Inflexxion, A Division of Integrated Behavioral Health, Irvine, CA, USA.
Drug Saf. 2021 Feb;44(2):235-244. doi: 10.1007/s40264-020-01012-4. Epub 2020 Nov 11.
Drug safety studies regarding comparative risk of different opioid compounds are important as providers and regulatory agencies in the United States continue to balance pain management with an ongoing opioid epidemic.
The aim of this study was to evaluate nonmedical use (NMU) and diversion of tramadol and comparator opioids using real-world data from the Addiction Severity Index-Multimedia Version (ASI-MV).
A cross-sectional study design was used to evaluate past 30-day tramadol and comparator opioid NMU among adults assessed for substance abuse treatment using the ASI-MV from 2010 to 2018. Population and drug utilization-adjusted rates were studied, as well as patient characteristics, route of administration, and diversion.
Past 30-day NMU of one or more prescription opioid was reported in 125,048 (22.6%) of ASI-MV assessments (2010-2018); 46.5% reported oxycodone, 43.2% hydrocodone, 8.1% morphine, and 7.2% tramadol. Male respondents ranged from 43.2% in the tramadol group to 51.8% in the oxycodone group. Majority (~ 76%) were Caucasian in all groups, with 86.9% Caucasian in the morphine group. Prevalence of past 30-day tramadol NMU was significantly lower than that of morphine, oxycodone, and hydrocodone for both population and utilization-adjusted rates. Rate of snorting of tramadol was 4-7 times lower than comparator opioids and injection was 14-34 times lower than morphine and oxycodone. Tramadol was most likely to be obtained via the patient's own prescription while the comparator opioids were more often obtained via dealers or family/friends.
Tramadol had a significantly lower rate of NMU than comparator opioids and was less likely to be diverted or used via higher-risk non-oral routes. These findings support previous evaluations by WHO and the United States Drug Enforcement Agency that concluded that tramadol has a low potential for abuse.
由于美国的医疗服务提供者和监管机构继续在平衡疼痛管理与持续的阿片类药物泛滥之间进行权衡，因此对不同阿片类化合物相对风险的药物安全性研究非常重要。
本研究旨在使用来自成瘾严重程度评估多媒体版（Addiction Severity Index-Multimedia Version，ASI-MV）的真实世界数据评估曲马多和比较类阿片药物的非医疗用途（nonmedical use，NMU）和转用情况。
采用横断面研究设计，评估 2010 年至 2018 年间使用 ASI-MV 评估的药物滥用治疗成年人中过去 30 天内曲马多和比较类阿片药物的 NMU 情况。研究了人口和药物使用调整后的发生率，以及患者特征、给药途径和转用情况。
在 ASI-MV 评估中（2010-2018 年），报告过去 30 天内使用一种或多种处方阿片类药物的有 125048 人（22.6%）；46.5%报告使用羟考酮，43.2%报告使用氢可酮，8.1%报告使用吗啡，7.2%报告使用曲马多。男性受访者比例在曲马多组为 43.2%，在羟考酮组为 51.8%。所有组中，大多数（~76%）为白人，而在吗啡组中，这一比例为 86.9%。在人口和使用率调整后的发生率方面，过去 30 天内曲马多 NMU 的发生率明显低于吗啡、羟考酮和氢可酮。曲马多鼻吸的发生率比比较类阿片药物低 4-7 倍，而注射的发生率比吗啡和羟考酮低 14-34 倍。曲马多最有可能通过患者自己的处方获得，而比较类阿片药物则更有可能通过经销商或家人/朋友获得。
曲马多 NMU 的发生率明显低于比较类阿片药物，且更不可能转用或通过风险较高的非口服途径使用。这些发现支持世界卫生组织（World Health Organization，WHO）和美国缉毒署（United States Drug Enforcement Agency，DEA）先前的评估结论，即曲马多滥用潜力较低。
