title: Use of prescription opioids with abuse-deterrent technology to address opioid abuse.
abstract: OBJECTIVE
  The development of new formulations of extended-release (ER) opioids with abuse-deterrent technology attempts to deter prescription opioid abuse while maintaining appropriate access to care for pain patients. This study examined the degree to which some patients may avoid switching to reformulated ER opioids with abuse-deterrent technology and the extent to which those patients are more likely to be abusers.
  
  
  METHODS
  We analyzed Truven MarketScan pharmacy and medical claims data following the introduction of two reformulated ER opioids with abuse-deterrent technology. Adults aged 18-64 who were continuous users of extended-release oxycodone HCl (ER oxycodone) or extended-release oxymorphone HCl (ER oxymorphone) in a 6 month period prior to the introduction of the respective reformulations of those products were identified and categorized based on whether they switched to the reformulation, switched to other ER/long-acting (LA) opioids (without abuse-deterrent technology), or discontinued ER/LA opioid treatment in a 6 month post-reformulation period. Abusers were identified using ICD-9-CM diagnosis codes for opioid abuse/dependence. Pearson's chi-squared tests and Fisher's exact tests were then used to compare rates of abuse between patients who avoided switching to a reformulated ER opioid. Sensitivity analyses examined several definitions used in this analysis.
  
  
  METHODS
  ER/LA opioid utilization; rates of diagnosed opioid abuse.
  
  
  RESULTS
  A total of 31%-50% of patients avoided switching to reformulated ER opioids. Rates of diagnosed opioid abuse were higher among these patients compared to patients who transitioned to the reformulated ER opioids.
  
  
  CONCLUSIONS
  Due to the observational research design, caution is warranted in causal interpretation of the findings. The study was conducted among commercially insured continuous ER oxycodone or ER oxymorphone users; future research should consider additional patient populations, such as non-continuous users and those without commercial insurance (i.e., Medicare, Medicaid, uninsured).
  
  
  CONCLUSIONS
  Some patients switched to other ER/LA opioids without abuse-deterrent technology or discontinued ER/LA opioid treatment when their existing ER treatment was reformulated. Rates of opioid abuse were higher among patients who switched to other ER/LA opioids or discontinued ER/LA opioid treatment, suggesting that abusers may seek more easily abuseable alternatives such as prescription opioids without abuse-deterrent technology.
authors.affiliation: Brigham and Women's Hospital , Chestnut Hill, MA , USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Michna
authors.forename: Noam Y
authors.initials: NY
authors.lastname: Kirson
authors.forename: Amie
authors.initials: A
authors.lastname: Shei
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D010098:Oxycodone / Q000008:administration & dosage* / Q000627:therapeutic use; D010111:Oxymorphone / Q000008:administration & dosage* / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010111:Oxymorphone; D010098:Oxycodone
keywords: Drug abuse; Opioid-related disorders; Opioids; Pain