Measuring prescription opioid misuse and its consequences

Abstract

Prescription drug misuse in the USA increased during the 1990s to 2010. The epidemic stimulated the need new analytical strategies and techniques to understand the medications involved, user characteristics and other factors needed to address the epidemic. Methods: A strategy of mosaic surveillance has evolved. Using real world evidence, the goal is to paint a more complete profile of a drug's real world misuse using triangulation-integrating results from multiple sources, where each approach has unrelated sources of bias. Results: Research findings have been remarkably consistent across multiple data sources. The most commonly misused opioid medications: hydrocodone = oxycodone > methadone = buprenorphine = tramadol = fentanyl (prescription form) > morphine > hydromorphone = oxymorphone > tapentadol. This rank order is similar to the number of prescriptions dispensed for each product in the USA. In the USA, prescription opioid misuse started to decrease about 2011. Typically, multiple drugs are misused together, particularly in lethal cases. Immediate release formulations are more commonly misused than extended release formulations. The introduction of tamper resistant formulations to resist crushing were followed by a decrease in misuse of those products. Conclusions: The rapid expansion of opioid prescribing was accompanied by increasing misuse and mortality. Interventions such as prescription drug monitoring programmes, increased law enforcement and abuse deterrent formulations have been followed by decreases in misuse of most opioid analgesics.

Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data

“…A strategy of mosaic surveillance, crossing information from spontaneous reports and dedicated pharmacoepidemiological surveys and record systems, enables in-depth analysis of each type of high-risk use. 14,20 The French Addictovigilance centres have implemented national programmes allowing a multidimensional analysis for a given substance.…”

“…According to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) system based on multiple data sources over 20 years, tramadol medicine has been misused at the same level as methadone, buprenorphine and fentanyl (prescription forms) in the United States. 14 After adjustment for availability, tramadol use in a way not directed by the healthcare provider was observed to be lower than codeine in several European countries (Germany, Italy, Spain, and the UK) in 2018. 15 However, in Italy, tramadol use to get high was endorsed at a higher rate than codeine, morphine and oxycodone by patients entering substance use treatment in the survey of entrants to treatment programmes (OTPS) from 2015 to 2018.…”

Long-Term Stability of Hydromorphone in Human Plasma Frozen at −20°C for Three Years Quantified by LC-MS/MS

“…Hydromorphone (4,5alpha-epoxy-3-hydroxy-17-methylmorphinan-6-one) is an analgesic opioid with sevenfold stronger analgesic potency than morphine [ 1 ], which is commonly used for the relief of strong acute and chronic pain [ 2 ]. All opioid analgesics are accompanied by misuse even if hydromorphone is not the first-line opioid for abuse and addiction [ 3 ]. High-potency opioids such as hydromorphone might independently influence the risk of suicide as well [ 4 ].…”

Commentary on McCoy et al.: More pieces of the mosaic describing outcomes of the Australian up‐scheduling of over‐the‐counter codeine to prescription only

“…Understanding the trends in non‐medical use of pharmaceutical drugs and its consequences relies upon triangulating signals from different data sources to provide a mosaic overview [1]. McCoy et al .’s recent work forms an integral part of the picture in understanding outcomes from a major Australian opioid policy decision: the removal of codeine sales without a prescription [2].…”