a Department of Psychiatry , Washington University School of Medicine in St. Louis , St. Louis , MO , USA.
b Centrexion Therapeutics Corp , Boston , MA , USA.
Postgrad Med. 2019 Apr;131(3):225-229. doi: 10.1080/00325481.2019.1585688. Epub 2019 Mar 19.
Opioids with abuse-deterrent properties may reduce widespread abuse, misuse, and diversion of these products. This study aimed to quantify misuse, abuse, dependence, and health resource use of extended-release morphine sulfate with sequestered naltrexone hydrochloride (ER-MSN; EMBEDA®), compared with non-abuse-deterrent extended-release morphine (ERM) products in Medicaid non-cancer patients.
Administrative medical and pharmacy claims data were analyzed for 10 Medicaid states from 1 January 2015, to 30 June 2016. Patients were included if they received a prescription for ER-MSN or any oral, non-abuse-deterrent ERM. Index date was the date of first prescription for an ER-MSN or ERM. Abuse/dependence, non-fatal overdose, emergency department (ED) visits, and ED/inpatient readmissions were determined for each participant. An overall measure of misuse and abuse was also calculated. To account for differences in follow-up, all counts are expressed per 100 patient-years.
There were 4,857 patients who received ER-MSN and 10,357 who received an ERM. The average age in the two cohorts was approximately 45 years old. From pre-index to follow-up, the number of patients per 100 patient-years with a diagnosis code indicating abuse or dependence increased by 0.91 (95% confidence interval [CI]: 0.85, 0.97) in the ER-MSN cohort and 2.23 (95% CI: 2.14, 2.32) in the ERM cohort. The number of patients per 100 patient-years with an opioid-related non-fatal overdose increased by 0.05 (95% CI: 0.04, 0.06) in the ER-MSN cohort compared with 0.11 (95% CI: 0.09, 0.13) in the ERM cohort. The opioid abuse overall composite score increased by 1.36 (95% CI: 1.24, 1.48) in the post-index period in the ER-MSN cohort compared to 3.21 (95% CI: 3.10, 3.32) in the ERM cohort.
Misuse, abuse, and dependence events were numerically lower in patients receiving ER-MSN compared with those receiving ERM products.
具有滥用抑制特性的阿片类药物可能会减少这些产品的广泛滥用、误用和转移。本研究旨在量化延长释放硫酸吗啡与隔离纳曲酮盐酸盐（ER-MSN；EMBEDA®）的滥用、误用、依赖性和卫生资源使用情况，并与 Medicaid 非癌症患者中的非滥用抑制延长释放吗啡（ERM）产品进行比较。
对 2015 年 1 月 1 日至 2016 年 6 月 30 日期间的 10 个 Medicaid 州的医疗和药房管理索赔数据进行分析。纳入的患者需接受 ER-MSN 或任何口服、非滥用抑制的 ERM 处方。索引日期为首次处方 ER-MSN 或 ERM 的日期。为每位参与者确定滥用/依赖、非致命性药物过量、急诊部（ED）就诊和 ED/住院再入院情况。还计算了整体误用和滥用的衡量指标。为了说明随访差异，所有计数均按每 100 患者年表示。
有 4857 名患者接受 ER-MSN 治疗，10357 名患者接受 ERM 治疗。两个队列的平均年龄约为 45 岁。从预索引到随访，每 100 患者年中被诊断为滥用或依赖的患者人数分别增加了 0.91（95%置信区间[CI]：0.85，0.97）在 ER-MSN 队列和 2.23（95%CI：2.14，2.32）在 ERM 队列。每 100 患者年中与阿片类药物相关的非致命性药物过量的患者人数分别增加了 0.05（95%CI：0.04，0.06）在 ER-MSN 队列中，而在 ERM 队列中增加了 0.11（95%CI：0.09，0.13）。在 ER-MSN 队列中，指数后期间总体阿片类药物滥用综合评分增加了 1.36（95%CI：1.24，1.48），而在 ERM 队列中则增加了 3.21（95%CI：3.10，3.32）。
与接受 ERM 产品的患者相比，接受 ER-MSN 治疗的患者的误用、滥用和依赖事件数量较低。
