Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration. (1st June 2017)

• Record Type: Journal Article
• Authors: Green, Jody L.; Bucher Bartelson, Becki; Le Lait, M. Claire; Roland, Carl L.; Masters, Elizabeth T.; Mardekian, Jack; Bailey, J. Elise; Dart, Richard C.
• Is Part Of: Drug and alcohol dependence. Volume 175(2017)
• Page Start: 140
• Page End: 145
• Publication Date: 2017-06-01
• Subjects: Prescription drug abuse -- Route of abuse -- Opioid abuse -- Medical outcomes -- Abuse- deterrent; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2017.01.039
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: The majority of poison center intentional abuse cases involve oral routes. Non-oral routes are reported and double the risk of life-threatening event. Abuse-deterrent formulations (ADFs) are relevant in reducing non-oral abuse but do not address oral abuse. ADF products are a small part of the overall prescription opioid market. Their public health impact may not be realized until they are more widely used. Abstract: Background: Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. Methods: This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. Results: While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. Conclusion: Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.