Office of the Commissioner, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
Behavioral Health Financing, Economics, and Evaluation Program, RTI International, 3040 East Cornwallis Road, 12194, Research Triangle Park, NC 27709, USA.
Addict Behav. 2020 Jun;105:106268. doi: 10.1016/j.addbeh.2019.106268. Epub 2019 Dec 24.
The introduction of abuse-deterrent OxyContin in 2010 was intended to reduce its misuse by making it more tamper resistant. However, some studies have suggested that this reformulation might have had unintended consequences, such as increases in heroin-related deaths. We used the 2005-2014 cross-sectional U.S. National Survey on Drug Use and Health to explore the impact of this reformulation on intermediate outcomes that precede heroin-related deaths for individuals with a history of OxyContin misuse. Our study sample consisted of adults who misused any prescription pain reliever prior to the reformulation of OxyContin (n = 81,400). Those who misused OxyContin prior to the reformulation were considered the exposed group and those who misused other prescription pain relievers prior to the reformulation were considered the unexposed group. We employed multivariate logistic regression under a difference-in-differences framework to examine the effect of the reformulation on five dichotomous outcomes: prescription pain reliever misuse; prescription pain reliever use disorder; heroin use; heroin use disorder; and heroin initiation. We found a net reduction in the odds of prescription pain reliever misuse (OR:0.791, p < 0.001) and heroin initiation (OR:0.422, p = 0.011) after the reformulation for the exposed group relative to the unexposed group. We found no statistically significant effects of the reformulation on prescription pain reliever use disorder (OR: 0.934, p = 0.524), heroin use (OR: 1.014p = 0.941), and heroin use disorder (OR: 1.063, p = 0.804). Thus, the reformulation of OxyContin appears to have reduced prescription pain reliever misuse without contributing to relatively greater new heroin use among those who misused OxyContin prior to the reformulation.
2010 年引入了具有防滥用特性的羟考酮，旨在通过提高其抗篡改能力来减少其被滥用的可能性。然而，一些研究表明，这种改革可能产生了意想不到的后果，例如与海洛因相关的死亡人数增加。我们使用了 2005-2014 年美国全国药物使用与健康调查的横断面数据，探讨了这种改革对具有羟考酮滥用史的个体中先于与海洛因相关的死亡的中间结果的影响。我们的研究样本包括在羟考酮改革之前滥用任何处方止痛药的成年人（n=81400）。在改革之前滥用羟考酮的人被视为暴露组，而在改革之前滥用其他处方止痛药的人被视为非暴露组。我们采用差异中的差异框架下的多变量逻辑回归来检验改革对五个二分结果的影响：处方止痛药滥用；处方止痛药使用障碍；海洛因使用；海洛因使用障碍；和海洛因使用开始。我们发现，与非暴露组相比，暴露组在改革后处方止痛药滥用（OR：0.791，p<0.001）和海洛因使用开始（OR：0.422，p=0.011）的几率有所降低。我们没有发现改革对处方止痛药使用障碍（OR：0.934，p=0.524）、海洛因使用（OR：1.014，p=0.941）和海洛因使用障碍（OR：1.063，p=0.804）有统计学上显著的影响。因此，羟考酮的改革似乎减少了处方止痛药的滥用，而在改革之前滥用羟考酮的人中，并没有导致相对更多的新海洛因使用。
