Characterizing Abuse Progression of Immediate-Release Hydrocodone Combination Products

• Date: 01 July 2018
• Author: Jared Beaumont,Sven Guenther,Travis C. Mickle,Natasha Oyedele,Theresa A. Cassidy
• DOI: 10.1177/0022042618756691
• Published date: 01 July 2018
• Subject Matter: Articles

https://doi.org/10.1177/0022042618756691

Journal of Drug Issues

2018, Vol. 48(3) 312 –326

© The Author(s) 2018

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DOI: 10.1177/0022042618756691

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Article

Characterizing Abuse Progression

of Immediate-Release Hydrocodone

Combination Products

Jared Beaumont1, Theresa A. Cassidy1, Natasha Oyedele1,

Sven Guenther2, and Travis C. Mickle2

Abstract

This study examined patterns of hydrocodone combination product (HCP) abuse and their

potential role in abuse progression of prescription opioids and other drugs. An Internet survey

was administered to 472 adult opioid users in the United States who used HCPs nonmedically.

Alternate routes (33%) and concomitant drug use (45%) were indicated more frequently during

respondent’s most recent HCP nonmedical use compared with their initial use (20% and 24%,

respectively). Those initiating HCP nonmedical use during adolescence used alternate routes

(e.g., chewing, snorting) throughout their lifetime more frequently (69.5%) compared with those

older when initiating HCP nonmedical use (51.0%). A different abuse pattern was observed

from first to most recent HCP use, starting with oral administration of intact tablets followed by

use of alternate routes and concomitant use of illicit drugs, sometimes use of heroin. These data

may inform future public health interventions, including the potential development of abuse-

deterrent immediate-release opioids.

Keywords

hydrocodone, opioid abuse, progression, gateway, abuse trajectory, route of administration

Introduction

Misuse of prescription opioids is a significant public health problem. Due to their potency and

large amount of active pharmaceutical ingredient per tablet, extended-release (ER) opioid prod-

ucts have been the focus of both regulatory efforts and the development of abuse-deterrent for-

mulations (ADFs) to reduce risks of abuse, addiction, and overdose death, and to ensure safe use

of these medications (U.S. Food and Drug Administration [FDA], 2013). All marketed ADF

opioids to date are ER products, though immediate-release (IR) products play a key role in the

opioid abuse epidemic as well. With this consideration, the first IR opioid ADF (an oxycodone

single-entity product) was approved by FDA in late 2017. IR opioid products are more widely

prescribed and available compared with ER products. During 2015, approximately 86% of retail,

mail service, and long-term care pharmacy opioid prescriptions in the United States were for IR

products (IMS Health LifeLink, 2016). At the forefront of IR opioid abuse are hydrocodone

1Inflexxion, Inc., Waltham, MA, USA

2KemPharm, Inc., Coralville, IA, USA

Corresponding Author:

Jared Beaumont, Inflexxion, Inc., 890 Winter Street, Ste. 235, Waltham, MA 02451, USA.

Email: jbeaumont@inflexxion.com

756691JODXXX10.1177/0022042618756691Journal of Drug IssuesBeaumont et al.

research-article2018