title: Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone.
abstract: The development of abuse deterrent formulations is one strategy for reducing prescription opioid misuse and abuse. A putative abuse deterrent formulation of oxycodone extended release (OxyContin®) was introduced in 2010. Early reports demonstrated reduced abuse and diversion, however, an analysis of social media found 32 feasible methods to circumvent the abuse deterrent mechanism. We measured trends of diversion, abuse and street price of OxyContin to assess the durability of the initial reduction in abuse.
  
  
  
  Data from the Poison Center Program, Drug Diversion Program, Opioid Treatment Program, Survey of Key Informant Patients Program and StreetRx program of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) System were used. The average quarterly rates of abuse and diversion for OxyContin were compared from before reformulation to the rate in second quarter 2015. Rates were adjusted for population using US Census data and drug availability.
  
  
  
  OxyContin abuse and diversion declined significantly each quarter after reformulation and persisted for 5 years. The rate of abuse of other opioid analgesics increased initially and then decreased, but to lesser extent than OxyContin. Abuse through both oral and non-oral routes of self-administration declined following the reformulation. The geometric mean difference in the street price of reformulated OxyContin was 36% lower than the reformulated product in the year after reformulation.
  
  
  
  Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.
authors.affiliation: Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA. Electronic address: Geoff.Severtson@rmpdc.org.
authors.forename: Stevan Geoffrey
authors.initials: SG
authors.lastname: Severtson
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, Washington University School of Medicine, Box 8134, 660 S Euclid, St. Louis, MO, 63110, USA. Electronic address: ellism@psychiatry.wustl.edu.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ellis
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Department of Justice and Human Services, College of Humanities, Arts and Social Sciences, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL, 33138, USA. Electronic address: Steven.kurtz@nova.edu.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kurtz
authors.affiliation: American Association for the Treatment of Opioid Dependence, New York, NY, USA. Electronic address: Rosenblum@ndri.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenblum
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, Washington University School of Medicine, Box 8134, 660 S Euclid, St. Louis, MO, 63110, USA. Electronic address: cicerot@psychiatry.wustl.edu.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cicero
authors.affiliation: American Association for the Treatment of Opioid Dependence, New York, NY, USA. Electronic address: Mark.Parrino@aatod.org.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parrino
authors.affiliation: Epidemico, Inc., 50 Milk St., 20th floor, Boston, MA, 02109, USA. Electronic address: michael@epidemico.com.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gilbert
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Department of Justice and Human Services, College of Humanities, Arts and Social Sciences, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL, 33138, USA. Electronic address: mance.buttram@nova.edu.
authors.forename: Mance E
authors.initials: ME
authors.lastname: Buttram
authors.affiliation: Epidemico, Inc., 50 Milk St., 20th floor, Boston, MA, 02109, USA. Electronic address: nabarun@epidemico.com.
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.affiliation: Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA. Electronic address: Becki.Bucher-Bartelson@rmpdc.org.
authors.forename: Becki
authors.initials: B
authors.lastname: BucherBartelson
authors.affiliation: Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA. Electronic address: Jody.Green@rmpdc.org.
authors.forename: Jody L
authors.initials: JL
authors.lastname: Green
authors.affiliation: Rocky Mountain Poison and Drug Center, 777 Bannock Street, Mailcode 0180, Denver, CO, 80204, USA. Electronic address: rdart@rmpdc.org.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
mesh_terms: D000701:Analgesics, Opioid / Q000138:chemical synthesis* / Q000600:supply & distribution; D002626:Chemistry, Pharmaceutical / Q000379:methods; D003692:Delayed-Action Preparations; D004339:Drug Compounding; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control*; D010098:Oxycodone / Q000138:chemical synthesis* / Q000600:supply & distribution; D064226:Prescription Drug Diversion / Q000706:statistics & numerical data / Q000639:trends*; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000639:trends*; D011306:Prescription Fees; D061108:Social Media; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010098:Oxycodone
keywords: Abuse; Diversion; Drug abuse; Opioid analgesics; OxyContin