Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone: results from a cohort study

J Pain. 2013 Oct;14(10):1227-41. doi: 10.1016/j.jpain.2013.05.010. Epub 2013 Jul 10.

Abstract

Tapentadol may have a lower abuse risk than other opioids because it has a relatively low affinity for the mu-opioid receptor. The aim of this retrospective cohort study was to compare the risk of opioid abuse between tapentadol immediate release (IR) and oxycodone IR using 2 claims databases (Optum and MarketScan). Subjects with no recent opioid use exposed to tapentadol IR or oxycodone IR in 2010 were followed for 1 year. The outcome was the proportion of subjects who developed opioid abuse, defined as subjects with International Classification of Diseases, 9th revision, codes for opioid abuse, addiction, or dependence. The relative odds of abuse were estimated using a logistic regression model with propensity-score stratification. The estimates from the 2 databases were pooled using a random effects model. There were 13,814 subjects in Optum (11,378 exposed to oxycodone, 2,436 exposed to tapentadol) and 25,553 in MarketScan (21,728 exposed to oxycodone, 3,825 exposed to tapentadol). The risk of abuse was higher in the oxycodone group than in the tapentadol group in each database. The pooled adjusted estimate for the odds of abuse was 65% lower with tapentadol than with oxycodone (odds ratio = .35, 95% confidence interval = .21-.58). The risk of receiving an abuse diagnosis with tapentadol was lower than the risk with oxycodone. Continued monitoring is warranted because opioid desirability can change over time.

Perspective: This study compared the risk of receiving an opioid abuse diagnosis between tapentadol and oxycodone in 2 U.S. claims databases. The risk of receiving an abuse diagnosis was lower with tapentadol during the year of follow-up. Opioid prescribers and patients must be aware of the risk of abuse associated with all opioids.

Keywords: Opioids; cohort studies; opioid abuse; opioid dependence; oxycodone; tapentadol.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / adverse effects*
  • Cohort Studies
  • Databases, Factual
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • International Classification of Diseases
  • Male
  • Middle Aged
  • Odds Ratio
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / psychology*
  • Oxycodone / adverse effects*
  • Pain / complications
  • Pain / drug therapy
  • Phenols / adverse effects*
  • Propensity Score
  • Retrospective Studies
  • Risk
  • Sample Size
  • Tapentadol

Substances

  • Analgesics, Opioid
  • Phenols
  • Oxycodone
  • Tapentadol