Citation

Green JL, Bucher Bartelson B, Le Lait MC, Roland CL, Masters ET, Mardekian J, Bailey JE, Dart RC. Drug Alcohol Depend. 2017; 175: 140-145.

Affiliation

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.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2017.01.039

PMID

28414990

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.

Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Language: en

Keywords

Abuse- deterrent; Medical outcomes; Opioid abuse; Prescription drug abuse; Route of abuse