formulation on population-level opioid use and opioid-related harm — overdose, help-seeking, and treatment-seeking. They analyzed opioid sales data; multiple routinely collected health datasets; follow-up data on 606 users of pharmaceutical opioids, who reported tampering with the drugs, before and after the introduction the oxycodone formulation; and annual surveys of people who inject drugs.
Larance and colleagues found that the introduction of tamper-resistant oxycodone was linked to a reduction in use among people who tampered with the tablets to inject opioids. Analyses showed a reduction in the sales of high-strength controlled-release oxycodone and an increase in the sales of other oxycodone formulations at the population-level; however, there was no significant effect among opioid overdose, help or treatment-seeking at the population level.
"Tamper-resistant oxycodone was effective in reducing the levels of oxycodone use and injection among high risk groups of people who inject drugs,” Larance said in an interview. “However, the vast majority of people exposed to opioids in Australia are prescribed them and do not inject drugs. As a strategy to address population-level issues such as overprescribing, overuse and harm of opioids taken via their intended route of administration, tamper-resistant formulations will have limited impact.”
Meta-analyses results showed a drop in controlled-release oxycodone use through tampering, particularly injection, with no evidence of switching to heroin or of other drug use. Furthermore, opioid use progressively increased before and after the introduction of the tablets at a similar rate.
“Tamper-resistant formulations comprise one small component of a suite of strategies that are needed in response to the opioid problem. Good clinical practice that minimizes unnecessary exposure to opioids and maximizes the health outcomes among people in long-term opioid treatment is important, including physician and patient education, careful patient selection, monitoring and multidisciplinary approaches to the treatment of pain,” Larance told Healio Psychiatry. “We also need enhanced approaches to the treatment of chronic pain and comorbidity, more attractive and accessible treatments for opioid use disorders, and more targeted harm reduction strategies such as scaling-up the provision of take-home naloxone for people using both prescribed and illicit opioids.”
In a related comment, Nabarun Dasgupta, PhD, MPH, from the Injury Prevention Research Center and Eshelman School of Pharmacy at University of North Carolina, Chapel Hill, wrote, “Drug use has been long recognized to be an interaction between drug, individual-level influences, and social context. ... [This] study leads us to consider whether abuse deterrence is an inherent property of the drug itself, or its intended effect lies in an interaction with social context.” – by Savannah Demko
Disclosures: Larance reports support from National Health and Medical Research Council fellowships, and has received investigator-initiated untied educational grants from Reckitt Benckiser/Indivior and an untied educational grant from Seqirus for studies of tapentadol. Please see the study for other authors’ relevant financial disclosures. Dasgupta is a part-time employee of the RADARS System.