The Lancet Psychiatry: Tamper-resistant oxycodone tablets have no impact on overall opioid use or harm

March 2018

Tamper-resistant tablets prove less attractive to people who inject drugs, but have little effect on population level issues linked to overprescribing, overuse, and harm of opioids.

The introduction of tamper-resistant opioid tablets does not have an effect on rates of opioid use or harms at a population level, according to a new study in The Lancet Psychiatry journal.

A tamper resistant, difficult to crush formulation of OxyContin, a strong opioid prescribed for chronic pain management, was introduced in Australia in April 2014 in response to growing concerns about its contribution to an increase in opioid use and related harms.

Led by the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, the National Opioid Medications Abuse Deterrence (NOMAD) study is the most comprehensive analysis of the impact of tamper-resistant opioid formulations to date.

The study used both sales and health data across Australia, as well as survey data from a cohort of 600 people who misuse pharmaceutical opioids, to measure the new formulation’s impact on population-level opioid use and opioid-related harm as well as opioid use and tampering among high risk populations.

While the study found that people who inject drugs were less likely to tamper with the tablets, the lack of any significant effect on opioid use or harms highlights the need for a multifaceted approach to opioid overuse.

“Although the introduction of this tamper-resistant formulation resulted in less use of that particular opioid among people who inject drugs, its introduction must be considered as part of a multifaceted response. This includes increasing the availability of non-medication approaches to chronic pain, good clinical practice in long-term opioid treatment, and harm reduction among people who use opioids outside the recommendations of their prescriber,” NDARC’s Dr Briony Larance said.

“Approximately 2.9 million Australians were prescribed an opioid in 2014, compared with an estimated 93,000 people who injected drugs. As a population-wide strategy to reduce harm of overuse or overprescription of opioids, the introduction of tamper-resistant formulations alone will not be sufficient to affect these outcomes.”

The opioid epidemic in the USA is widely documented and similar problems in Australia are emerging, with opioid use in 2012, 15 times that reported in 1992. Pharmaceutical opioids cause more than 70% of opioid overdose deaths in Australia – similar rates to the USA.

The NOMAD study analysed a total of 17 data sources including opioid sales data, multiple health datasets, annual surveys of people who inject drugs, and a cohort of 606 people who reported tampering with opioids before and after the introduction of tamper-resistant tablets. Data from three Australian states (New South Wales, South Australia and Tasmania) were included in the study.

Please visit the NDARC website to read the full media release from The Lancet Psychiatry.