title: Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States.
abstract: BACKGROUND
  Therapeutic use and abuse of prescription opioids in the United States increased substantially between 1990 and 2010. The Centers for Disease Control estimated deaths related to pharmaceutical opioids reached nearly 19,000 in 2014. Of prescription opioids sold, 10% are extended release (ER) and 90% immediate release (IR). However, most regulations and interventions have focused on decreasing ER abuse. Our objective was to compare rates of abuse and diversion of ER and IR opioid analgesics over time using multiple surveillance programs.
  
  
  METHODS
  Rates of abuse and diversion of ER and IR opioid formulations were compared using data from four surveillance programs in the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS®) System. Data were evaluated from 2009 through 2015, and Poisson regression used to compare IR and ER opioid cases over time.
  
  
  RESULTS
  From 2009 to 2015, IR opioids were prescribed at a rate 12 to 16 times higher than ER. In the Poison Center Program, population-adjusted rates of Intentional Abuse for IR were 4.6 fold higher than ER opioids (p<0.001). In the Drug Diversion Program, population-adjusted rates of diversion were 6.1 fold higher for IR than ER opioids (p<0.001). In the Opioid Treatment Program, population-adjusted rates of endorsements for abuse were 1.6 fold higher for IR opioids than ER (p = 0.002). In the Survey of Key Informants' Patients Program, population-adjusted rates of endorsements for abuse were 1.5 fold higher for IR opioids than ER (p<0.001).
  
  
  CONCLUSIONS
  Between 2009 and 2015, IR opioids were prescribed at a much higher rate than ER opioids. Results from four surveillance programs show population-adjusted rates of prescription opioid abuse were markedly higher for IR than ER medications. For the greatest public health benefit, future interventions to decrease prescription opioid abuse should focus on both IR and ER formulations.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America.
authors.forename: Janetta L
authors.initials: JL
authors.lastname: Iwanicki
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America.
authors.forename: S Geoff
authors.initials: SG
authors.lastname: Severtson
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America.
authors.forename: Heather
authors.initials: H
authors.lastname: McDaniel
authors.affiliation: National Development and Research Institutes, Incorporated, New York, New York, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenblum
authors.affiliation: National Development and Research Institutes, Incorporated, New York, New York, United States of America.
authors.forename: Chunki
authors.initials: C
authors.lastname: Fong
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cicero
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ellis
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kurtz
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
authors.forename: Mance E
authors.initials: ME
authors.lastname: Buttram
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado, United States of America.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000009:adverse effects*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011039:Poison Control Centers / Q000706:statistics & numerical data; D015995:Prevalence; D012044:Regression Analysis; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations