Poster Number-9 - Association between per capita prescribing and abuse of tapentadol and other opioids among individuals entering treatment for opioid use disorders

Poster Abstracts

Author(s)

GS

Geoff Severtson, PhD

Associate Research Scientist
Rocky Mountain Poison and Drug Safety
Denver, Colorado
AC

Annika Czizik, MS

Biostatistician I
Rocky Mountain Poison and Drug Safety
Denver, Colorado
ME

Matthew Ellis, PhD

Instructor
Washington University in St. Louis
St. Louis, Missouri
JB

Joshua Black, PhD

Senior Research Scientist
Rocky Mountain Poison and Drug Safety
Denver, Colorado
JI

Janetta Iwanicki, MD

Physician
Denver Health and Hospital Authority
Denver, Colorado
RD

Richard Dart, MD PhD

Director
Rocky Mountain Poison and Drug Safety
Denver, Colorado

Association between per capita prescribing and abuse of tapentadol and other opioids among individuals entering treatment for opioid use disorders

Purpose: Tapentadol is a schedule II atypical opioid analgesic thought to have dual mechanisms of action: mu-receptor agonism and inhibition of norepinephrine reuptake. Scheduling was based on clinical studies where tapentadol had rewarding and reinforcing effects similar to morphine and drug liking scores similar to comparable potencies of hydromorphone. However, in post-marketing surveillance studies, tapentadol has consistently been found to have lower abuse, misuse, and diversion rates than conventional schedule II opioids. Among individuals assessed for substance use disorders, tapentadol abuse has been lower than other schedule II opioids after adjusting for utilization. Drug utilization-adjusted estimates are important adjustments when comparing tapentadol to other drug products given the different degrees of exposure to prescription opioid products. These adjustments allow for comparisons of odds of past month abuse at equivalent levels of exposure. However, in previous studies of treatment-seeking populations, utilization adjustments are performed with prescribing values aggregated for a particular time-period or geographic region. These studies are useful in assessing overall cases relative to prescriptions but may be limited because they do not examine an individual respondents’ odds of using a particular drug based on prescribing within their community. The goal of this study was to compare differences in an individuals’ odds of reporting past month abuse of tapentadol to other opioid analgesics using prescriptions per capita in each respondents three-digit ZIP code as the exposure variable.

Methods: Data collected from 2019 through 2021 from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System’s Treatment Center Programs Combined (Opioid Treatment Program and the Survey of Key Informants’ Patients Program) are included. The data were collected from 2019 through 2021 from individuals enrolling for treatment for opioid use disorder who endorsed abuse of at least one substance. An abuse case was defined as a respondent who endorsed past month use of one or more products within the drug groups of interest to get high. We use the term abuse because the type of use asked about on this survey is nontherapeutic and for psychotropic effects. This is distinct from other forms of non-medical use (e.g. self-treating pain without a prescription) and may be of greater risk to the respondent. Odds of abuse of tapentadol were compared to hydrocodone, hydromorphone, morphine, oxycodone, oxymorphone, and tramadol. Information on prescriptions dispensed was obtained from the IQVIA® (Danbury, CT) US-Based Longitudinal Prescription Data database. Per capita prescribing was calculated by dividing quarterly prescriptions dispensed value for each three-digit ZIP code by the estimated population in that ZIP code. A generalized linear mixed model was performed with a binary outcome indicating past month abuse or not of each drug group. A random intercept was included to account for within subject responses. In each model the predictor was the natural log of prescriptions dispensed per person within a respondents’ three-digit ZIP code. Comparisons of odds of abuse were conducted at the median prescriptions per capita value for tapentadol.

Results:

The association between prescriptions dispensed per capita within a respondents’ three-digit ZIP code and odds of past month abuse was not statistically significant for tapentadol (OR=1.05, p=0.793). The association between prescriptions dispensed per capita within a respondents’ three-digit ZIP code was statistically significantly greater for oxycodone (p< 0.001), hydrocodone (p=0.001), hydromorphone (p< 0.001), and tramadol (p< 0.001) than for tapentadol. Drug groups were compared at the median per capita prescribing value of tapentadol. The odds a respondent abused oxycodone (OR=13.8, 95% CI: 8.4 - 22.9,p< 0.001), hydrocodone (OR=2.4, 95% CI:1.4 - 4.1, p=0.001), hydromorphone (OR=26.1, 95% CI: 18.4 - 37.1, p< 0.001), morphine (OR=28.2, 95% CI:18.1 - 44.0, p< 0.001), oxymorphone (OR=40.9, 95% CI: 29.8 - 56.2, p< 0.001), and tramadol (OR=3.1, 95% CI: 1.4 - 7.1, p=0.006) were each greater than odds of abuse of tapentadol.

Conclusion: These findings are consistent with other published studies that, among individual seeking treatment for opioid use disorders, abuse of tapentadol is less frequent than other schedule II opioid analgesics after adjusting for prescribing volume. This study is unique in the adjustment for exposure to prescription opioids. Notably, we examined an individuals’ risk of abuse relative to prescriptions dispensed per person in their residential ZIP code. Our findings indicate that tapentadol abuse is less common than tramadol when accounting for different levels of prescribing. This study adds to several years of post-marketing surveillance finding that tapentadol abuse is infrequent relative to conventional opioids. Though additional surveillance and research are needed to fully understand the motivations and risks to individuals who abuse tapentadol, our findings suggest that tapentadol may be an option for pain management with lower abuse potential than other Schedule II opioids.

References:

Learning Objectives:

Describe the relationship between tapentadol dispensing and abuse among those entering treatment
Compare the odds of abuse of tapentadol to other opioids drugs used to treat pain
List other studies that describe tapentadol abuse relative to other opioids