Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest

FORT LAUDERDALE, Fla. — An abuse-deterrent formulation of oxycodone led to fewer severe medical outcomes and less intentional abuse compared with other opioid products, poison center data found.

Of 189 exposures to oxycodone extended-release (Xtampza ER) reported to poison centers from 2016 to 2022, severe medical outcomes occurred in 12.7% of cases, which was lower versus other opioid products (14-19%), according to Richard Dart, MD, PhD, of the Rocky Mountain Poison and Drug Center in Denver.

The percentage of exposures associated with death, however, was numerically highest with oxycodone ER, at 1.6% (three cases) versus 0.4-1.0% with the other opioid products, which included immediate-release oxycodone and other abuse-deterrent opioids.

Among the oxycodone ER cases followed to a known outcome, 42% were either intentional exposures or suspected suicidal exposures, which was lower than other the other drug groups (55-78%), according to a poster presentation at the American Academy of Pain Medicine (AAPM) annual meeting

“Compared with other opioid analgesics, Xtampza ER resulted in less severe medical outcomes, which highlights the effects of its abuse-deterrent formulation,” Dart said.

AAPM session moderator Rosanne Sheinberg, MD, of the University of Washington in Seattle, told MedPage Today that “there are probably two reasons for the low number of cases seen with Xtampza ER: It is an expensive drug and insurance doesn’t cover it, so people aren’t getting it.” But she agreed that the drug “has a low potential for being altered” or being abused.

The researchers analyzed data from all poison centers in the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) system (51 of the nation’s 55 centers).

During the study period, there were 3,907 exposures to other abuse-deterrent ER opioid formulations, 6,011 exposures to immediate-release oxycodone, 2,155 exposures to other ER opioids, 19,782 exposures to oxycodone not otherwise specified (NOS), and 5,247 exposures to morphine NOS.

Of these, the percentages of major effect medical outcome or death were as follows:

• Other abuse-deterrent ER opioids: 16.5% and 0.7%, respectively
• Immediate-release oxycodone: 14.6% and 0.4%
• Other ER opioids: 14.2% and 0.6%
• Oxycodone NOS: 18.7% and 0.7%
• Morphine NOS: 16.9% and 1.0%

Rates of all intentional exposures, including suspected suicide, were 78% for oxycodone NOS, 72% for other abuse-deterrent ER opioids, 68% for morphine NOS, 61% for immediate-release oxycodone, and 55% with other ER opioids.

“We think that many of the pills associated with NOS oxycodone are counterfeit pills,” Dart said, explaining that, based on descriptions given to poison control, the pills were the wrong size or color to be genuine oxycodone. He added that many of these counterfeit pills may also contain fentanyl.