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Opioid Abuse Deterrent Formulations: Evaluation of Nonmedical Use of Other Prescription Opioid Substances and Routes of Administration in Adults Evaluated for Substance Use Treatment with the Addiction Severity Index-Multimedia Version (ASI-MV®)

P-019 - (Poster #19) Opioid Abuse Deterrent Formulations: Evaluation of Nonmedical Use of Other Prescription Opioid Substances and Routes of Administration in Adults Evaluated for Substance Use Treatment with the Addiction Severity Index-Multimedia Version (ASI-MV®)

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background: Prescription opioid nonmedical use (NMU) includes opioid use that has not been sanctioned by a medical professional.  Most prescribed use is with an oral route of administration (taking the medication by mouth). NMU can involve oral or nonoral routes like inhalation (smoking), intranasal (snorting), or intravenous (injecting) use. When employed for prescription opioid NMU, nonoral routes of administration have been associated with higher risk of life-threatening events and death (Green et al., 2017; Viste et al., 2023). Abuse deterrent formulations were designated by the US Food and Drug Administration as products that may meaningfully deter abuse even if they do not fully prevent abuse. Abuse deterrent formulation opioid medications include technology expected to make tablet/capsule manipulation more difficult and thereby reduce use via nonoral routes (FDA: CDER ADF Guidance, 2015).  An example of an abuse deterrent formulation (ADF) is Xtampza® ER. Xtampza ER is an extended-release formulation of oxycodone containing DETERx® microspheres that resist crushing.  Whether a reduction in Xtampza ER NMU via nonoral routes is also accompanied by a reduction in NMU of other prescription opioids, both ADFs and non-ADFs, via nonoral routes within the same timeframe has yet to be determined.

Purpose/Objectives: The purpose of this study was to evaluate routes of administration for Xtampza ER and comparator prescription oxycodone opioids (both ADFs and non-ADFs) with real-world data collected during the same time frame with the Addiction Severity Index-Multimedia Version (ASI-MV).

Methods: The ASI-MV is a self-administered, structured, validated computerized assessment tool for adults being evaluated or entering treatment for substance use. It measures the severity of difficulties in areas associated with drug and alcohol use and collects product-specific information regarding past 30-day use and NMU of prescription medications, including route of administration and source of procurement. Oral routes of administration include swallowing whole, chewing then swallowing, dissolving in mouth like a cough drop, and drinking after dissolving in liquid; nonoral routes include smoking, snorting and injection.  This was a cross-sectional, quasi-experimental analysis of prescription opioid NMU reported by adults, age 18 years or older, who completed the ASI-MV between 1 July 2016 and 31 December 2023. Three groups were created: assessments reporting XTAMPZA ER (ADF) NMU, assessments reporting other oxycodone ER (all oxycodone ER products except Xtampza ER - ADFs) NMU, and assessments reporting oxycodone Immediate Release (IR) (non-ADFs) NMU. Descriptive analyses assessed the number and proportion of assessments reporting past 30-day NMU oral routes of administration and nonoral routes of administration among the three study groups.

Results:

Of the 341,851 ASI-MV assessments completed from 01 July 2016 through 31 December 2023, 141 assessments reported past 30-day XTAMPZA ER NMU; 4,935 reported other oxycodone ER NMU; and 20,394 reported oxycodone IR NMU. 138 of the 141 (97.9%) XTAMPZA ER NMU assessments also reported other prescription opioid NMU; 4,733 of the 4,935 (95.9%) other oxycodone ER NMU assessments also reported other prescription opioid NMU, and 16,517 of the 20,394 (81.0%) oxycodone IR NMU assessments also reported other prescription opioid NMU.

Nonoral routes of administration (ROAs) were indicated in 22.0% of assessments reporting XTAMPZA ER NMU including snorting only (9.9%); oral ROAs and snorting (5.0%); injecting only (2.1%); oral ROAs, snorting, smoking and injecting (1.4%); smoking only (0.7%); oral ROAs and smoking (0.7%); and snorting and injecting (0.7%). Within this group, nonoral ROAS for any prescription opioid NMU were reported in 22.0%.

Nonoral ROAs were reported in 45.0% of other oxycodone ER NMU assessments including snorting only (15.1%); injecting only (10.8%); oral ROAs and snorting (8.7%); oral ROAs, snorting, and injecting (2.4%); snorting and injecting (2.1%); oral ROAs and injecting (2.0%); oral ROAs, snorting and smoking (1.2%); oral ROAs, snorting, smoking and injecting (0.9%); smoking only (0.5%); snorting and smoking (0.5%); oral ROAs and smoking (0.3%); oral ROAs, smoking and injecting  (0.2%); snorting, smoking and injecting (0.2%); and smoking and injecting (0.1%). Within this group, nonoral ROAs for any prescription opioid NMU were reported in 29.7% of assessments.  

Nonoral were reported in 52.0% of oxycodone IR NMU assessments including snorting only (16.9%); oral ROAs and snorting (15.9%); injecting only (5.0%); oral ROAs, snorting, and injecting (3.1%); snorting and injecting (2.7%); oral ROAs and injecting (2.1%); oral ROAs, snorting and smoking (1.7%); smoking only (1.3%); oral ROAs, snorting, smoking and injecting (1.2%);  snorting and smoking (1.0%); oral ROAs and smoking (0.5%); snorting, smoking and injecting (0.4%); smoking and injecting (0.2%); and oral ROAs, smoking and injecting (0.1%). Within this group, nonoral ROAs for any prescription opioid NMU were reported in 30.6%.   

Conclusions/Implications for future research and/or clinical care:

The proportion of nonoral ROAs was lowest among those reporting XTAMPZA ER NMU. Notably, it was lower than other oxycodone ADFs and oxycodone non-ADFs. Nonoral use of any prescription opioid was also lowest in the XTAMPZA ER group. While these data cannot determine a causal relationship between an ADF and reduction of general nonoral prescription opioid NMU, they suggest additional investigation of this potential relationship is warranted. Limitations of this study include reliance on self-report of historical behaviors, self-reported product identification with potential misclassification, and the inability to assign causality to the differences found between study groups. Additionally, the ASI-MV is not a nationally representative sample. Nevertheless, the ASI-MV is recognized as a source of real-world data, and the present study reveals its utility in investigating NMU of multiple opioid formulations.