Postmarketing analysis of misuse, abuse, and diversion of Xtampza ER

Abstract

Objective. To evaluate abuse, misuse, and diversion of Xtampza ER, an extended-release (ER) abuse-deterrent formulation (ADF) of oxycodone. Methods. Abuse, misuse, and diversion of Xtampza ER were assessed using Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System data sources. Xtampza ER was compared with immediate-release (IR) oxycodone, other ADF ER products combined, and non-ADF ER products combined. Results. Xtampza ER prescriptions increased 50-fold during the study period. In contrast, cases from poison centers, substance abuse treatment centers, and diversion were infrequent and did not increase. Adjusted for prescriptions dispensed, poison center exposures were greater for IR oxycodone (rate ratio [RR] 2.3, P0.008), other ADF ER opioids (RR = 5.2, P<0.001), and non-ADF ER opioids (RR = 2.5, P=0.004) than for Xtampza ER. In Treatment Center Programs Combined, past-month abuse prevalence for other ADF ER opioids (odds ratio [OR] = 7.4, P<0.001) and non-ADF ER opioids (OR=2.0, P=0.002) was greater than Xtampza ER; IR oxycodone was not significantly different (OR=1.2, P=0.349). In the Drug Diversion Program, rates for IR oxycodone (RR=3.7, P=0.003), other ADF ER opioids (RR=4.2, P=0.002), and non-ADF ER opioids (RR=3.4, P=0.007) were greater than Xtampza ER. Adjustment using morphine equivalents provided similar results, except that IR oxycodone in Treatment Center Programs Combined became higher than Xtampza ER. Nonoral abuse cases involving Xtampza ER were infrequent; Web monitoring data support findings that Xtampza ER is difficult to abuse nonorally. Conclusion. Xtampza ER abuse, misuse, and diversion and tampering are low relative to other prescription opioid analgesics. Abuse and diversion did not increase over the study period.