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Plæhn G, Fuglsang T, Hindersson P, Breindahl T. Adverse effects from counterfeit and mislabeled medicine containing tapentadol and carisoprodol. Clin Case Rep 2024; 12:e9241. [PMID: 39114837 PMCID: PMC11303665 DOI: 10.1002/ccr3.9241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
When self-administration with counterfeit or mislabeled medicine is suspected, comprehensive laboratory analysis should be preferred over immunoassay screening to avoid false negative results. Carisoprodol, which was formerly a popular muscle relaxant drug in many countries, has reappeared on illegal drug markets, and may cause an itching, purple-colored rash, even after a single dose.
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Affiliation(s)
- Gitte Plæhn
- KABS Stjernevang, Drug and Alcohol Rehabilitation CentreCopenhagenDenmark
| | - Thomas Fuglsang
- KABS Stjernevang, Drug and Alcohol Rehabilitation CentreCopenhagenDenmark
| | - Peter Hindersson
- Department of Clinical BiochemistryNorth Denmark Regional HospitalHjørringDenmark
| | - Torben Breindahl
- Department of Clinical BiochemistryNorth Denmark Regional HospitalHjørringDenmark
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2
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Lamy FR, Meemon N. Exploring Twitter chatter to assess the type and availability of cannabis-related products in Thailand. J Ethn Subst Abuse 2024:1-21. [PMID: 38949657 DOI: 10.1080/15332640.2024.2367253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Cannabis-related tweets were collected between January and April 2022 to estimate the availability and characteristics of cannabis products advertised on Twitter amid the legalization of recreational cannabis in Thailand. The Twitter API was called using the tweepy Python library to collect cannabis-related tweets in the Thai language. A total of 185,558 unique tweets were collected over the duration of the data collection period based on 83 search terms. Twenty thousand random tweets were manually coded by four Thai native speakers to assess the volume and characteristics of tweets proposing cannabis. 72.6% of collected tweets from the 20,000 random samples were coded as relevant to the study. 54.6% of relevant tweets were advertising cannabis products, 29.8% were personal communications, and 15.6% were related to news or media content. Among the tweets that advertised cannabis products, 94.4% proposed cannabis flower, 2.4% cannabis edibles and 1.8% cannabis concentrates. Consumption of potent forms of cannabis such as cannabis edibles and concentrates increase the risk of harmful side-effects, especially in a population with limited knowledge about these products. Our findings call for additional monitoring efforts and for increasing the public awareness on potent cannabis products emerging in Thailand.
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Affiliation(s)
- Francois R Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
- Health Solutions Research Unit, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
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3
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Stephenson L, van den Heuvel C, Humphries M, Scott T, Byard RW. Increased incidence of mixed drug toxicity deaths involving tapentadol - A forensic study. MEDICINE, SCIENCE, AND THE LAW 2024; 64:113-120. [PMID: 37350115 DOI: 10.1177/00258024231183504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Tapentadol is a relatively new synthetic opioid analgesic prescribed for the management of moderate to severe pain. While tapentadol has been shown to be more effective than traditional opioid analgesics, it still carries the risk of addiction, abuse, and misuse. In Australia, tapentadol has become one of the top five most commonly prescribed opioid drugs, with prescriptions increasing by approximately 150,000 each year since it first became available. The rapid increase in tapentadol prescriptions has occurred in parallel to an increasing number of post-mortem tapentadol detections in South Australia (SA). While the number of deaths in SA related to tapentadol use was low in the current study, findings suggest that an increasing trend of deaths involving tapentadol will continue in parallel to a rapidly increasing number of prescriptions, mirroring trends associated with traditional opioids in SA. As a comparatively new opioid analgesic, monitoring future trends will be important to determine if additional prescribing education, intervention, or restrictions are required.
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Affiliation(s)
- Lilli Stephenson
- School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | | | - Melissa Humphries
- School of Mathematical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Timothy Scott
- Forensic Science SA (FSSA), Adelaide, SA, Australia
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Roger W Byard
- School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
- Forensic Science SA (FSSA), Adelaide, SA, Australia
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Vosburg SK, Dailey-Govoni T, Beaumont J, Butler SF, Green JL. Characterizing the Experience of Tapentadol Nonmedical Use: Mixed Methods Study. JMIR Form Res 2022; 6:e16996. [PMID: 35687397 PMCID: PMC9233245 DOI: 10.2196/16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/19/2022] [Accepted: 04/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of abuse, diversion, and web-based endorsement of tapentadol (extended-release [ER], immediate-release [IR]) has been characterized as low compared with other prescription opioids. Little is known about individual experience with tapentadol nonmedical use (NMU). Objective This study aims to pilot web-based survey technologies to investigate the motivation for tapentadol NMU, sources of procurement, routes of administration, tampering methods, doses used, and impressions of tapentadol products (Nucynta and Nucynta ER). Methods Recruitment flyers and banner advertisements were placed on the Bluelight website [DragonByte Technologies Ltd] with a link to a web-based survey (Qualtrics) designed to query about individuals’ lifetime tapentadol NMU. This web-based survey was followed by an interactive web-based chat (Cryptocat) with respondents who were willing to be contacted. Respondents were queried about sources for obtaining tapentadol, motives for use, routes of administration, tampering methods, drugs used in combination, tablet strengths and dosages, and reasons for continued or discontinued use. Desirability and attractiveness for NMU was rated. Results Web-based recruitment successfully attracted difficult-to-find study participants. A total of 78 participants reported that tapentadol was obtained from friends and family (ER 11/30, 37%; IR 18/67, 27%), the internet (ER 11/30, 37%; IR 12/67, 18%) or participants’ own prescriptions from a doctor (ER 9/30, 30%; IR 17/67, 25%). It was used nonmedically for pain relief (ER 18/30, 60%; IR 33/67, 49%) and multiple psychotropic effects, including relaxation (ER 13/30, 43%; IR 29/67, 43%), reduction in depression or anxiety (ER 7/30, 23%; IR 30/67, 45%), or getting high (ER 12/30, 40%; IR 33/67, 49%). Tapentadol was primarily swallowed (ER 22/30, 73%; IR 55/67, 82%), although snorting (ER 2/30, 7%; IR 8/67, 12%) and injection (ER 2/30, 7%; IR 5/67, 8%) were also reported. The preferred dose for NMU was 100 mg (both ER and IR). The participants reported tapentadol use with benzodiazepines (ER 12/21, 57%; IR 28/47, 60%). Most participants had discontinued tapentadol NMU at the time of survey completion (ER 22/30, 73%; IR 55/67, 82%). Reasons for discontinued ER NMU included side effects (10/22, 46%) and lack of effective treatment (10/22, 46%). Reasons for discontinued IR NMU included lack of access (26/55, 47%) and better NMU options (IR 21/55, 38%). Few individuals were willing to divulge identifying information about themselves for the interactive chat (8/78, 10%), demonstrating the strength of anonymous, web-based surveys. Interactive chat supported the survey findings. A subgroup of participants (4/78, 5%) reported hallucinogenic side effects with high doses. Conclusions Web-based surveys can successfully recruit individuals who report drug NMU and those who are difficult to find. Tapentadol NMU appears to occur primarily for pain relief and for its psychotropic effects. Although it was liked by some, tapentadol did not receive a robust pattern of endorsement for NMU.
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Affiliation(s)
- Suzanne K Vosburg
- Inflexxion, An Uprise Health | IBH Company, Irvine, CA, United States
| | | | - Jared Beaumont
- Inflexxion, An Uprise Health | IBH Company, Irvine, CA, United States
| | - Stephen F Butler
- Inflexxion, An Uprise Health | IBH Company, Irvine, CA, United States
| | - Jody L Green
- Inflexxion, An Uprise Health | IBH Company, Irvine, CA, United States
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5
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Vosburg SK, Beaumont J, Dailey-Govoni ST, Butler SF, Green JL. Evaluation of Abuse and Route of Administration of Extended-Release Tapentadol Among Treatment-Seeking Individuals, as Captured by the Addiction Severity Index-Multimedia Version (ASI-MV). PAIN MEDICINE 2021; 21:1891-1901. [PMID: 31617931 PMCID: PMC7553020 DOI: 10.1093/pm/pnz250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Tapentadol is a molecule incorporating mu opioid receptor agonism and norepinephrine reuptake inhibition to provide analgesia, with the potential for a lower incidence of gastrointestinal side effects than full mu opioid agonists. Postmarketing surveillance of tapentadol as an active pharmaceutical ingredient has consistently revealed low levels of abuse and diversion. Objective The purpose of the present study was to further characterize the abuse liability of tapentadol extended-release (ER) by evaluating the prevalence of past 30-day tapentadol ER abuse and reported routes of administration as compared with ER opioids with Food and Drug Administration (FDA) abuse-deterrent labeling (“ADF opioids”) and ER opioids without FDA abuse-deterrent labeling (“non-ADF opioids”). Methods Data were collected from January 2014 through December 2017 from 776 centers located in 43 states throughout the United States using the Addiction Severity Index–Multimedia Version (ASI-MV), an instrument that is integral to the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO, Inflexxion, an IBH Company, Costa Mesa, CA, USA). Results Tapentadol ER had lower rates of past 30-day abuse than ADF ER and non-ADF ER opioid comparators, both at a population level and when adjusted for drug utilization. Tapentadol ER was primarily abused orally, although it was also abused through alternate routes of administration. Cumulative rates of tapentadol ER abuse by alternative routes of administration were lower than both ADF and non-ADF ER opioid comparators, although large confidence intervals resulting from the small sample size of reported tapentadol ER use limit firm conclusions. Conclusions In summary, tapentadol ER was found to have lower rates of both past 30-day abuse and use via alternate routes of administration, specifically snorting and smoking, than ADF and non-ADF ER comparators.
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Affiliation(s)
| | | | | | | | - Jody L Green
- Inflexxion, an IBH Company, Costa Mesa, California, USA
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6
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Sarker A, DeRoos A, Perrone J. Mining social media for prescription medication abuse monitoring: a review and proposal for a data-centric framework. J Am Med Inform Assoc 2021; 27:315-329. [PMID: 31584645 PMCID: PMC7025330 DOI: 10.1093/jamia/ocz162] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/14/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Prescription medication (PM) misuse and abuse is a major health problem globally, and a number of recent studies have focused on exploring social media as a resource for monitoring nonmedical PM use. Our objectives are to present a methodological review of social media–based PM abuse or misuse monitoring studies, and to propose a potential generalizable, data-centric processing pipeline for the curation of data from this resource. Materials and Methods We identified studies involving social media, PMs, and misuse or abuse (inclusion criteria) from Medline, Embase, Scopus, Web of Science, and Google Scholar. We categorized studies based on multiple characteristics including but not limited to data size; social media source(s); medications studied; and primary objectives, methods, and findings. Results A total of 39 studies met our inclusion criteria, with 31 (∼79.5%) published since 2015. Twitter has been the most popular resource, with Reddit and Instagram gaining popularity recently. Early studies focused mostly on manual, qualitative analyses, with a growing trend toward the use of data-centric methods involving natural language processing and machine learning. Discussion There is a paucity of standardized, data-centric frameworks for curating social media data for task-specific analyses and near real-time surveillance of nonmedical PM use. Many existing studies do not quantify human agreements for manual annotation tasks or take into account the presence of noise in data. Conclusion The development of reproducible and standardized data-centric frameworks that build on the current state-of-the-art methods in data and text mining may enable effective utilization of social media data for understanding and monitoring nonmedical PM use.
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Affiliation(s)
- Abeed Sarker
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Annika DeRoos
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Hockenhull J, Black JC, Bletz A, Margolin Z, Olson R, Wood DM, Dart RC, Dargan PI. An evaluation of online discussion relating to nonmedical use of prescription opioids within the UK. Br J Clin Pharmacol 2020; 87:1637-1646. [PMID: 33464643 DOI: 10.1111/bcp.14603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/21/2020] [Accepted: 09/30/2020] [Indexed: 01/06/2023] Open
Abstract
AIM To identify and describe the nature of online discussion relating to prescription opioids within the UK. METHODS We performed analysis of posts originating in the UK related to buprenorphine, hydrocodone, oxycodone and tramadol using Social Studio, a web-monitoring platform. The study included posts published between January 2014 and December 2016. The data were cleaned to produce a final dataset consisting only of substantive mentions, which were then categorised by defined themes. RESULTS The final dataset included a total of 17 361 substantive mentions (2936 buprenorphine, 2894 hydrocodone, 3826 oxycodone and 7705 tramadol). The most common theme for all 4 drugs was sharing experience or opinion comprising over 90% of mentions for each drug, while discussion related to polysubstance use was present in >1/4 of mentions across drug substances. Mentions related to diversion were more common for hydrocodone and oxycodone (8.1% [6.3-10.1 95% confidence interval] and 7.8% [6.5-9.2], respectively) than buprenorphine or tramadol (4.1 and 3.9% [3.5-4.3], respectively). CONCLUSION This investigation shows that there is substantial online discussion relating to a variety of nonmedical use (NMU) behaviours of prescription opioids within the UK, including for hydrocodone, which is not medically available. Web monitoring provides useful data and merits future investigation; this could include expansion to other categories of drugs and a more in-depth analysis of motivations behind NMU, both of which could add timely evidence regarding the current situation in the UK and help inform public health interventions for NMU of prescription drugs.
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Affiliation(s)
- Joanna Hockenhull
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joshua C Black
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authorty, Denver, CO, USA
| | - Alex Bletz
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authorty, Denver, CO, USA
| | - Zachary Margolin
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authorty, Denver, CO, USA
| | - Rick Olson
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authorty, Denver, CO, USA
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard C Dart
- Rocky Mountain Poison & Drug Safety, Denver Health and Hospital Authorty, Denver, CO, USA
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
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8
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The Potential Role of Dual Mechanistic Opioids in Combating Opioid Misuse. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Butler SF, Oyedele NK, Dailey Govoni T, Green JL. How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users. JMIR Public Health Surveill 2020; 6:e16038. [PMID: 32209533 PMCID: PMC7142742 DOI: 10.2196/16038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/17/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users' motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one's own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. OBJECTIVE The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. METHODS Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. RESULTS Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. CONCLUSIONS An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.
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Affiliation(s)
| | - Natasha K Oyedele
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, United States
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10
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Peacock A, Gisev N, Memedovic S, Larance B, Brown J, Cairns R, Buckley N, Farrell M, Degenhardt L. Opioid use and harms associated with a sustained-release tapentadol formulation: A post-marketing surveillance study. Drug Alcohol Depend 2020; 206:107697. [PMID: 31869601 DOI: 10.1016/j.drugalcdep.2019.107697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
AIMS A sustained-release formulation (SRF) of tapentadol has been marketed in Australia since February 2013. This study examined tapentadol SRF extra-medical use, attractiveness for extra-medical use, and associated harms in Australia. METHODS This post-marketing study comprises analyses of Australian community sales data (2011-2017) for eleven pharmaceutical opioids (prescription and over-the-counter codeine disaggregated); calls to three poisons information centres (covering five of the eight jurisdictions in Australia) related to pharmaceutical opioids and coded by the centres as 'misuse' or 'abuse' (2011-2017); and interviews with people who inject drugs (n = 888) recruited as part of the Illicit Drug Reporting System (IDRS) from all Australian capital cities (2017). RESULTS Population-level availability of tapentadol SRF increased from market launch, comprising the sixth largest market share of all opioid unit sales, and third greatest share in oral morphine equivalent milligrams sold, in December 2017. Lifetime tapentadol SRF use among the IDRS sample (n = 888) was low (1.5%; 95%CI 0.9-2.5), with few reporting past-6 month non-prescribed use or injection. Non-fatal overdose following tapentadol use was self-reported by less than 1% (95%CI 0.1-0.8). Between 2013-2017, 1.1% (n = 25) of pharmaceutical opioid 'misuse/abuse' calls were related to tapentadol, and predominantly the SRF. CONCLUSIONS Increasing utilisation of tapentadol sustained-release formulation was observed, along with indications of extra-medical use and harms associated with use, although on a smaller scale relative to other opioids. These findings need to be interpreted in the context of the low level of exposure to tapentadol sustained-release formulation among the sentinel population of people who inject drugs.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Medicine, University of Tasmania, TAS, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia
| | - Jared Brown
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia; School of Medical Sciences, University of Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
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11
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Evaluation of the Relative Abuse of an OROS Extended-release Hydromorphone HCI Product. Clin J Pain 2018; 34:618-628. [DOI: 10.1097/ajp.0000000000000585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Pergolizzi JV, Taylor R, LeQuang JA, Raffa RB. What’s holding back abuse-deterrent opioid formulations? Considering 12 U.S. stakeholders. Expert Opin Drug Deliv 2018; 15:567-576. [DOI: 10.1080/17425247.2018.1473374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | | | | | - Robert B. Raffa
- College of Pharmacy, University of Arizona College of Pharmacy, Tucson, Ariz, USA
- School of Pharmacy, Temple University School of Pharmacy, Philadelphia, PA, USA
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13
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Vosburg SK, Severtson SG, Dart RC, Cicero TJ, Kurtz SP, Parrino MW, Green JL. Assessment of Tapentadol API Abuse Liability With the Researched Abuse, Diversion and Addiction-Related Surveillance System. THE JOURNAL OF PAIN 2018; 19:439-453. [DOI: 10.1016/j.jpain.2017.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/18/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022]
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14
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Peacock A, Larance B, Farrell M, Cairns R, Buckley N, Degenhardt L. Opioid use and harms associated with a sustained-release tapentadol formulation: a postmarketing study protocol. BMJ Open 2018; 8:e020006. [PMID: 29574444 PMCID: PMC5875643 DOI: 10.1136/bmjopen-2017-020006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION It has been argued that tapentadol may pharmacologically have lower abuse potential than other pharmaceutical opioids currently available. However, there has been no comprehensive triangulation of data regarding use and harms associated with this formulation. A sustained-release formulation (SRF) of tapentadol (Palexia) was released in Australia in 2011 and listed for public subsidy in 2013. We summarise here the methods of a postmarketing study which will measure postintroduction: (1) population level availability, (2) extramedical use and diversion, (3) attractiveness for extramedical use and (4) associated harms, of tapentadol compared against other pharmaceutical opioids. METHODS AND ANALYSIS We evaluated key sources on pharmaceutical use and harms in Australia. This review indicateddata from four sources that disaggregate pharmaceutical opioid formulations and capture tapentadol SRF could be triangulated. These data sources comprised: (1) national pharmaceutical opioid community sales data from 2011 to 2017, (2) national pharmaceutical opioid poisonings reported to Poison Information Centres (PICs) from 2011 to 2017, (3) number of vendors on online marketplaces listing pharmaceutical opioids for sale and (4) data on pharmaceutical opioid extramedical use, attractiveness and harms from interviews with people who regularly inject drugs in Australia. ETHICS AND DISSEMINATION Ethics approval is not required for use of pharmaceutical sales data. Ethics approval has been obtained for use of national pharmaceutical opioid poisonings reported to PICs (LNR/16/SCHN/44) and for use of online marketplace data and interview data from people who inject drugs (HC12086). Key findings will be published mid-2018 in a peer-reviewed academic journal, and presented at various conferences and professional meetings.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Faria J, Barbosa J, Moreira R, Queirós O, Carvalho F, Dinis-Oliveira RJ. Comparative pharmacology and toxicology of tramadol and tapentadol. Eur J Pain 2018; 22:827-844. [PMID: 29369473 DOI: 10.1002/ejp.1196] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2018] [Indexed: 12/18/2022]
Abstract
Moderate-to-severe pain represents a heavy burden in patients' quality of life, and ultimately in the society and in healthcare costs. The aim of this review was to summarize data on tramadol and tapentadol adverse effects, toxicity, potential advantages and limitations according to the context of clinical use. We compared data on the pharmacological and toxicological profiles of tramadol and tapentadol, after an extensive literature search in the US National Library of Medicine (PubMed). Tramadol is a prodrug that acts through noradrenaline and serotonin reuptake inhibition, with a weak opioid component added by its metabolite O-desmethyltramadol. Tapentadol does not require metabolic activation and acts mainly through noradrenaline reuptake inhibition and has a strong opioid activity. Such features confer tapentadol potential advantages, namely lower serotonergic, dependence and abuse potential, more linear pharmacokinetics, greater gastrointestinal tolerability and applicability in the treatment of chronic and neuropathic pain. Although more studies are needed to provide clear guidance on the opioid of choice, tapentadol shows some advantages, as it does not require CYP450 system activation and has minimal serotonergic effects. In addition, it leads to less side effects and lower abuse liability. However, in vivo and in vitro studies have shown that tramadol and tapentadol cause similar toxicological damage. In this context, it is important to underline that the choice of opioid should be individually balanced and a tailored decision, based on previous experience and on the patient's profile, type of pain and context of treatment. SIGNIFICANCE This review underlines the need for a careful prescription of tramadol and tapentadol. Although both are widely prescribed synthetic opioid analgesics, their toxic effects and potential dependence are not completely understood yet. In particular, concerning tapentadol, further research is needed to better assess its toxic effects.
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Affiliation(s)
- J Faria
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J Barbosa
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Moreira
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - O Queirós
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - F Carvalho
- Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal
| | - R J Dinis-Oliveira
- Department of Sciences, IINFACTS, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal.,Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy UCIBIO-REQUIMTE, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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Anderson LS, Bell HG, Gilbert M, Davidson JE, Winter C, Barratt MJ, Win B, Painter JL, Menone C, Sayegh J, Dasgupta N. Using Social Listening Data to Monitor Misuse and Nonmedical Use of Bupropion: A Content Analysis. JMIR Public Health Surveill 2017; 3:e6. [PMID: 28148472 PMCID: PMC5311422 DOI: 10.2196/publichealth.6174] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/02/2016] [Accepted: 01/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background The nonmedical use of pharmaceutical products has become a significant public health concern. Traditionally, the evaluation of nonmedical use has focused on controlled substances with addiction risk. Currently, there is no effective means of evaluating the nonmedical use of noncontrolled antidepressants. Objective Social listening, in the context of public health sometimes called infodemiology or infoveillance, is the process of identifying and assessing what is being said about a company, product, brand, or individual, within forms of electronic interactive media. The objectives of this study were (1) to determine whether content analysis of social listening data could be utilized to identify posts discussing potential misuse or nonmedical use of bupropion and two comparators, amitriptyline and venlafaxine, and (2) to describe and characterize these posts. Methods Social listening was performed on all publicly available posts cumulative through July 29, 2015, from two harm-reduction Web forums, Bluelight and Opiophile, which mentioned the study drugs. The acquired data were stripped of personally identifiable identification (PII). A set of generic, brand, and vernacular product names was used to identify product references in posts. Posts were obtained using natural language processing tools to identify vernacular references to drug misuse-related Preferred Terms from the English Medical Dictionary for Regulatory Activities (MedDRA) version 18 terminology. Posts were reviewed manually by coders, who extracted relevant details. Results A total of 7756 references to at least one of the study antidepressants were identified within posts gathered for this study. Of these posts, 668 (8.61%, 668/7756) referenced misuse or nonmedical use of the drug, with bupropion accounting for 438 (65.6%, 438/668). Of the 668 posts, nonmedical use was discouraged by 40.6% (178/438), 22% (22/100), and 18.5% (24/130) and encouraged by 12.3% (54/438), 10% (10/100), and 10.8% (14/130) for bupropion, amitriptyline, and venlafaxine, respectively. The most commonly reported desired effects were similar to stimulants with bupropion, sedatives with amitriptyline, and dissociatives with venlafaxine. The nasal route of administration was most frequently reported for bupropion, whereas the oral route was most frequently reported for amitriptyline and venlafaxine. Bupropion and venlafaxine were most commonly procured from health care providers, whereas amitriptyline was most commonly obtained or stolen from a third party. The Fleiss kappa for interrater agreement among 20 items with 7 categorical response options evaluated by all 11 raters was 0.448 (95% CI 0.421-0.457). Conclusions Social listening, conducted in collaboration with harm-reduction Web forums, offers a valuable new data source that can be used for monitoring nonmedical use of antidepressants. Additional work on the capabilities of social listening will help further delineate the benefits and limitations of this rapidly evolving data source.
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Affiliation(s)
| | - Heidi G Bell
- Gyra MediPharm ConsultingResearch Triangle Park, NCUnited States
| | | | | | | | - Monica J Barratt
- National Drug and Alcohol Research Centre, UNSW AustraliaRandwickAustralia.,Bluelight.orgDover, DEUnited States.,Kadiant AnalyticsBoston, MAUnited States
| | - Beta Win
- GlaxoSmithKlineStockley Park, MiddlesexUnited Kingdom
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Lamy FR, Daniulaityte R, Sheth A, Nahhas RW, Martins SS, Boyer EW, Carlson RG. "Those edibles hit hard": Exploration of Twitter data on cannabis edibles in the U.S. Drug Alcohol Depend 2016; 164:64-70. [PMID: 27185160 PMCID: PMC4893972 DOI: 10.1016/j.drugalcdep.2016.04.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/22/2022]
Abstract
AIMS Several states in the U.S. have legalized cannabis for recreational or medical uses. In this context, cannabis edibles have drawn considerable attention after adverse effects were reported. This paper investigates Twitter users' perceptions concerning edibles and evaluates the association edibles-related tweeting activity and local cannabis legislation. METHODS Tweets were collected between May 1 and July 31, 2015, using Twitter API and filtered through the eDrugTrends/Twitris platform. A random sample of geolocated tweets was manually coded to evaluate Twitter users' perceptions regarding edibles. Raw state proportions of Twitter users mentioning edibles were ajusted relative to the total number of Twitter users per state. Differences in adjusted proportions of Twitter users mentioning edibles between states with different cannabis legislation status were assesed via a permutation test. RESULTS We collected 100,182 tweets mentioning cannabis edibles with 26.9% (n=26,975) containing state-level geolocation. Adjusted percentages of geolocated Twitter users posting about edibles were significantly greater in states that allow recreational and/or medical use of cannabis. The differences were statistically significant. Overall, cannabis edibles were generally positively perceived among Twitter users despite some negative tweets expressing the unreliability of edible consumption linked to variability in effect intensity and duration. CONCLUSION Our findings suggest that Twitter data analysis is an important tool for epidemiological monitoring of emerging drug use practices and trends. Results tend to indicate greater tweeting activity about cannabis edibles in states where medical THC and/or recreational use are legal. Although the majority of tweets conveyed positive attitudes about cannabis edibles, analysis of experiences expressed in negative tweets confirms the potential adverse effects of edibles and calls for educating edibles-naïve users, improving edibles labeling, and testing their THC content.
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Affiliation(s)
- Francois R Lamy
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States; Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States.
| | - Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
| | - Amit Sheth
- Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Department of Computer Science and Engineering, Wright State University, Dayton, OH, United States
| | - Ramzi W Nahhas
- Center for Global Health, Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Edward W Boyer
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert G Carlson
- Center for Interventions, Treatment, and Addictions Research (CITAR), Department of Community Health, Wright State University Boonshoft School of Medicine, 3171 Research Blvd., Suite 124, Dayton, OH 45420-4006, United States
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Chang EJ, Choi EJ, Kim KH. Tapentadol: Can It Kill Two Birds with One Stone without Breaking Windows? Korean J Pain 2016; 29:153-7. [PMID: 27413479 PMCID: PMC4942642 DOI: 10.3344/kjp.2016.29.3.153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/05/2022] Open
Abstract
Tapentadol is a novel oral analgesic with a dual mode of action as an agonist of the µ-opioid receptor (MOR), and as a norepinephrine reuptake inhibitor (NRI) all in a single molecule. Immediate release (IR) tapentadol shows its analgesic effect quickly, at around 30 minutes. Its MOR agonistic action produces acute nociceptive pain relief; its role as an NRI brings about chronic neuropathic pain relief. Absorption is rapid, with a mean maximal serum concentration at 1.25-1.5 h after oral intake. It is present primarily in the form of conjugated metabolites after glucuronidation, and excretes rapidly and completely via the kidneys. The most common adverse reactions are nausea, dizziness, vomiting, and somnolence. Constipation is more common in use of the ER formulation. Precautions against concomitant use of central nervous system depressants, including sedatives, hypnotics, tranquilizers, general anesthetics, phenothiazines, other opioids, and alcohol, or use of tapentadol within 14 days of the cessation of monoamine oxidase inhibitors, are advised. The safety and efficacy have not been established for use during pregnancy, labor, and delivery, or for nursing mothers, pediatric patients less than 18 years of age, and cases of severe renal impairment and severe hepatic impairment. The major concerns for tapentadol are abuse, addiction, seeking behavior, withdrawal, and physical dependence. The presumed problem for use of tapentadol is to control the ratio of MOR agonist and NRI. In conclusion, tapentadol produces both nociceptive and neuropathic pain relief, but with worries about abuse and dependence.
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Affiliation(s)
- Eun Jung Chang
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Eun Ji Choi
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Butler SF, McNaughton EC, Black RA. Tapentadol Abuse Potential: A Postmarketing Evaluation Using a Sample of Individuals Evaluated for Substance Abuse Treatment. PAIN MEDICINE 2015; 16:119-30. [DOI: 10.1111/pme.12524] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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