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

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

Background:

Tapentadol is a schedule II atypical opioid analgesic that has similar effects to morphine. Individuals entering treatment for misuse of opioid drugs represent high-intensity users, typically with polydrug use. This study compared differences in self-reported past-month abuse of tapentadol to other opioid analgesics.

Purpose/Objectives:

Atypical opioids such as tapentadol, tramadol, and buprenorphine are options for pain treatment with differentiated mechanisms of action comparted to conventional opioids.  Tapentadol is a centrally acting atypical opioid thought to have dual mechanisms of action: mu-receptor agonism and inhibition of norepinephrine reuptake. Since the launch of NUCYNTA (tapentadol immediate release) in 2009, several postmarketing surveillance studies suggest tapentadol abuse and diversion events are rare relative to conventional opioid analgesics. This study compares the abuse of tapentadol to other atypical opioids among individuals entering treatment for opioid use disorder.

Method:

Data were collected from 1^st quarter 2019 through 2^nd quarter 2022 from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System’s Treatment Center Programs Combined. In the Treatment Center Programs Combined, respondents entering treatment for opioid use disorders complete a questionnaire asking about prescription medications abused in the past month. Odds of endorsing opioid abuse were compared between active pharmaceutical ingredients using a mixed effects binomial regression, controlling for dispensing volume in a community and multiple opioid abuse by participants. Unadjusted and prescriptions dispensed adjusted prevalence and odds ratios (OR) were calculated. Prescriptions dispensed estimates were obtained from the IQVIA® (Danbury, CT) US-Based Longitudinal Prescription Data.  National prescriptions dispensed estimates were included in logistic regression models as an offset. Adjusted prevalence estimates were set at 1 million prescriptions dispensed for each drug group.

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 but was for other drugs. The odds of endorsing abuse were statistically significantly greater for oxycodone (OR= 12.9, p< 0.001), hydrocodone (OR= 2.0, p=0.0068), hydromorphone (OR= 22.7, p< 0.001), morphine (OR= 24.5, p< 0.001), oxymorphone (OR= 35.7, p< 0.001) and tramadol (OR= 3.0, p=0.0038) than for tapentadol.

Conclusions: Though the scheduling of tapentadol indicates greater abuse potential than other atypical opioids, we observed that among respondents entering treatment for opioid use disorder, abuse of tapentadol is less frequent than for other atypical opioids. Local drug availability was related to drug abuse for all opioids studied except tapentadol. The odds of abuse of other comparator drugs were much higher than for tapentadol. Although additional research is needed to fully understand the motivations and risks to individuals who abuse tapentadol, our findings suggest that tapentadol is not disproportionately used by individuals entering substance abuse treatment for opioid use disorder compared to other Schedule II opioids. Continued examination and surveillance of tapentadol abuse is needed to assess abuse potential in a real-world setting.

References: Raffa RB, Elling C, Tzschentke TM. Does 'Strong Analgesic' Equal 'Strong Opioid'? Tapentadol and the Concept of 'micro-Load'. Advances in therapy. 2018;35(10):1471-84.

Vosburg SK, Severtson SG, Dart RC, Cicero TJ, Kurtz SP, Parrino MW, et al. Assessment of Tapentadol API Abuse Liability With the Researched Abuse, Diversion and Addiction-Related Surveillance System. The journal of pain: official journal of the American Pain Society. 2018;19(4):439-53.