Determinants of fentanyl and other potent µ opioid agonist misuse in opioid-dependent individuals.
OBJECTIVE
Based on preclinical and clinical abuse liability assessments, fentanyl and other potent µ opioid agonists (e.g., hydromorphone and morphine) should be the most misused opioids if accessibility in the real world were not an issue. Since the latter is seldom true, we postulated that there would be a significant mismatch between actual and predicted rates of misuse.


METHODS
We recruited 1818 prescription-opioid dependent patients entering drug treatment programs to complete an anonymous survey, covering drug use and health related issues.


RESULTS
Hydrocodone and oxycodone products were the drugs of choice in 75% of patients, whereas potent µ opioid agonists (fentanyl, hydromorphone, and morphine), with the greatest predicted abuse potential, were very rarely chosen (< 5% each). Most unexpectedly, the rank order of the actual drug of choice and the preferred drug in an ideal world were highly correlated. The reason most commonly given for the failure to endorse fentanyl, for example, as an actual or preferred drug, was fear of toxicity and overdose. We found few differences in drug use patterns between a subset of high-risk, impaired health care professionals (N = 196), and all other patients other than source of drug (forged prescriptions and doctors more common and dealers much less common in the HC sample).


CONCLUSIONS
These results indicate that it should not be assumed--particularly for new drug formulations--that a high potential for abuse will result in actual abuse; and, most importantly, that the hesitancy to use potent opioids because of fears of abuse may be misguided.
Cicero
Theodore J
TJ
Department of Psychiatry, Washington University, St. Louis, MO 63110, USA. Cicerot@wustl.edu
Ellis
Matthew S
MS
Paradis
Alethea
A
Ortbal
Zachary
Z
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000494:pharmacology*; D003625:Data Collection; D005260:Female; D005283:Fentanyl; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017450:Receptors, Opioid, mu / Q000819:agonists*; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders
D000701:Analgesics, Opioid; D017450:Receptors, Opioid, mu; D005283:Fentanyl