Stevan G. Severtson

Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone

BACKGROUND The development of abuse deterrent formulations is one strategy for reducing prescription opioid misuse and abuse. A putative abuse deterrent formulation of oxycodone extended release (OxyContin®) was introduced in 2010. Early reports demonstrated reduced abuse and diversion, however, an analysis of social media found 32 feasible methods to circumvent the abuse deterrent mechanism. We measured trends of diversion, abuse and street price of OxyContin to assess the durability of the initial reduction in abuse. METHODS Data from the Poison Center Program, Drug Diversion Program, Opioid Treatment Program, Survey of Key Informant Patients Program and StreetRx program of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) System were used. The average quarterly rates of abuse and diversion for OxyContin were compared from before reformulation to the rate in second quarter 2015. Rates were adjusted for population using US Census data and drug availability. RESULTS OxyContin abuse and diversion declined significantly each quarter after reformulation and persisted for 5 years. The rate of abuse of other opioid analgesics increased initially and then decreased, but to lesser extent than OxyContin. Abuse through both oral and non-oral routes of self-administration declined following the reformulation. The geometric mean difference in the street price of reformulated OxyContin was 36% lower than the reformulated product in the year after reformulation. DISCUSSION Despite methods to circumvent the abuse deterrent mechanism, abuse and diversion of OxyContin decreased promptly following the introduction of a crush- and solubility- resistant formulation and continued to decrease over the subsequent 5 years.

The association between planning abilities and sharing injection drug use equipment among injection drug users in Baltimore, MD

Injection drug use continues to be a significant public health problem due to the association with HIV, Hepatitis C, and other infectious diseases. Harm reduction programmes aim to reduce sharing of injection equipment among injection drug users (IDUs). This study explored the association between performance on the Tower of London (TOL), a cognitive measure of planning ability, and the sharing of injection equipment among current IDUs. Data from 225 IDUs from the Baltimore NEURO-Study were used. Logistic regression analyses indicated that performance on the Total Moves Score of the TOL moderated the association between frequency of injection drug use and sharing of injection drug use equipment within the past 6 months. Findings suggest that impaired planning ability moderates the association between frequency of injection use and risky injection practices. Executive functioning abilities are potentially useful constructs to consider when developing harm reduction strategies.

The moderating influence of cognitive performance on risk awareness to predict HIV/AIDS risk-taking behaviors

Conclusion This finding refines the application of the protection motivation theory by specifying that risk awareness alone is insufficient to predict protective behaviors. Above average cognitive performance combined with risk awareness reduced HIV/AIDS risk behaviors. Future research should explore the causal mechanisms linking the interaction between risk awareness and cognitive performance in predicting a reduction in risk behaviors. from 2006 International Meeting of The Institute of Human Virology Baltimore, USA. 17–21 November, 2006

Factors associated with HIV and HCV infection among individuals with a history of injection drug use in Baltimore

Results Preliminary results suggest that being African American (OR = 11.3 CI: 2.1–60.1) and reporting cocaine/crack (OR = 16.5 CI: 4.5–60.2) as a drug of choice were associated HIV infection, but not years of regular drug use. HCV prevalence was associated with white race (OR = 2.4, CI: 1.15–4.83) and years of regular drug use (OR = 3.6, CI: 1.8–7.1), but not drug of choice. Estimated intellectual functioning was associated with both HIV and HCV infection (OR = 7.4, CI: 1.6–33.4; OR = 2.6, CI: 1.4–5.0).

Factors associated with HIV and hepatitis C infection among regular and non-regular injection drug users in Baltimore

Results Long term IDUs were more likely to be infected with HCV (OR = 2.61) or HIV (OR = 2.60) compared to short term injectors. Those who became regular injectors the first week (OR = 3.44), a week to 6 months (OR = 3.92), or more than 6 months (OR = 3.00) after first use were more likely to be infected with HCV than those who never became regular users. Time to regular injection drug use was not associated with HIV infection.