title: Diversion and Illicit Sale of Extended Release Tapentadol in the United States.
abstract: Prescription opioid analgesics are commonly prescribed for moderate to severe pain. An unintended consequence of prescribing opioid analgesics is the abuse and diversion of these medications. Tapentadol ER is a recently approved centrally acting analgesic with synergistic mechanisms of action: μ-opioid receptor agonism and inhibition of norepinephrine reuptake. We assessed the amount of diversion and related cost of obtaining tapentadol IR (Nucynta®) and tapentadol ER (Nucynta ER®) as well as other Schedule II opioid medications in street transactions in the United States using the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System.
  
  
  
  The Drug Diversion Program measures the number of cases opened by 260 drug diversion investigators in 49 states. StreetRx(TM) uses a crowd-sourcing Website to collect the prices paid for licit or illicit drugs.
  
  
  
  The population-based rates of diversion were 0.003 (tapentadol IR), 0.001 (tapentadol ER), and 1.495 (other Schedule II opioid tablets) reports per 100,000 population. The tapentadol ER rate was lower than the other Schedule II opioid tablets (P < 0.001) and tapentadol IR (P= 0.004). Diversion rates based on drug availability were 0.03 (tapentadol IR), 0.016 (tapentadol ER), and 0.172 (other Schedule II opioid tablets) per 1,000 prescriptions dispensed. The median street price per milligram was $0.18 (tapentadol IR), $0.10 (tapentadol ER), and $1.00 (other Schedule II opioid tablets).
  
  
  
  Our results indicate that tapentadol ER is rarely sold illicitly in the United States. When sold illicitly, tapentadol ER costs less than other Schedule II opioid products.
authors.affiliation: *Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado Richard.dart@rmpdc.org.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida.
authors.forename: Hilary L
authors.initials: HL
authors.lastname: Surratt
authors.affiliation: *Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Le Lait
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida.
authors.forename: Yami
authors.initials: Y
authors.lastname: Stivers
authors.affiliation: Department of Emergency Medicine, Antonio Military Medical Center, San Antonio, Texas.
authors.forename: Vikhyat S
authors.initials: VS
authors.lastname: Bebarta
authors.affiliation: Epidemico, Inc., Boston, Massachusetts.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Freifeld
authors.affiliation: Epidemico, Inc., Boston, Massachusetts.
authors.forename: John S
authors.initials: JS
authors.lastname: Brownstein
authors.affiliation: National Association of Drug Diversion Investigators, Lutherville, Maryland, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Burke
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kurtz
authors.affiliation: Epidemico, Inc., Boston, Massachusetts.
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
mesh_terms: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D006801:Humans; D013287:Illicit Drugs; D010636:Phenols; D064226:Prescription Drug Diversion / Q000706:statistics & numerical data*; D000077432:Tapentadol; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D013287:Illicit Drugs; D010636:Phenols; D000077432:Tapentadol
keywords: Abuse; Diversion; Opioid; RADARS System; StreetRx; Tapentadol
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