• Tara Gomes, Andrea Mastorakos, J Michael Paterson, Ingrid Sketris, Patricia Caetano, Simon Greaves, David Henry, and Canadian Network for Observational Drug Effect Studies Investigators.
• Affiliations: Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Paterson, Greaves, Henry); Institute of Health Policy, Management, and Evaluation (Gomes, Paterson, Henry), University of Toronto; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; Faculty of Arts and Sciences (Mastorakos), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Pharmacy (Sketris), Dalhousie University, Halifax, NS; Faculty of Health Sciences (Caetano), University of Manitoba; Provincial Drug Programs (Caetano), Government of Manitoba, Winnipeg, Man.; Centre for Research in Evidence-Based Practice (Henry), Bond University, Gold Coast, Australia.
• CMAJ Open. 2017 Nov 22; 5 (4): E800-E807.

BackgroundIn February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNeo, was introduced in Canada. We investigated the impact of the introduction of OxyNeo on patterns of opioid prescribing.MethodsWe conducted population-based, cross-sectional analyses of opioid dispensing in Canada between 2008 and 2016. We estimated monthly community pharmacy dispensing of oral formulations of codeine, morphine, hydromorphone and oxycodone, and a transdermal formulation of fentanyl, and converted quantities to milligrams of morphine equivalents (MMEs) per 1000 population. We used time series analysis to evaluate the effect of the introduction of OxyNeo on these trends.ResultsNational dispensing of long-acting opioids fell by 14.9% between February 2012 and April 2016, from 36 098 MMEs to 30 716 MMEs per 1000 population (p < 0.01). This effect varied across Canada and was largest in Ontario (reduction of 22.8%) (p = 0.01) and British Columbia (reduction of 30.0%) (p = 0.01). The national rate of oxycodone dispensing fell by 46.4% after the introduction of OxyNeo (p < 0.001); this was partially offset by an increase of 47.8% in hydromorphone dispensing (p < 0.001). Although dispensing of immediate-release opioids was a substantial contributor to overall population opioid exposure across Canada, it was unaffected by the introduction of OxyNeo (p > 0.05 in all provinces).InterpretationThe findings suggest that the introduction of a tamper-deterrent formulation of long-acting oxycodone in Canada, against a background of changing public drug benefits, was associated with sustained changes in selection of long-acting opioids but only small changes in the quantity of long-acting opioids dispensed. This illustrates the limited effect a tamper-deterrent formulation and associated coverage policy can have when other, non-tamper-deterrent alternatives are readily available.Copyright 2017, Joule Inc. or its licensors.

2 keywords...

hide…