Monitoring of Internet Forums to Evaluate Reactions to the Introduction of Reformulated OxyContin to Deter Abuse

Abstract

BackgroundReformulating opioid analgesics to deter abuse is one approach toward improving their benefit-risk balance. To assess sentiment and attempts to defeat these products among difficult-to-reach populations of prescription drug abusers, evaluation of posts on Internet forums regarding reformulated products may be useful. A reformulated version of OxyContin (extended-release oxycodone) with physicochemical properties to deter abuse presented an opportunity to evaluate posts about the reformulation in online discussions.ObjectiveThe objective of this study was to use messages on Internet forums to evaluate reactions to the introduction of reformulated OxyContin and to identify methods aimed to defeat the abuse-deterrent properties of the product.MethodsPosts collected from 7 forums between January 1, 2008 and September 30, 2013 were evaluated before and after the introduction of reformulated OxyContin on August 9, 2010. A quantitative evaluation of discussion levels across the study period and a qualitative coding of post content for OxyContin and 2 comparators for the 26 month period before and after OxyContin reformulation were conducted. Product endorsement was estimated for each product before and after reformulation as the ratio of endorsing-to-discouraging posts (ERo). Post-to-preintroduction period changes in ERos (ie, ratio of ERos) for each product were also calculated. Additionally, post content related to recipes for defeating reformulated OxyContin were evaluated from August 9, 2010 through September 2013.ResultsOver the study period, 45,936 posts related to OxyContin, 18,685 to Vicodin (hydrocodone), and 23,863 to Dilaudid (hydromorphone) were identified. The proportion of OxyContin-related posts fluctuated between 6.35 and 8.25 posts per 1000 posts before the reformulation, increased to 10.76 in Q3 2010 when reformulated OxyContin was introduced, and decreased from 9.14 in Q4 2010 to 3.46 in Q3 2013 in the period following the reformulation. The sentiment profile for OxyContin changed following reformulation; the post-to-preintroduction change in the ERo indicated reformulated OxyContin was discouraged significantly more than the original formulation (ratio of ERos=0.43, P<.001). A total of 37 recipes for circumventing the abuse-deterrent characteristics of reformulated OxyContin were observed; 32 were deemed feasible (ie, able to abuse). The frequency of posts reporting abuse of reformulated OxyContin via these recipes was low and decreased over time. Among the 5677 posts mentioning reformulated OxyContin, 825 posts discussed recipes and 498 reported abuse of reformulated OxyContin by such recipes (41 reported injecting and 128 reported snorting).ConclusionsAfter introduction of physicochemical properties to deter abuse, changes in discussion of OxyContin on forums occurred reflected by a reduction in discussion levels and endorsing content. Despite discussion of recipes, there is a relatively small proportion of reported abuse of reformulated OxyContin via recipes, particularly by injecting or...

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

“…[124] Despite discussion of recipes (32 of which were deemed feasible, i.e., able to abuse), the frequency of posts reporting abuse via these recipes was low and decreased over time. Of the 5677 posts mentioning the abuse-deterrent reformulation, 498 reported abuse (41 reported injecting and 128 reported snorting).…”

The Comparative Pharmacokinetics of Physical Manipulation by Crushing of Xtampza ® ER Compared with OxyContin ®

“…In a survey of oral abusers, 42% reported manipulation (e.g., chewing, dissolving in mouth) of crush-resistant tablet formulations prior to oral administration [3]. Further, a review of Internet forums found 32 potentially feasible recipes to overcome the crush-resistant properties of OxyContin [17]. Tampering methods to compromise the OxyContin formulation are not always sophisticated, and often chewing tablets before oral administration is used to attempt to elicit rapid onset of euphoria sought by drug abusers [17].…”

“…Further, a review of Internet forums found 32 potentially feasible recipes to overcome the crush-resistant properties of OxyContin [17]. Tampering methods to compromise the OxyContin formulation are not always sophisticated, and often chewing tablets before oral administration is used to attempt to elicit rapid onset of euphoria sought by drug abusers [17]. It is thought that novice drug abusers often begin with oral administration and evolve their drug use habits to chewing, snorting and eventually injection, a progression that is associated with more dire outcomes [18].…”

Methods and predictors of tampering with a tamper-resistant controlled-release oxycodone formulation

“…(Boyce & Hoag, 2014), fewer than one-fifth (15%) of the reported methods in the present study were based on internet sources. This in itself may reduce the potential for harm to the consumer: McNaughton et al (2014) reported only a small number of posts identifying preparation methods for tampering post-introduction; only 9% of posts related to potentially feasible manipulation techniques. There were few distinguishing characteristics of those who tampered with the reformulated oxycodone compared with those who tampered only with the original oxycodone formulation, with similar socio-demographic profiles, mental and physical health, and, most importantly, levels of pharmaceutical opioid dependence.…”

“…US studies have examined levels of tampering (Butler et al, 2013) and perceived attractiveness . Whilst there has been analysis of internet posts regarding methods for tampering (McNaughton et al, 2014, this study represents, to the author's knowledge, the first in-depth systematic investigation of self-reported methods of tampering and their perceived success. The high retention rate for Wave 2 interviews, comprehensive assessment of pharmaceutical opioid tablet forms and sizes, and emphasis on confidentiality and anonymity are strengths of this study.…”