Minimal impact

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Mixed findings for benefits of tamper-resistant oxycodone

The introduction of tamper-resistant oxycodone formulations in Australia in early 2014 has led to little change in the levels of population-level opioid use or harm, new research has revealed.

Time-series analyses of opioid sales data and collected health datasets have shown that controlled-release oxycodone reduced tampering with pharmaceutical opioids among people who inject drugs but had no general population impact.

In findings of “international relevance”, there was “no significant effect” observed among population-level indicators of opioid overuse, or help or treatment seeking, said the authors, from a range of leading research centres.

“Consistent, contrasting findings were observed, according to whether the data were of whole-of-population or from sentinel populations of people who inject drugs,” they said.

So, while there had been a reduction in use and tampering by primarily injecting drug users since the introduction of the controlled-release formula, this was not replicated on a wider level.

At population level, “no effect on total pharmaceutical opioid use overall (measured in oral morphine equivalent mg sold) was observed,” the authors said.

“Opioid use continued to increase and previous observed increases in sales of oxycodone or oxycodone-naloxone, or both, continued at a similar rate continued post-introduction of the tamper-resistant formulation.”

“Abuse-deterrent formulations might make tampering with opioids more difficult, but this study suggests that it might have little effect as a strategy to address population-level issues related to over-prescribing, overuse, and harm of opioid medicines taken via the intended route,” the authors concluded.

However, they said these formulations needed to form part of a multifaceted response to reducing usage, along with increased availability of non-medication approaches to treating chronic non-cancer pain, good clinical practice in long-term opioid treatment (such as reviews, monitoring and multifaceted treatments) and implementation of strategies to minimise harm among those using opioids outside prescriber recommendations.

The National Opioid Medications Abuse Deterrence (NOMAD) study, published in the journal Lancet Psychiatry, was partially funded by Mundipharma Australia, as well as the Australian Government and the National Health and Medical Research Council.

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