Drop in opioid Rx, overdoses linked to pharmacy changes

The introduction of abuse-deterrent OxyContin, coupled with the removal of propoxyphene from the US prescription marketplace, may have played a role in decreasing opioid prescribing and overdoses, according to a study published in JAMA Internal Medicine.

These 2 changes led to a 19% drop in prescription opioid supply that was mirrored by a 20% drop in prescription opioid overdose between August 2010 and December 2012. The drop in prescription opioid overdose was partially offset by an increase in overdose due to heroin.

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The pharmaceutical industry has developed formulations designed to reduce misuse of opioid medications, including making pills resistant to crushing and dissolving. FDA approved an abuse-deterrent form of OxyContin that was made available by prescription in August 2010. Additionally, propoxyphene, which was approved by FDA in 1957 to treat pain but was shown to have high rates of overdose deaths and cardiac side effects, was pulled from the market in November 2010.

Researchers from Boston Medical Center, in collaboration with Harvard Medical School, examined claims from a large US commercial health insurer of 31.3 million members between aged 18 and 64 years between January 2003 and December 2012. The researchers used an interrupted time series analysis to analyze change in prescribing and overdose outcomes after reformulation of extended-release (ER) oxycodone and withdrawal of propoxyphene. 

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OxyContin prescribing dropped by 39% in the 2 years after the formulation change. There was no evidence that people switched to alternative extended-release prescription pain medications, nor did the cost of OxyContin rise for consumers during the study period.

“Managed care formulary managers may want to reevaluate their formulary coverage for OxyContin,” according to lead study author Marc LaRochelle, MD, MPH, research scientist and physician at Boston Medical Center. “This is especially true if past coverage decisions were made based on concern of the increased risk due to the older non-abuse-deterrent formulation.

“The weight of data to date support that the new abuse-deterrent formulation is likely safer than the older formulation,” Dr LaRochelle continued. “However, the old product was also a very common target for those who misused opioids. However, what remains unclear is if the new abuse-deterrent OxyContin is safer than alternative ER/ long-acting [LA] opioid formulations, and as such should be the ER/LA opioid of choice. I am not aware of good data about about whether or not existing ER/LA opioids without formal abuse-deterrent properties are riskier than the new OxyContin formulation,” Dr LaRochelle said.

The number of overdose deaths from prescription opioid abuse quadrupled in the United States between 1999 and 2010; and sales of prescription opioids skyrocketed during that same timeframe. National data has shown that areas with higher prescription opioid rates have higher overdose rates.

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