Jody L Green1, Becki Bucher Bartelson2, M Claire Le Lait3, Carl L Roland4, Elizabeth T Masters5, Jack Mardekian6, J Elise Bailey7, Richard C Dart8. 1. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA. Electronic address: Jody.Green@rmpdc.org. 2. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA. Electronic address: Becki.BucherBartelson@rmpdc.org. 3. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA. Electronic address: Marie-Claire.LeLait@rmpdc.org. 4. Pfizer Inc, 4222 Emperor Blvd., Suite 335, Durham, NC 27703 USA. Electronic address: Carl.Roland@pfizer.com. 5. Pfizer Inc, 235 E 42 St, New York, NY 10017 USA. Electronic address: Elizabeth.Masters@pfizer.com. 6. Pfizer Inc, 235 E 42 St, New York, NY 10017 USA. Electronic address: Jack.Mardekian@pfizer.com. 7. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA. Electronic address: Elise.Bailey@rmpdc.org. 8. Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA. Electronic address: Richard.Dart@rmpdc.org.
Abstract
BACKGROUND: Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. METHODS: This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. RESULTS: While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. CONCLUSION: Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.
BACKGROUND: Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. METHODS: This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. RESULTS: While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. CONCLUSION: Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.
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