• Stephen F Butler, Emily C McNaughton, Ryan A Black, and Theresa A Cassidy.
• Inflexxion Inc., Waltham.
• Clin J Pain. 2018 Jul 1; 34 (7): 618-628.

ObjectiveFormulating prescription opioids to limit abuse remains a priority. OROS extended-release (ER) hydromorphone HCl (EXALGO) may have lower abuse potential than many other opioid products. Three postmarketing studies of the relative abuse liability of OROS hydromorphone ER were conducted.MethodsEstimates of abuse, unadjusted, and adjusted for prescription volume, were generated for OROS hydromorphone ER and comparators from Q2 2010 through Q2 2014 for a high-risk, substance abuse treatment population and the general population using poison control center data. Comparators were selected for compound, market penetration, and route of administration (ROA) profile. ROA comparisons were made among the substance abuse treatment population. Internet discussion was examined to determine abusers' interest in and desire for the OROS formulation.ResultsExamination of abuse prevalence among adults within substance abuse treatment, intentional poison exposures, and Internet discussion levels generally support the hypothesis that OROS hydromorphone ER may have lower abuse potential than many other opioid products. OROS hydromorphone ER also seems to be abused less often by alternate ROAs (eg, snorting and injection). Lower levels of online discussion were observed along with relatively low endorsement for abuse.DiscussionAbuse of OROS hydromorphone ER was observed in high-risk substance abuse and general population samples but at a very low relative prevalence compared to comparators. Evidence suggests it may be less often abused by alternate ROAs than some comparators. Online data did not find evidence of high levels of desire for OROS hydromorphone ER by recreational abusers. Continued monitoring of this product's abuse liability is warranted.

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