title: Changes in oxycodone and heroin exposures in the National Poison Data System after introduction of extended-release oxycodone with abuse-deterrent characteristics.
abstract: OBJECTIVE
  Abuse and misuse of prescription opioids are serious public health problems. Abuse-deterrent formulations are an intervention to balance risk mitigation with appropriate patient access. This study evaluated the effects of physicochemical barriers to crushing and dissolving on safety outcomes associated with extended-release oxycodone (ERO) tablets (OxyContin) using a national surveillance system of poison centers. Other single-entity (SE) oxycodone tablets and heroin were used as comparators and to assess substitution effects.
  
  
  METHODS
  The National Poison Data System covering all US poison centers was used to measure changes in exposures in the year before versus the 2 years after introduction of reformulated ERO (7/2009-6/2010 vs 9/2010-9/2012). Outcomes included abuse, therapeutic errors affecting patients, and accidental exposures.
  
  
  RESULTS
  After ERO reformulation, abuse exposures decreased 36% for ERO, increased 20% for other SE oxycodone, and increased 42% for heroin. Therapeutic errors affecting patients decreased 20% for ERO and increased 19% for other SE oxycodone. Accidental exposures decreased 39% for ERO, increased 21% for heroin, and remained unchanged for other SE oxycodone. During the study period, other interventions to reduce opioid abuse occurred, for example, educational and prescription monitoring programs. However, these have shown small effects and do not explain a drop for ERO exposures but not for other opioids.
  
  
  CONCLUSIONS
  After ERO reformulation, calls to poison centers involving abuse, therapeutic errors affecting patients, and accidental exposures decreased for ERO, but not for comparator opioids. Abuse-deterrent formulations of opioid analgesics can reduce abuse, but switching to other accessible non abuse-deterrent opioids might occur.
authors.affiliation: Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, CT, USA; Adjunct, Department of Clinical Biostatistics and Epidemiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Coplan
authors.forename: Hrishikesh
authors.initials: H
authors.lastname: Kale
authors.forename: Lauren
authors.initials: L
authors.lastname: Sandstrom
authors.forename: Craig
authors.initials: C
authors.lastname: Landau
authors.forename: Howard D
authors.initials: HD
authors.lastname: Chilcoat
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D003932:Heroin / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D008961:Models, Structural; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control; D010098:Oxycodone / Q000008:administration & dosage*; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D003932:Heroin; D010098:Oxycodone
keywords: abuse deterrence; heroin; opioid abuse; oxycodone; patient outcomes; pharmacoepidemiology; poison centers