Changes in oxycodone misuse and abuse trends across COVID-19: A look back

Changes in oxycodone misuse and abuse trends across COVID-19: A look back

Background:

Opioid abuse that includes tampering continues to be a source of harm, such as overdose, for many individuals.[1] Individuals with opioid use disorder have indicated they choose immediate release (IR) opioids over extended-release (ER) opioids because they are easier to tamper.[2] This preference is likely the result of abuse-deterrent formulations (ADFs) which were developed to increase the difficulty of tampering and currently include formulations of oxycodone and hydrocodone. Previous evidence supports the conclusion that ADFs have pharmacological properties that deter tampering and warrant continued research to further understand the circumstances where their use might be most beneficial.[4]

A previous study investigated trends in XTAMPZA ER use from initial marketing in July 2016 through June 2019  to explore how ADF drugs are used in a real-world setting.[3] Since the culmination of that study, there have been significant changes in the landscape of opioid abuse, primarily due to the COVID-19 pandemic.[4, 5]

Purpose/Objectives:

Drug abuse and misuse has been difficult to track due to the myriad challenges that arose during COVID-19 data collection including decreased access to treatment facilities and harm reduction opportunities and decreased access to preferred drugs.[6, 7] The effects of COVID-19 on misuse and abuse of ADF opioids, such as XTAMPZA ER® (Collegium Pharmaceutical, Inc.), and comparators may shed light on how these drugs are used during exceptional circumstances. Final FDA guidance on ADF labelling requires continued surveillance of ADF misuse and abuse in the general population.[8] In addition, ongoing tracking of the trends in opioid use is vital to understanding the impact of regulatory and public health efforts to reduce misuse and abuse. In this study, we will quantify shifts in abuse and misuse of XTAMPZA ER and other similar oxycodone products prior to and during COVID-19 to better understand the shifts that have occurred in ADF opioid use.

Method:

This study explored XTAMPZA ER, other ER oxycodone, and single-entity immediate-release (SE-IR) oxycodone from 3^rd quarter 2019 through 4^th quarter 2022. Data from the RADARS® System included the Poison Centers Program (PC) and Treatment Center Programs Combined (TC). In PC Programs, all intentional exposure calls to US-based poison centers for misuse or abuse of the drugs were included.  In TC Programs, data included self-administered surveys from individuals entering opioid treatment programs reporting their drug use in the last 30 days. In both sources, if a call or survey included a report of multiple drug groups of interest, it was included in each group for analysis. To explore the changes across drugs after COVID-19, changes in the observed trends were explored. The pandemic-related shutdown occurred during 2nd quarter 2020, therefore, spline regression models were fit with a break point in the linear time component of the trends at 3^rd quarter 2020.  

Results:

In PC Programs, ER oxycodone and SE-IR oxycodone call rates were increasing before COVID followed by a significant change to decreasing during COVID (spline p< 0.001 for both). XTAMPZA ER rates were lower than either comparator drug across with no change observed (p=0.737). In TC Programs, the odds of abuse for ER oxycodone were decreasing before COVID and transitioned to a less steep decline during COVID (p=0.026). Odds of abuse for SE-IR oxycodone were decreasing with no change (p=0.235) during COVID. Odds of abuse of XTAMPZA ER were lower than either drug but did not show any change in trend (p=0.203).

Conclusions: These analyses shed light on the changes that occurred in misuse and abuse of various oxycodone drugs during the COVID-19 pandemic. The PC Program demonstrated that while XTAMPZA ER maintained a relatively flat rate, there was a reversal of trends for both ER oxycodone and SE-IR oxycodone during the COVID pandemic. XTAMPZA ER continues to have a lower rate than the comparators. Call rates for each drug group are currently decreasing, suggesting decreased need for expert toxicology advice and possibly safer use.
In the TC Programs, the ER oxycodone trend appears to be decreasing after COVID-19 while both SE-IR oxycodone and XTAMPZA ER did not have a significant change in trend. Across both programs we see lower rates of misuse and abuse trends for XTAMPZA ER than other ADF products. None of the included drug groups demonstrated increasing rates during COVID-19. Increased use of telehealth, increased home delivery of medication assisted therapy, decreased access to diverted drugs, and decreased availability of prescription medication may have all contributed to observed prescription oxycodone misuse and abuse not increasing during COVID-19.

References: 1. Iwanicki, J.L., et al., Abuse and Diversion of Immediate Release Opioid Analgesics as Compared to Extended Release Formulations in the United States. PLOS ONE, 2016. 11(12): p. e0167499.
2. Cicero, T.J., M.S. Ellis, and Z.A. Kasper, Relative preferences in the abuse of immediate-release versus extended-release opioids in a sample of treatment-seeking opioid abusers. Pharmacoepidemiol Drug Saf, 2017. 26(1): p. 56-62.
3. Severtson, S.G., et al., Postmarketing Analysis of Misuse, Abuse, and Diversion of Xtampza ER. Pain Med, 2020. 21(12): p. 3660-3668.
4. Khatri, U.G. and J. Perrone, Opioid Use Disorder and COVID-19: Crashing of the Crises. J Addict Med, 2020. 14(4): p. e6-e7.
5. Krawczyk, N., et al., Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review. Addict Sci Clin Pract, 2021. 16(1): p. 68.
6. Jacka, B.P., et al., Impacts of the COVID-19 pandemic on healthcare access among patients receiving medication for opioid use disorder. Drug Alcohol Depend, 2021. 221: p. 108617.
7. Currie, J.M., et al., Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic. JAMA Netw Open, 2021. 4(4): p. e216147.
8. Center for Drug Evaluation and Research (CDER), Assessment of Abuse Potential of Drugs: Guidance for Industry. 2017.