Evaluation of Abuse and Route of Administration of Extended-Release Tapentadol Among Treatment-Seeking Individuals, as Captured by the Addiction Severity Index–Multimedia Version (ASI-MV)

Vosburg, Suzanne K.; Beaumont, Jared; Dailey-Govoni, S Taryn; Butler, Stephen F.; Green, Jody L.

doi:10.1093/pm/pnz250

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…This practice could have potential patient safety implications with accidental overdose and misuse. On the other hand, several US and Australian studies showed that both tapentadol IR and extended release (ER) might have lower abuse liability in the community than oxycodone 33–35 . Hence, use of a lower abuse liability drug in the hospital setting could potentially reduce the risk of chronic use but care needs to be taken on the choice of opioid upon hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, several US and Australian studies showed that both tapentadol IR and extended release (ER) might have lower abuse liability in the community than oxycodone. [33][34][35] Hence, use of a lower abuse liability drug in the hospital setting could potentially reduce the risk of chronic use but care needs to be taken on the choice of opioid upon hospital discharge. Finally, initiatives to reduce inappropriate prescription, including prescriber education regarding the risks of prescribing SR opioids for acute pain should be encouraged.…”

Section: Pattern Of Tapentadol Prescribingmentioning

confidence: 99%

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Prescribing trend of tapentadol in a Sydney local health district

Mirabella

Deepa

Chiew

et al. 2022

Brit J Clinical Pharma

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Aims Tapentadol, an opioid with mu‐opioid receptor agonism and noradrenaline reuptake inhibition, has been increasingly used in Australia since 2011. However, data on hospital prescribing trends and indications are scarce. This study aimed to investigate hospital prescribing trends of tapentadol, oxycodone and tramadol in a Sydney local health district (LHD) and the indications for tapentadol hospital prescriptions in an Australian tertiary hospital. Methods We analysed 5‐year patient dispensing for tapentadol, oxycodone and tramadol from four hospitals in a Sydney LHD with data expressed as oral morphine equivalents (OME). We also conducted a retrospective review of 140 and 54 patients prescribed tapentadol at a tertiary hospital's surgical and spinal units in 2020. Results Over 5 years in the Sydney LHD, there was a 19.5% reduction in total dispensing of these opioids from 1 225 210 to 986 477.5 OME milligrams. Decreases were specifically for oxycodone (−37.8% immediate‐release, −65.2% sustained‐release) and tramadol (−74.6% immediate‐release, −70.1% sustained‐release). Contrastingly, hospital prescriptions of tapentadol immediate‐release increased by 223.2% between 2018–19 and 2020–21 while sustained‐release increased by 17.9% from 2016–17 to 2020–21. By 2020–21, tapentadol overtook oxycodone to become the most prescribed opioid in the Sydney LHD (51.4%). At the hospital's surgical units, 137 (97.9%) patients were prescribed tapentadol for acute post‐operative pain with the majority (54.0%) prescribed both immediate‐release and sustained‐release tapentadol, while 71.1% were prescribed for neuropathic pain in the spinal units. Conclusion In a Sydney LHD, tapentadol prescriptions increased significantly to become the preferred opioid analgesic. At the hospital's surgical units, off‐label prescriptions of tapentadol sustained‐release for acute post‐operative pain were observed.

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Section: Discussionmentioning

confidence: 99%

Section: Pattern Of Tapentadol Prescribingmentioning

confidence: 99%

Prescribing trend of tapentadol in a Sydney local health district

Mirabella

Deepa

Chiew

et al. 2022

Brit J Clinical Pharma

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“…The modest number of participants may be because of the market share of tapentadol, but it may also be because of the nondesirability of tapentadol for NMU. This may be a topic for future research [ 8 ]. Extension of the recruitment period longer than 5 months might result in a larger sample size, if the reason for the modest sample is the lack of tapentadol market penetration.…”

Section: Discussionmentioning

confidence: 99%

“…Thus far, the prevalence of tapentadol abuse and diversion (both ER and IR) has been characterized as low compared with other prescription opioid compounds, particularly when considered at the population level [ 6 - 8 ]. For instance, from the fourth quarter of 2011 to the second quarter of 2016, tapentadol had an event rate of 0.015 for intentional abuse, an event rate of 0.029 for diversion, and an event rate of 0.245 for past 30-day use to get high.…”

Section: Introductionmentioning

confidence: 99%

Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study

Vosburg¹,

Govoni²,

Beaumont³

et al. 2022

JMIR Form Res

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Background The prevalence of abuse, diversion, and web-based endorsement of tapentadol (extended-release [ER], immediate-release [IR]) has been characterized as low compared with other prescription opioids. Little is known about individual experience with tapentadol nonmedical use (NMU). Objective This study aims to pilot web-based survey technologies to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used, and impressions of tapentadol products (Nucynta and Nucynta ER). Methods Recruitment flyers and banner advertisements were placed on the Bluelight website [DragonByte Technologies Ltd] with a link to a web-based survey (Qualtrics) designed to query about individuals’ lifetime tapentadol NMU. This web-based survey was followed by an interactive web-based chat (Cryptocat) with respondents who were willing to be contacted. Respondents were queried about sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued or discontinued use. Desirability and attractiveness for NMU was rated. Results Web-based recruitment successfully attracted difficult-to-find study participants. A total of 78 participants reported that tapentadol was obtained from friends and family (ER 11/30, 37%; IR 18/67, 27%), the internet (ER 11/30, 37%; IR 12/67, 18%) or participants’ own prescriptions from a doctor (ER 9/30, 30%; IR 17/67, 25%). It was used nonmedically for pain relief (ER 18/30, 60%; IR 33/67, 49%) and multiple psychotropic effects, including relaxation (ER 13/30, 43%; IR 29/67, 43%), reduction in depression or anxiety (ER 7/30, 23%; IR 30/67, 45%), or getting high (ER 12/30, 40%; IR 33/67, 49%). Tapentadol was primarily swallowed (ER 22/30, 73%; IR 55/67, 82%), although snorting (ER 2/30, 7%; IR 8/67, 12%) and injection (ER 2/30, 7%; IR 5/67, 8%) were also reported. The preferred dose for NMU was 100 mg (both ER and IR). The participants reported tapentadol use with benzodiazepines (ER 12/21, 57%; IR 28/47, 60%). Most participants had discontinued tapentadol NMU at the time of survey completion (ER 22/30, 73%; IR 55/67, 82%). Reasons for discontinued ER NMU included side effects (10/22, 46%) and lack of effective treatment (10/22, 46%). Reasons for discontinued IR NMU included lack of access (26/55, 47%) and better NMU options (IR 21/55, 38%). Few individuals were willing to divulge identifying information about themselves for the interactive chat (8/78, 10%), demonstrating the strength of anonymous, web-based surveys. Interactive chat supported the survey findings. A subgroup of participants (4/78, 5%) reported hallucinogenic side effects with high doses. Conclusions Web-based surveys can successfully recruit individuals who report drug NMU and those who are difficult to find. Tapentadol NMU appears to occur primarily for pain relief and for its psychotropic effects. Although it was liked by some, tapentadol did not receive a robust pattern of endorsement for NMU.

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“…Data sources that capture actual use and drug-related behaviors, including the Addiction Severity Index-Multimedia Version (ASI-MV ® , Inflexxion, a division of Integrated Behavioral Health, Irvin, CA, USA), may provide more accurate insights into nonmedical use (NMU) of prescription opioid medications. ASI-MV data have been previously used to evaluate NMU prevalence of specific opioid products or compounds [14][15][16] and effectiveness of interventions such as abuse deterrent formulations [17].…”

Section: Introductionmentioning

confidence: 99%

Real-World Data on Nonmedical Use of Tramadol from Patients Evaluated for Substance Abuse Treatment in the NAVIPPRO Addiction Severity Index—Multimedia Version (ASI-MV®) Network

2020

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Introduction Drug safety studies regarding comparative risk of different opioid compounds are important as providers and regulatory agencies in the United States continue to balance pain management with an ongoing opioid epidemic. Objective The aim of this study was to evaluate nonmedical use (NMU) and diversion of tramadol and comparator opioids using real-world data from the Addiction Severity Index—Multimedia Version (ASI-MV ® ). Methods A cross-sectional study design was used to evaluate past 30-day tramadol and comparator opioid NMU among adults assessed for substance abuse treatment using the ASI-MV from 2010 to 2018. Population and drug utilization-adjusted rates were studied, as well as patient characteristics, route of administration, and diversion. Results Past 30-day NMU of one or more prescription opioid was reported in 125,048 (22.6%) of ASI-MV assessments (2010–2018); 46.5% reported oxycodone, 43.2% hydrocodone, 8.1% morphine, and 7.2% tramadol. Male respondents ranged from 43.2% in the tramadol group to 51.8% in the oxycodone group. Majority (~ 76%) were Caucasian in all groups, with 86.9% Caucasian in the morphine group. Prevalence of past 30-day tramadol NMU was significantly lower than that of morphine, oxycodone, and hydrocodone for both population and utilization-adjusted rates. Rate of snorting of tramadol was 4–7 times lower than comparator opioids and injection was 14–34 times lower than morphine and oxycodone. Tramadol was most likely to be obtained via the patient’s own prescription while the comparator opioids were more often obtained via dealers or family/friends. Conclusion Tramadol had a significantly lower rate of NMU than comparator opioids and was less likely to be diverted or used via higher-risk non-oral routes. These findings support previous evaluations by WHO and the United States Drug Enforcement Agency that concluded that tramadol has a low potential for abuse.

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Evaluation of Abuse and Route of Administration of Extended-Release Tapentadol Among Treatment-Seeking Individuals, as Captured by the Addiction Severity Index–Multimedia Version (ASI-MV)

Cited by 10 publications

References 34 publications

Prescribing trend of tapentadol in a Sydney local health district

Prescribing trend of tapentadol in a Sydney local health district

Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study

Real-World Data on Nonmedical Use of Tramadol from Patients Evaluated for Substance Abuse Treatment in the NAVIPPRO Addiction Severity Index—Multimedia Version (ASI-MV®) Network

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