Delcher Chris, Smith Anna L, Romanelli Frank, Gaskill Logan, Surratt Hilary L
Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.
Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.
Pharmacoepidemiol Drug Saf. 2024 Dec;33(12):e70066. doi: 10.1002/pds.70066.
The largest rural outbreak of human immunodeficiency virus (HIV) in the US was centered in Scott County, Indiana, and linked to injection practices involving the opioid Opana ER (oxymorphone extended release [ER] reformulated). We examined supply trends using pharmacy transactions of Opana ER in Scott and all US counties from January 2007 to December 2019.
We calculated the monthly morphine milligram equivalents (MME) of Opana ER (and its competitor OxyContin) in pharmacies using the Automation of Reports and Consolidated Orders System (ARCOS) database from the Washington Post. We modeled the MME rate per capita in Scott County and five geographic comparators in seven distinct time periods including the market introduction of abuse deterrent formulations of both drugs and the HIV outbreak period (circa 2014).
After Opana ER introduction, transaction rates surged in Scott County, where annual OxyContin MMEs were already seven-fold higher than Indiana overall (CY2009: 46.8 vs. 6.8 MME/pop., respectively). Immediately after OxyContin's reformulation, the Opana ER growth rate in Scott County surpassed all geographic comparators modeled (~27 times faster than the US, 1.28 vs. 0.047 MME/pop/month, respectively). By 2012, prior to the outbreak, MMEs from Opana ER almost perfectly replaced the diminishing OxyContin supply. When Opana ER with INTAC was subsequently introduced, pharmacy transactions declined precipitously by nearly 50%, persisting through the HIV outbreak period and market withdrawal.
Opana ER rapidly supplanted OxyContin in a vulnerable population that was at heightened risk for HIV who subsequently faced an immediate supply shock after its reformulation. Pharmacy transactions are critical for suspicious order monitoring and pharmacovigilance by US and international agencies especially during deleterious supply shocks in legal and illicit drug markets.
美国最大规模的农村地区人类免疫缺陷病毒（HIV）疫情集中在印第安纳州斯科特县，且与涉及阿片类药物奥施康定缓释片（奥施康定ER，重新配方的羟考酮缓释片）的注射行为有关。我们利用2007年1月至2019年12月斯科特县及美国所有县的奥施康定ER药房交易数据，研究了其供应趋势。
我们使用《华盛顿邮报》的报告与综合订单系统自动化（ARCOS）数据库，计算药房中奥施康定ER（及其竞争对手奥施康定）的每月吗啡毫克当量（MME）。我们对斯科特县以及七个不同时间段内的五个地理对照地区的人均MME率进行建模，这些时间段包括两种药物的滥用威慑配方上市以及HIV疫情爆发期（约2014年）。
奥施康定ER上市后，斯科特县的交易率激增，该县奥施康定的年度MME已经比印第安纳州总体水平高出七倍（2009年：分别为46.8与6.8 MME/人口）。奥施康定重新配方后，斯科特县奥施康定ER的增长率超过了所有建模的地理对照地区（比美国快约27倍，分别为1.28与0.047 MME/人口/月）。到2012年，在疫情爆发前，奥施康定ER的MME几乎完全取代了逐渐减少的奥施康定供应。随后，当带有INTAC的奥施康定ER上市时，药房交易急剧下降近50%，这种情况一直持续到HIV疫情爆发期及该药物退出市场。
奥施康定ER在一个HIV感染风险较高的脆弱人群中迅速取代了奥施康定，而该药物重新配方后，这一人群随即面临供应冲击。药房交易对于美国和国际机构进行可疑订单监测和药物警戒至关重要，尤其是在合法和非法毒品市场出现有害供应冲击期间。
