Crush-proof controlled-release oxycodone tablets are effective in reducing the levels of the drug’s use among people who inject it, according to research from Australia published in The Lancet Psychiatry. There was no evidence that these high-risk participants switched to heroin or other drugs. However, there was also no evidence of any effect on population-level indicators of opioid overdose or seeking out help or treatment.
The National Opioid Medications Abuse Deterrence (NOMAD) study began in 2013, a year before abuse-deterrent sustained-release Reformulated OxyContin tablets were introduced to the Australian market. The study focused on the reformulation’s impact on both the target population of opioid abusers and on broader population-level data on opioid usage, help-seeking, and overdose. Data were collected from several Australian states, including New South Wales, South Australia, and Tasmania.
“We found that tamper-resistant oxycodone did have important impacts, but they were limited to specific high-risk groups of people who actively tamper with opioids,” lead author Briony Larance, PhD, tells Drug Topics.
“We didn’t observe any impacts on population-level indicators of opioid overdose—hospital admissions, ED data, ambulance data—or help or treatment-seeking.”
Larance, a Senior Research Fellow at the National Drug and Alcohol Research Centre at the University of New South Wales, says the reformulation achieved what it was intended to do—reduce oxycodone’s attractiveness for tampering. She notes that NOMAD participants who previously injected opioids did not switch to swallowing more tamper-resistant oxycodone tablets to obtain the euphoric opioid effect they seek. Rather, they reduced their use of oxycodone with no evidence of switching to other opioids or more risky patterns of drug use.
Larance explains that people in Australia who inject opioids typically use a range of different opioids, including heroin. “Although recent oxycodone use was common in this group, it wasn’t used frequently — certainly nowhere near daily. So making that formulation more difficult to tamper with didn’t result in displacement to other opioids,” she says.
Australia has not experienced the same rapid escalation in opioid abuse as seen in the United States, where HHS statistics for 2016 show that 2.1 million people had an opioid use disorder and 11.5 million misused prescription opioids. The CDC reports that opioid prescribing continues to fuel the epidemic. Forty percent of all opioid overdose deaths involve a prescription, and over 1,000 people are treated daily in emergency departments for misusing prescription opioids.
Larance warns that abuse-deterrent formulations are not a panacea for opioid abuse and addiction. She acknowledges that a careful balance is needed between maintaining access to opioids for when they are needed medically, and minimizing overprescribing and overuse.
Noting that the vast majority of people exposed to opioids in Australia received prescriptions and don’t inject, she recommends increased prescriber and patient education as well as regulatory responses such as prescription drug monitoring programs.
“We need enhanced approaches to the management of pain and co-occurring mental health problems, especially in areas outside our major cities,” she adds. “We also need to work towards more attractive and accessible treatments for opioid use disorders, and more targeted harm reduction strategies, such as scaling up take-home naloxone programs.”
Funding for the NOMAD study came from the Australian Government, the National Health and Medical Research Council, and Mundipharma, a pharmaceutical company that sells some of the extended-release opioid painkillers in Australia, but which did not have oversight or input into the study’s design.