Peacock Amy, Degenhardt Louisa, Larance Briony, Cama Elena, Lintzeris Nicholas, Ali Robert, Bruno Raimondo
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Pharmacoepidemiol Drug Saf. 2015 Dec;24(12):1321-33. doi: 10.1002/pds.3883. Epub 2015 Sep 30.
In April 2014, a tamper-resistant controlled-release oxycodone formulation was released in Australia. We aimed to determine whether there are latent classes of people who tamper with pharmaceutical opioids based on frequency of opioid and illicit drug use, the demographic and clinical profiles of these groups, and if there were changes in use and harms following the introduction.
A prospective cohort of 606 people who regularly tamper with pharmaceutical opioids was interviewed January to March 2014 (Wave 1) and May to August 2014 (Wave 2). Latent class analysis identified groups based on non-prescribed opioid, illicit drug and prescribed opioid substitution therapy (OST) use at Wave 1. Regression models examined whether group membership predicted use and harms at Wave 2.
Four groups were identified: frequent OST group (39%), mixed OST/heroin group (7%), infrequent pharmaceutical opioid and heroin group (44%) and frequent oxycodone group (25%). Compared with the frequent OST group, the infrequent pharmaceutical opioid/heroin group was more likely to report non-everyday pain and risky alcohol use, and the frequent oxycodone group had higher odds of homelessness. At Wave 2, oxycodone use decreased across groups (odds ratios (OR) ≤ 0.18, p < 0.001, particularly for the frequent oxycodone group: OR ≤ 0.05, p < 0.001), with reductions in days of use (g ≥ 0.35, p < 0.050). Non-prescribed pharmaceutical opioid use, illicit drug use and harms remained stable or decreased.
Despite heterogeneity among people who tamper with pharmaceutical opioids, the tamper-resistant formulation was followed by reductions in oxycodone tampering among high-frequency and low-frequency users. There was no evidence of increased use of other opioids or illicit drugs.
2014年4月，一种具有防篡改功能的控释羟考酮制剂在澳大利亚上市。我们旨在确定是否存在基于阿片类药物和非法药物使用频率、这些群体的人口统计学和临床特征而篡改药用阿片类药物的潜在人群类别，以及在该制剂引入后使用情况和危害是否发生了变化。
2014年1月至3月（第1波）和2014年5月至8月（第2波）对606名经常篡改药用阿片类药物的人群进行了前瞻性队列研究。潜在类别分析根据第1波时非处方阿片类药物、非法药物和处方阿片类药物替代疗法（OST）的使用情况确定了不同群体。回归模型检验了群体归属是否能预测第2波时的使用情况和危害。
确定了四个群体：频繁使用OST组（39%）、混合使用OST/海洛因组（7%）、不频繁使用药用阿片类药物和海洛因组（44%）以及频繁使用羟考酮组（25%）。与频繁使用OST组相比，不频繁使用药用阿片类药物/海洛因组更有可能报告非日常疼痛和危险饮酒行为，而频繁使用羟考酮组无家可归的几率更高。在第2波时，各群体的羟考酮使用量均有所下降（优势比（OR）≤0.18，p<0.001，尤其是频繁使用羟考酮组：OR≤0.05，p<0.001），使用天数减少（g≥0.35，p<0.050）。非处方药用阿片类药物的使用、非法药物的使用和危害保持稳定或有所下降。
尽管篡改药用阿片类药物的人群存在异质性，但在引入具有防篡改功能的制剂后，高频和低频使用者中羟考酮的篡改行为有所减少。没有证据表明其他阿片类药物或非法药物的使用有所增加。
