The characteristics of a cohort who tamper with prescribed and diverted opioid medications.
OBJECTIVE
To describe the methods and baseline characteristics of a cohort of people who tamper with pharmaceutical opioids, formed to examine changes in opioid use following introduction of Reformulated OxyContin®.


METHODS
Participants were 606 people from three Australian jurisdictions who reported past month injecting, snorting, chewing or smoking of a pharmaceutical opioid and had engaged in these practices at least monthly in the past 6 months. Baseline interviews were conducted prior to introduction of Reformulated OxyContin® in April 2014. Patterns of opioid use and cohort characteristics were examined according to whether participants were prescribed opioid medications, or exclusively used diverted medication.


RESULTS
The cohort reported high levels of moderate/severe depression (61%), moderate/severe anxiety (43%), post-traumatic stress disorder (42%), chronic pain or disability (past 6 months, 54%) and pain (past month, 47%). Lifetime use of oxycodone, morphine, opioid substitution medications and codeine were common. Three-quarters (77%) reported ICD-10 lifetime pharmaceutical opioid dependence and 40% current heroin dependence. Thirteen percent reported past year overdose, and 70% reported at least one past month opioid injection-related injury or disease. The cohort displayed complex clinical profiles, but participants currently receiving opioid substitution therapy who were also prescribed other opioids particularly reported a wide range of risk behaviors, despite their health service engagement.


CONCLUSIONS
Findings highlight the heterogeneity in the patterns and clinical correlates of opioid use among people who tamper with pharmaceutical opioids. Targeted health interventions are essential to reduce the associated harms.
National Drug and Alcohol Research Centre, UNSW, NSW, Australia. Electronic address: b.larance@unsw.edu.au.
Briony
B
Larance
Sydney Medical School, Sydney University, NSW, Australia; The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, NSW, Australia.
Nicholas
N
Lintzeris
School of Medicine, University of Tasmania, Tasmania, Australia.
Raimondo
R
Bruno
School of Medicine, University of Tasmania, Tasmania, Australia.
Amy
A
Peacock
National Drug and Alcohol Research Centre, UNSW, NSW, Australia.
Elena
E
Cama
University of Adelaide, South Australia, Australia.
Robert
R
Ali
National Drug and Alcohol Research Centre, UNSW, NSW, Australia.
Ivana
I
Kihas
National Drug and Alcohol Research Centre, UNSW, NSW, Australia.
Antonia
A
Hordern
University of Adelaide, South Australia, Australia.
Nancy
N
White
National Drug and Alcohol Research Centre, UNSW, NSW, Australia; School of Population and Global Health, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Australia; Department of Global Health, School of Public Health, University of WA, USA.
Louisa
L
Degenhardt
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000523:psychology; D001315:Australia; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000523:psychology*; D064226:Prescription Drug Diversion
D000701:Analgesics, Opioid
Abuse deterrent; Abuse liability; Cohort; Opioids; Pharmaceutical opioids; Tamper resistant