Prescription opioid misuse and abuse is a public health epidemic in the United States (ONDCP 2015) and a growing source of morbidity, mortality, and substance abuse treatment admissions (SAMHSA 2015, SAMHSA 2014, Okie 2010, and Dart 2015). It is crucial to evaluate and characterize the abuse profiles associated with specific opioid compounds and formulations so that prescribers, payers, and patients can make informed decisions regarding pain treatment with opioid medications. Tapentadol is a centrally acting analgesic with two mechanisms of action: opioid receptor agonism and noradrenaline reuptake inhibition (Tzschentke 2013, Kress 2010). Tapentadol has a lower affinity to the opioid receptor compared to morphine and its noradrenaline reuptake inhibition may not be significantly rewarding compared to other opioids, suggesting an opioid-sparing effect and lower abuse potential for tapentadol products (Terlinden 2007, Raffa 2012). Previous literature suggests that the prevalence of non-medical use (NMU) of tapentadol is relatively low compared to other prescription opioid compounds (Butler 2015, Cepeda 2013). However, little has been published on the profile of those who use tapentadol products non-medically, including their motivation for use, methods of administration, tampering efforts, opinions, and experiences with tapentadol products. The Tapentadol Use Internet survey and follow-up semi-structured online interviews were developed to describe and characterize
NMU of tapentadol products (i.e., Nucynta ® and Nucynta ER ®) among a community of recreational drug abusers frequenting the online discussion forum website Bluelight.org.
A mixed-methods qualitative study was conducted via a survey and in-depth active online interviews to better understand NMU of tapentadol. NMU was defined as use of prescription opioids “in a way not prescribed,” including: 1) taking a medication not prescribed to you, 2) taking a medication for reasons other than what it was prescribed for, and/or 3) using a medication in a way not intended (e.g., taking more than prescribed, using an unintended route of administration, or tampering with the product).
Participants for the survey and interviews were recruited from January through May 2017. To participate, individuals must have met the following conditions: ability to read/understand English; visited Bluelight.org; consented to participate; at least 18 years of age; resided in the United States; and reported NMU of Nucynta and/or Nucynta ER. Survey participants were asked if they were interested in a follow-up active online interview and, if so, were prompted to provide contact information (Bluelight.org username or email address). Eligibility requirements included the ability to use an online chat program and consent to participate. The survey was administered using the online data collection software Qualtrics. Survey data was analyzed using SAS ® statistical software, with descriptive statistics reported using frequencies and percentages for binary/categorical variables and calculated means, medians, and ranges for continuous variables. Interviews were conducted using Cryptocat, a free, open-source, encrypted online chat program (Cryptocat, 2017). Interview transcripts were qualitatively evaluated by multiple reviewers using a modified Grounded Theory approach.
Seventy-eight adults completed the survey, eight of whom completed a follow-up interview. Most survey participants were under 35 years old, male, White, and completed at least some college. Over half indicated opioids were their preferred recreational substance. A similar demographic profile was noted among the subset (n=8) who completed the follow-up interview.