Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia

Schaffer, Andrea L; Buckley, Nicholas A.; Degenhardt, Louisa; Larance, Briony; Cairns, Rose; Dobbins, Timothy; Pearson, Sallie‐Anne

doi:10.1503/cmaj.170666

Cited by 9 publications

(9 citation statements)

References 38 publications

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“…We included all oral formulations (tablets) of oxycodone CR, excluding suppositories. During the study period, the single-ingredient oxycodone CR was available in the following strengths: 5 (until March 30, 2014, only), 10,15,20,30,40, and 80 mg (Table 1).…”

Section: Key Pointsmentioning

confidence: 99%

“…Australian data suggest that there has been a change in the utilisation patterns of oxycodone CR, coinciding with the introduction of oxycodone/naloxone CR. First, dispensing of the single‐ingredient oxycodone CR has been decreasing, but oxycodone/naloxone CR has increased rapidly . Further, recent data show that while the number of oxycodone dispensings and people being dispensed oxycodone are increasing, the total volume (as measured in milligrams of oxycodone dispensed) is not …”

Section: Introductionmentioning

confidence: 99%

“…First, dispensing of the single-ingredient oxycodone CR has been decreasing, but oxycodone/naloxone CR has increased rapidly. 10,11 Further, recent data show that while the number of oxycodone dispensings and people being dispensed oxycodone are increasing, the total volume (as measured in milligrams of oxycodone dispensed) is not. 12 Therefore, the objective of this study was to document the uptake of oxycodone/naloxone CR and how it has affected overall trends in utilisation of oxycodone CR formulations as a whole.…”

Section: Introductionmentioning

confidence: 99%

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Increases in controlled‐release oxycodone utilisation following the subsidy of oxycodone with naloxone formulations: An Australian population‐based study

Schaffer

Karanges

Buckley

et al. 2018

Pharmacoepidemiology and Drug

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Purpose Despite increasing use of oxycodone/naloxone controlled-release (CR) in Australia, little is known about how it has affected the overall oxycodone CR market since its subsidy in 2011. Methods We used Pharmaceutical Benefits Scheme dispensing claims (2006–2016) and interrupted time series analysis to examine changes in the quarterly rates of dispensing of oral oxycodone CR formulations (oxycodone/naloxone CR and single-ingredient oxycodone CR) and new oxycodone CR treatment episodes. We also performed a retrospective cohort study in a sample of people initiating a new oxycodone CR treatment episode in 2009, 2012/13 and 2016 to compare opioid utilisation patterns over time. Results The subsidy of oxycodone/naloxone CR was associated with a 1.6-fold increase in the growth rate of oxycodone CR dispensing, resulting from rapid uptake of low strength (≤5 mg) oxycodone/naloxone CR. In our cohort of initiators, the number of new oxycodone CR treatment episodes increased 2.1-fold between 2009 and 2016; in 2016, 91.4% of new treatment episodes involved oxycodone/naloxone CR. Comparing 2016 to 2009, we observed an increase in people initiating with a tablet strength ≤5 mg (Risk difference (RD) = 21.1%, 95% CI 19.9%−22.4%), in people initiating with no other opioid dispensing 90 days prior to initiation (RD = 5.2%, 3.8%−6.6%), and with no further opioid dispensing 90 days after initiation (RD = 8.8%, 7.4%−10.2%). Conclusions After its subsidy, the uptake of low-dose oxycodone/naloxone CR was greater than expected if it were substituting the single-ingredient oxycodone CR, resulting in an expansion of the oxycodone CR market.

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Section: Key Pointsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increases in controlled‐release oxycodone utilisation following the subsidy of oxycodone with naloxone formulations: An Australian population‐based study

Schaffer

Karanges

Buckley

et al. 2018

Pharmacoepidemiology and Drug

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“…Previous studies have used interrupted time‐series comparing abuse rates before and after tamper‐resistant reformulations of existing drugs . For example, studies evaluating the reformulation of extended‐release oxycodone reported relative reductions in abuse ranging from 22% to 83% .…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Previous studies have used interrupted time-series comparing abuse rates before and after tamper-resistant reformulations of existing drugs. [12][13][14][15][16][17][18][19][20][21][22][23] For example, studies evaluating the reformulation of extended-release oxycodone reported relative reductions in abuse ranging from 22% 18 to 83%. 13 However, this approach has been criticized 11 because concurrent "competing" interventions to curb opioid prescribing or reduce drug abuse are threats to validity.…”

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confidence: 99%

Causal inference for evaluating prescription opioid abuse using trend‐in‐trend design

Dasgupta

Schwarz

Hennessy

et al. 2019

Pharmacoepidemiology and Drug

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Purpose One response to the opioid crisis in the United States has been the development of opioid analgesics with properties intended to reduce non‐oral use. Previous evaluations of abuse in the community have relied on population averaged interrupted time series Poisson models with utilization offsets. However, competing interventions and secular trends complicate interpretation of time‐series analyses. An alternative research design, trend‐in‐trend, accounts for heterogeneity in per capita opioid dispensing and unmeasured time‐varying confounding, which provides a causal evaluation, provided that underlying assumptions are met. Methods Trend‐in‐trend can be modeled using a logistic regression framework. In logistic regression, exposure was any product‐specific outpatient dispensing by three‐digit ZIP code and calendar quarter, for 22 opioids. The outcome was any product‐specific abuse case ascertained from poison centers and drug treatment programs, covering 94% of the US population, between July 2009 and December 2016. Product‐specific odds ratios compared places without dispensing with places with any dispensing; the causal contrast represents the odds of product‐specific abuse in the community given exposure. Results Dispensing of new and low‐volume opioids varied considerably across the country, with no region showing high of all products. Of 22 opioids analyzed, the three with approved labeling as intended to deter abuse ranked near the lowest in both absolute (population‐adjusted rates: 1.7, 0.9, and 8.2 per million people per quarter, respectively) and relative measures (trend‐in‐trend ORs: 1.96, 1.79, 1.69, respectively). Conclusions Postmarketing studies of prescription opioid abuse may benefit by evolving from unadjusted surveillance rates to a causal inference approach.

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Current Opioid Access, Use, and Problems in Australasian Jurisdictions

et al. 2018

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Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia

Cited by 9 publications

References 38 publications

Increases in controlled‐release oxycodone utilisation following the subsidy of oxycodone with naloxone formulations: An Australian population‐based study

Increases in controlled‐release oxycodone utilisation following the subsidy of oxycodone with naloxone formulations: An Australian population‐based study

Causal inference for evaluating prescription opioid abuse using trend‐in‐trend design

Current Opioid Access, Use, and Problems in Australasian Jurisdictions

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