Two major changes in the pharmaceutical market may have contributed to a reduction in opioid dispensing and overdose rates between 2010 and 2012, a new study suggests.
 
Researchers from Boston Medical Center and Harvard Medical School, in Boston, analyzed claims from a large national U.S. health insurer to determine the effect that the introduction of abuse-deterrent OxyContin (oxycodone hydrochloride controlled-release, Purdue) and the removal of propoxyphene had on the opioid market. Study participants included an open cohort of 31.3 million members, aged 18 to 64 years, insured between Jan. 1, 2003 and Dec. 31, 2012. Primary outcomes of the study were rates for standardized opioid dispensing and for prescription opioid and heroin overdose. The researchers used segmented regression to analyze changes in outcomes from 30 quarters before the market changes to eight quarters after.
 
They found that total opioid dispensing decreased by 19% in the two years following the changes (absolute change of –32.2 mg morphine equivalent dose per member per quarter; 95% confidence interval [CI], –38.1 to –26.3). The rate for prescription opioid–related overdoses decreased by 20% (absolute change, −1.10 per 100,000 members per quarter; 95% CI, −1.47 to −0.74]), whereas the rate for heroin-related overdoses increased by 23% (absolute change, 0.26 per 100,000 members per quarter; 95% CI, −0.01 to 0.53).
 
"Given the decreased supply of prescription opioids, those seeking out an opioid could be turning to heroin, which may partially explain the tremendous increase in heroin overdose deaths over the past few years locally and nationally," said Marc Larochelle, MD, study author and assistant professor of medicine at Boston University School of Medicine, in a press release.
 
The researchers did not find any changes in the type of pain medication used or the cost of OxyContin during the study period. Dr. Larochelle said the results of this study suggest that people "prescribed OxyContin before it was reformulated may have been diverting or misusing the drug."
 
Abuse-deterrent OxyContin was introduced on Aug. 9, 2010. Propoxyphene, an opioid pain reliever for mild to moderate pain, was removed on Nov. 19, 2010. The researchers concluded that pharmaceutical market interventions may help the opioid problem, but complementary strategies are needed.
 
"Our results indicate the potential of pharmaceutical changes in helping to combat the opioid epidemic, but we stress the need for complementary interventions targeting the identification and treatment of addiction to curb opioid abuse," Dr. Larochelle said.
 
The findings were published online in JAMA Intern Med on April 20, 2015.
PMN Staff
Based on a press release from Boston University Medical Center.