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The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study

Larance, B, Dobbins, T, Peacock, A ORCID: 0000-0002-5705-2026, Ali, R, Bruno, R ORCID: 0000-0001-6673-833X, Lintzeris, N, Farrell, M and Degenhardt, L 2018 , 'The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study' , The Lancet Psychiatry, vol. 5, no. 2 , pp. 155-166 , doi:

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Background: Escalation of pharmaceutical opioid use and harm in North America is well-documented, with similarissues emerging in Australia. One response is the development of tamper-resistant formulations of opioids.A potentially tamper-resistant formulation of controlled-release oxycodone was introduced in Australia in April, 2014,rapidly replacing the non-tamper-resistant formulation. Our study is the most systematic and comprehensiveexamination of the impact of a new opioid formulation to date, assessing the effect of tamper-resistant formulation ofcontrolled-release oxycodone on population-level opioid use and opioid-related harm (ie, overdose, help-seeking, andtreatment-seeking); and opioid use, tampering, and preference for the tamper-resistant formulation of controlledreleaseoxycodone compared with other drugs or formulations among sentinel populations likely to tamper withpharmaceutical opioids.Methods: We conducted interrupted time-series analyses of opioid sales data and multiple routinely collected healthdatasets, followed up a cohort of people who tamper with pharmaceutical opioids before and after the introduction ofthe tamper-resistant formulation of controlled-release oxycodone, and analysed annual surveys of people who injectdrugs. Data were collected from several Australian states: New South Wales, South Australia, and Tasmania.Meta-analyses (weighted Z tests) were conducted to synthesise across data sources providing evidence for a givenindicator.Findings: At the population level, we found reduced sales of higher strengths of controlled-release oxycodone andincreased sales of other oxycodone formulations. No significant effect was observed among population-level indicatorsof opioid overdose, or help or treatment-seeking. Mortality data were not available for inclusion at the time of ourstudy. Meta-analyses across sentinel populations (ie, prospective cohort, surveys of people who inject drugs, andclients of supervised injecting facilities or needle and syringe programmes) indicated reduced controlled-releaseoxycodone use via tampering (mainly injection), with no evidence of switching to heroin or other drug use.Interpretation: This formulation of controlled-release oxycodone reduced tampering with pharmaceutical opioidsamong people who inject drugs, but did not affect population-level opioid use or harm.

Item Type: Article
Authors/Creators:Larance, B and Dobbins, T and Peacock, A and Ali, R and Bruno, R and Lintzeris, N and Farrell, M and Degenhardt, L
Keywords: pharmaceutical opioid; tampering; opioid misuse
Journal or Publication Title: The Lancet Psychiatry
Publisher: The Lancet Publishing Group
ISSN: 2215-0366
DOI / ID Number:
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Copyright 2018 Elsevier Ltd.

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