A new tamper-resistant formulation of controlled-release oxycodone may help reduce pharmaceutical opioid tampering in individuals who inject drugs, but it was not found to reduce opioid use or harm at the population level, according to study findings published in Lancet Psychiatry.
Investigators followed a cohort of individuals with a history of manipulating pharmaceutical opioid medications prior to and after the introduction of a new tamper-resistant controlled-release oxycodone formulation.
They evaluated annual surveys of an estimated 900 patients per annum who injected drugs and collected data on population-level harm associated with the use of opioids across Tasmania, South Australia, and New South Wales.
At the population level, no significant change occurred in overall pharmaceutical opioid use (P =.78) or in oxycodone use (P =.095) after the introduction of the tamper-resistant opioid formulation. Sales of controlled-release oxycodone formulations decreased (40 mg: P =.0053; 80 mg: P =.00038), and sales of other oxycodone formulations increased (P =.00032) at the population level after the introduction of the new abuse-deterrent oxycodone formulation.
The introduction of tamper-resistant controlled-release oxycodone was not associated with increases in opioid overdoses or poisoning or seeking help for opioid use. Meta-analysis on several sentinel populations indicated that introduction of the new formulation led to a reduced number of injections of any pharmaceutical opioid, oxycodone, and 80-mg controlled-release oxycodone (P <.0001 for all).
In the datasets included in this analysis, specific opioid medications were clustered, thereby preventing direct comparison among formulations. In addition, data on mortality were not available for study, limiting the determination of the full extent of benefits associated with the new opioid therapy.
Tamper-resistant opioid formulations may, ”have little effect as a strategy to address population-level issues related to overprescribing, overuse, and harm of opioid medicines taken via the intended route,” noted the investigators.
Larance B, Dobbins T, Peacock A, et al. The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study [published online January 10, 2018]. Lancet Psychiatry. doi: 10.1016/S2215-0366(18)30003-8