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Lape EC, Paladino MB, Powers JM, LaRowe LR, Ditre JW. Awareness of the potential consequences of alcohol consumption in the context of chronic pain and prescription opioid use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:517-524. [PMID: 39079104 DOI: 10.1080/00952990.2024.2375515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/18/2024] [Accepted: 06/28/2024] [Indexed: 09/06/2024]
Abstract
Background: Alcohol and prescription opioid use are highly prevalent among chronic pain populations. One-fifth of individuals prescribed opioids report same-day use of alcohol and opioids. Alcohol use and alcohol/opioid co-use can have deleterious pain management and health outcomes. The extent to which individuals with chronic pain are aware of these deleterious outcomes is considerably understudied.Objectives: To explore individuals' understanding of seven health- and pain-related risks of alcohol/alcohol-opioid use. An exploratory aim was to examine whether greater risk awareness was associated with alcohol/opioid use patterns.Methods: Participants included 261 adults age ≥21(36.4% women) endorsing current alcohol use, chronic musculoskeletal pain, and opioid prescription who completed an online survey via Amazon Mechanical Turk.Results: Distribution of the total number of items for which a participant endorsed awareness was as follows: zero (10.7%), one (5.0%), two (13.0%), three (13.8%), four (13.8%), five (11.5%), six (10.0%), and seven items (22.2%). Awareness of the health consequences of alcohol/alcohol-opioid use was positively associated with opioid misuse behaviors (β = .525, ΔR2 = .251, p < .001), and higher-risk alcohol consumption (β = .152, ΔR2 = .021, p = .011).Conclusion: Many adults with chronic pain are unaware of the health consequences of alcohol/alcohol-opioid use. Findings of positive covariation between risk awareness and higher-risk alcohol/opioid use suggest that future interventions among this population should go beyond simple risk education and utilize motivational enhancement to help change decisional balance.
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Affiliation(s)
- Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Michael B Paladino
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica M Powers
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa R LaRowe
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Center for Health Behavior Research and Innovation, College of Arts and Sciences, Syracuse University, Syracuse, NY, USA
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Wilkinson CS, Blount HL, Davis S, Rojas G, Wu L, Murphy NP, Schwendt M, Knackstedt LA. Voluntary alcohol intake alters the motivation to seek intravenous oxycodone and neuronal activation during the reinstatement of oxycodone and sucrose seeking. Sci Rep 2023; 13:19174. [PMID: 37932476 PMCID: PMC10628226 DOI: 10.1038/s41598-023-46111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
Opioid-alcohol polysubstance use is prevalent and worsens treatment outcomes. Here we assessed whether co-consumption of oxycodone and alcohol influence the intake of one another, demand for oxycodone, and the neurocircuitry underlying cue-primed reinstatement of oxycodone-seeking. Male and female rats underwent oxycodone intravenous self-administration (IVSA) with homecage access to alcohol (20% v/v) and/or water immediately after the IVSA session. Next, economic demand for intravenous oxycodone was assessed while access to alcohol and/or water continued. Control rats self-administered sucrose followed by access to alcohol and/or water. Rats underwent a cue-primed reinstatement test and brains were processed for c-fos mRNA expression. While both sexes decreased oxycodone intake if they had access to alcohol, and decreased alcohol intake if they had access to oxycodone, only female oxycodone + alcohol rats exhibited decreased demand elasticity and increased cue-primed reinstatement. Alcohol consumption increased the number of basolateral and central amygdala neurons activated during sucrose and oxycodone reinstatement and the number of ventral and dorsal striatum neurons engaged by sucrose reinstatement. Nucleus accumbens shell dopamine 1 receptor expressing neurons displayed activation patterns consistent with oxycodone reinstatement. Thus, alcohol alters the motivation to seek oxycodone in a sex-dependent manner and the neural circuitry engaged by cue-primed reinstatement of sucrose and oxycodone-seeking.
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Affiliation(s)
- Courtney S Wilkinson
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Harrison L Blount
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Shane Davis
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Giselle Rojas
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
| | - Lizhen Wu
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
| | - Niall P Murphy
- Orthodontics Department, University of Florida, Gainesville, FL, USA
| | - Marek Schwendt
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Lori A Knackstedt
- Psychology Department, University of Florida, 114 Psychology, 945 Center Dr., Gainesville, FL, 32611, USA.
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA.
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Wilkinson CS, Blount HL, Davis S, Rojas G, Wu L, Murphy NP, Schwendt M, Knackstedt LA. Voluntary alcohol intake alters the motivation to seek intravenous oxycodone and neuronal activation during the reinstatement of oxycodone and sucrose seeking. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.20.549769. [PMID: 37546763 PMCID: PMC10401968 DOI: 10.1101/2023.07.20.549769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Opioid-alcohol polysubstance use is prevalent and worsens treatment outcomes. Here we assessed whether co-consumption of oxycodone and alcohol would influence intake of one another, demand for oxycodone, and the neurocircuitry underlying cue-primed reinstatement of oxycodone-seeking. Male and female rats underwent oxycodone intravenous self-administration (IVSA) with access to either alcohol (20% v/v) and water or only water immediately after the IVSA session. Next, economic demand for intravenous oxycodone was assessed while access to alcohol and/or water continued. Control rats self-administered sucrose followed by access to alcohol and/or water. Rats underwent extinction training and brains were processed for c-fos mRNA expression immediately following a cue-primed reinstatement test. While both sexes decreased oxycodone intake if they had access to alcohol, and decreased alcohol intake if they had access to oxycodone, female oxycodone+alcohol rats exhibited decreased demand elasticity for intravenous oxycodone and increased cue-primed reinstatement while male rats did not. Spontaneous withdrawal signs were correlated with oxycodone intake while alcohol intake was correlated with anxiety-like behavior. Alcohol consumption increased the number of basolateral and central amygdala neurons activated during sucrose and oxycodone reinstatement and the number of ventral and dorsal striatum neurons engaged by sucrose reinstatement. Nucleus accumbens shell dopamine 1 receptor containing neurons displayed activation patterns consistent with oxycodone reinstatement. Thus, alcohol alters the motivation to seek oxycodone in a sex-dependent manner and alters the neural circuitry engaged by cue-primed reinstatement of sucrose and oxycodone-seeking.
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Affiliation(s)
- Courtney S. Wilkinson
- Psychology Dept. University of Florida, Gainesville, FL
- Center for Addiction Research and Education, University of Florida, Gainesville, FL
| | - Harrison L. Blount
- Psychology Dept. University of Florida, Gainesville, FL
- Center for Addiction Research and Education, University of Florida, Gainesville, FL
| | - Shane Davis
- Psychology Dept. University of Florida, Gainesville, FL
- Center for Addiction Research and Education, University of Florida, Gainesville, FL
| | - Giselle Rojas
- Psychology Dept. University of Florida, Gainesville, FL
| | - Lizhen Wu
- Psychology Dept. University of Florida, Gainesville, FL
| | | | - Marek Schwendt
- Psychology Dept. University of Florida, Gainesville, FL
- Center for Addiction Research and Education, University of Florida, Gainesville, FL
| | - Lori A. Knackstedt
- Psychology Dept. University of Florida, Gainesville, FL
- Center for Addiction Research and Education, University of Florida, Gainesville, FL
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Powers JM, Lape EC, LaRowe LR, Hooker JE, Heckman BW, Ditre JW. Initial Validation of the Intentions to Co-Use Alcohol and Opioids Scale. J Psychoactive Drugs 2023; 55:369-377. [PMID: 35574916 PMCID: PMC9761858 DOI: 10.1080/02791072.2022.2075713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/26/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Co-use of alcohol and prescription opioid medication increases risk for harmful and potentially fatal health effects (e.g., overdose). Behavioral intentions (i.e., the immediate antecedent of corresponding behavior according to the Theory of Planned Behavior) are important in prediction of substance use, and a valid measure assessing intentions to co-use alcohol and opioids is needed to identify individuals at-risk for harmful substance use. The goal of the current study was to develop and conduct the psychometric validation of a six-item Intentions to Co-Use Alcohol and Opioids (ICAO) scale. Participants included 261 (Mage = 38; 64% male) past-month drinkers with a current opioid prescription and chronic musculoskeletal pain who completed a targeted online survey. Confirmatory factor analysis indicated that a single-factor structure provided good model fit (Bollen-Stine bootstrap p = .121). Moreover, the ICAO demonstrated high internal consistency (α = .96) and was correlated with measures of alcohol and opioid use/co-use. These findings provide support for the single-factor structure, reliability, and concurrent/convergent validity of the ICAO among individuals who endorse alcohol use, opioid use, and chronic musculoskeletal pain. The ICAO may offer clinical utility as a tool to identify individuals at greater risk of potentially fatal co-use of alcohol and opioid medications.
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Affiliation(s)
- Jessica M. Powers
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Emma C. Lape
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Lisa R. LaRowe
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, United States
| | - Julia E. Hooker
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Bryan W. Heckman
- Psychiatry & Behavioral Sciences, Meharry Medical College, Nashville, TN 37208, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
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Vowles KE, Schmidt ZS, Ford CG. Opioid and Alcohol Misuse in Veterans with Chronic Pain: A Risk Screening Study. THE JOURNAL OF PAIN 2022; 23:1790-1798. [PMID: 35753662 DOI: 10.1016/j.jpain.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
In United States military veterans, chronic pain represents a risk factor for opioid and alcohol misuse, yet few studies have examined interactions among chronic pain, opioid prescription, and opioid and alcohol misuse. Previous work found substantial risk of co-morbid alcohol and opioid misuse in a community sample of opioid-prescribed individuals with chronic pain, a finding expanded upon here. Specifically, 211 veterans assessed within a chronic pain treatment service for opioid-prescribed individuals completed self-report measures of opioid misuse, alcohol misuse, pain intensity, depression, pain catastrophizing, and post-traumatic stress symptoms (PTS). Based on the substance misuse measures, 32% (n = 68) were misusing neither opioids nor alcohol, 23% (n = 48) were misusing both opioids and alcohol, 40% (n = 84) were misusing opioids alone, and 5% (n = 11) were misusing alcohol alone. Group comparisons indicated that individuals not misusing either substance were less distressed in comparison to those who were misusing opioids alone or both substances. The latter groups differed in PTS. Overall, misuse frequencies mirrored previous work, with approximately 1 of 3 misusing opioids and approximately 1 of 5 misusing both substances. There is a need for increased focus on both polysubstance misuse and the development of integrated treatment.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast & Belfast Centre for Chronic Pain Rehabilitation, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
| | - Zachary S Schmidt
- Raymond G. Murphy Veterans Affairs Medical Center, New Mexico VA Healthcare System, Albuquerque, New Mexico, United States of America
| | - C Graham Ford
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
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Zale EL, Powers JM, Ditre JW. Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain. Alcohol Res 2021; 41:08. [PMID: 34306903 PMCID: PMC8289456 DOI: 10.35946/arcr.v41.1.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.
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Affiliation(s)
- Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York
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Drug addiction co-morbidity with alcohol: Neurobiological insights. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 157:409-472. [PMID: 33648675 DOI: 10.1016/bs.irn.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Addiction is a chronic disorder that consists of a three-stage cycle of binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These stages involve, respectively, neuroadaptations in brain circuits involved in incentive salience and habit formation, stress surfeit and reward deficit, and executive function. Much research on addiction focuses on the neurobiology underlying single drug use. However, alcohol use disorder (AUD) can be co-morbid with substance use disorder (SUD), called dual dependence. The limited epidemiological data on dual dependence indicates that there is a large population of individuals suffering from addiction who are dependent on more than one drug and/or alcohol, yet dual dependence remains understudied in addiction research. Here, we review neurobiological data on neurotransmitter and neuropeptide systems that are known to contribute to addiction pathology and how the involvement of these systems is consistent or divergent across drug classes. In particular, we highlight the dopamine, opioid, corticotropin-releasing factor, norepinephrine, hypocretin/orexin, glucocorticoid, neuroimmune signaling, endocannabinoid, glutamate, and GABA systems. We also discuss the limited research on these systems in dual dependence. Collectively, these studies demonstrate that the use of multiple drugs can produce neuroadaptations that are distinct from single drug use. Further investigation into the neurobiology of dual dependence is necessary to develop effective treatments for addiction to multiple drugs.
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LaRowe LR, Powers JM, Garey L, Rogers AH, Zvolensky MJ, Ditre JW. Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain. Drug Alcohol Depend 2020; 214:108171. [PMID: 32679522 PMCID: PMC7423687 DOI: 10.1016/j.drugalcdep.2020.108171] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Both alcohol and prescription opioid use/misuse are highly prevalent among individuals with chronic pain. Co-use of alcohol and prescription opioids is also common, despite contraindications due to increased risk of negative health effects and mortality. There is evidence that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with heavier drinking and prescription opioid use/co-use, and that these associations may be especially salient among men. METHODS This study is the first examination of pain-related anxiety in relation to hazardous alcohol use, prescription opioid use/misuse, and alcohol-opioid co-use. Participants included 1812 adults with chronic low back pain (69 % female, Mage = 43.95) who completed an online survey assessing health behaviors. RESULTS Pain-related anxiety was positively associated with indices of alcohol (i.e., alcohol-related consequences) and opioid use (i.e., prescription opioid use/misuse, daily opioid consumption). Of note, sex moderated associations between pain-related anxiety and both alcohol-related consequences and prescription opioid misuse. In addition to being associated with alcohol and prescription opioid use, independently, pain-related anxiety was also associated with greater likelihood of endorsing co-use of alcohol and opioids and engaging in concurrent hazardous drinking and prescription opioid misuse. CONCLUSIONS These findings contribute to a growing literature suggesting that pain-related anxiety is an important transdiagnostic factor in pain and alcohol and prescription opioid use/co-use, perhaps especially among males.
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Affiliation(s)
- Lisa R LaRowe
- Department of Psychology, Syracuse University, United States
| | | | - Lorra Garey
- Department of Psychology, University of Houston, United States
| | - Andrew H Rogers
- Department of Psychology, University of Houston, United States
| | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, United States.
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Vowles KE, Witkiewitz K, Pielech M, Edwards KA, McEntee ML, Bailey RW, Bolling L, Sullivan MD. Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status. THE JOURNAL OF PAIN 2018; 19:1181-1188. [PMID: 29758355 DOI: 10.1016/j.jpain.2018.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/16/2018] [Accepted: 04/29/2018] [Indexed: 12/11/2022]
Abstract
Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n = 47) were not misusing either opioids or alcohol, 22.9% (n = 30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n = 4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone. PERSPECTIVE Opioid and alcohol misuse was examined in 131 individuals prescribed opioids for chronic pain. In total, 35.9% were not misusing either, 22.9% were misusing both, 38.2% were misusing opioids, and 3.1% were misusing alcohol. Individuals not misusing either were generally less disabled and distressed compared to those misusing opioids or both.
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Affiliation(s)
- Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Melissa Pielech
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Karlyn A Edwards
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mindy L McEntee
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Robert W Bailey
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Lena Bolling
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mark D Sullivan
- University of Washington, Departments of Psychiatry and Behavioral Sciences, Seattle, Washington
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Larance B, Dobbins T, Peacock A, Ali R, Bruno R, Lintzeris N, Farrell M, Degenhardt L. 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. Lancet Psychiatry 2018; 5:155-166. [PMID: 29336948 DOI: 10.1016/s2215-0366(18)30003-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Escalation of pharmaceutical opioid use and harm in North America is well-documented, with similar issues 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 comprehensive examination of the impact of a new opioid formulation to date, assessing the effect of tamper-resistant formulation of controlled-release oxycodone on population-level opioid use and opioid-related harm (ie, overdose, help-seeking, and treatment-seeking); and opioid use, tampering, and preference for the tamper-resistant formulation of controlled-release oxycodone compared with other drugs or formulations among sentinel populations likely to tamper with pharmaceutical opioids. METHODS We conducted interrupted time-series analyses of opioid sales data and multiple routinely collected health datasets, followed up a cohort of people who tamper with pharmaceutical opioids before and after the introduction of the tamper-resistant formulation of controlled-release oxycodone, and analysed annual surveys of people who inject drugs. 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 given indicator. FINDINGS At the population level, we found reduced sales of higher strengths of controlled-release oxycodone and increased sales of other oxycodone formulations. No significant effect was observed among population-level indicators of opioid overdose, or help or treatment-seeking. Mortality data were not available for inclusion at the time of our study. Meta-analyses across sentinel populations (ie, prospective cohort, surveys of people who inject drugs, and clients of supervised injecting facilities or needle and syringe programmes) indicated reduced controlled-release oxycodone 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 opioids among people who inject drugs, but did not affect population-level opioid use or harm. FUNDING Mundipharma Australia, the Australian Government, and the National Health and Medical Research Council.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Robert Ali
- Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nicholas Lintzeris
- Sydney Medical School, Sydney University, Sydney, NSW, Australia; The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Global Health, School of Public Health, University of Washington, Washington, DC, USA
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