Pharmaceutical drug abuse has emerged as a fast-growing global problem that is largely driven by misuse of opioid analgesics.1 Tampering can take the form of breaking, crushing, chewing, or pulverizing slow-release opioid tablets, accelerating the release of larger doses, says Briony Larance, PhD, from the National Drug & Alcohol Research Centre at the University of New South Wales in Sydney, Australia.
“Sometimes [tampering] is done to make tablets easier to swallow, but this may also be done so that the tablet can be taken via an unintended route of administration (such as dissolving and drinking, snorting, smoking, or injecting) and/or to enhance the euphoric effects of the opioid. These practices can place people at risk of a range of adverse effects,” Dr. Larance told Clinical Pain Advisor.
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Although the majority of pain patients do not progress to this kind of abuse, not all individuals are completely adherent either, notes Steven D. Passik, PhD, vice president of clinical research and advocacy at Millennium Health in San Diego, California.
“One of the things that makes this whole area complex is that there are patients somewhere in the middle between adherent and addicted, who engage in less dramatic but sometimes equally dangerous forms of overuse of intact oral medicines when their pain flares or they have a hard time dealing with stressors,” Dr. Passik told Clinical Pain Advisor, noting that such behavior can also lead to overdose.
“In the world of trying to develop safer opioids, the problem of taking large amounts of intact pills is [also] a major problem, [whether] the person is overusing for pain relief or simply abusing but hasn’t ‘progressed’ to altering the drug,” Dr. Passik said.
The NOMAD Study: Early Findings
In April 2014, a new tamper-resistant tablet formulation of controlled-release oxycodone (Reformulated OxyContin, made by Purdue Pharma, LP) was released in Australia. The National Opioid Medications Abuse Deterrence (NOMAD) study was established determine whether the new tablets had any effect on opioid misuse, abuse, and diversion.2
In a NOMAD subanalysis published in the November 2015 issue of the Journal of Substance Abuse Treatment, Dr. Larance and colleagues examined patterns of opioid use among patients with a history of pharmaceutical tampering, primarily by injecting tablets intended for oral consumption. Participants reported obtaining various pharmaceutical opioids from a range of different sources, both prescribed by a doctor and diverted from other sources.3