“This [cohort] is particularly important from a public health perspective, as those who are prescribed opioids have existing health service engagement, offering greater opportunity for direct harm minimization strategies,” Dr. Larance pointed out.
Although demographic and clinical characteristics varied widely, the group as a whole displayed complex patterns of alcohol, pharmaceutical opioid, and illicit drug use and dependence.
“When we looked at different groups within the cohort based on whether they were prescribed opioids and why, there were different patterns of mental and physical health and drug use profiles. For example, we observed riskier profiles among those treated with methadone or buprenorphine for opioid dependence [while] using other prescribed opioids,” Dr. Larance said.
“Clearly, there is evidence to suggest that abuse-deterrent formulations can play a role in reducing the risk of a number of indicators of use, nonadherence, diversion, and harms related to pharmaceutical opioids,” Dr. Larance stated.
“[However], diversity in patterns of opioid use and clinical profiles within the cohort suggests that introducing tamper-resistant opioid formulations, such as reformulated OxyContin, will have differential effectiveness in terms of reducing tampering and associated harms in different groups,” Dr. Larance noted.
Spotting Abuse Potential
According to Dr. Larance, long-term NOMAD data will help clinicians spot the characteristics of individuals who tamper with opioid medications — specifically, how they source opioid medications, their patterns of use, and different risk profiles within the cohort.
“Future research utilizing data from this cohort will inform clinicians about the opioid use trajectories among people who tamper with opioids, the impacts of the reformulated oxycodone product introduced in Australia, and clinical outcomes over time,” Dr. Larance said.
Asked about the impact of tamper-resistant drug formulations, Dr. Pasik pointed out that addicted individuals who use prescription opioids (exclusively or in part) represent a highly diverse population often affected by comorbidities, such as serious mental illness.
“I think [that] if clinicians are going to try to help these people, they need to be ready to offer complex and multimodal treatments to this very complex patient group — delivery systems alone will not solve these problems,” Dr. Passik said.
“Approaching complex people [who have] pain, mental health issues, and drug abuse [issues] with humanity, sound clinical judgment, and multiple tools is the only way forward. Abuse deterrents will be one of many facets to offering these people relief in as safe a way possible,” Dr. Passik concluded.