Use of Causal Framework to Evaluate Effect of Abuse Deterrent Properties of Extended‐Release Oxycodone on Tampering in a Real‐World Settings.

Purpose: To assess whether exposure to an extended‐release (ER) oxycodone with abuse deterrent properties (ADF) reduced tampering of oxycodone in a real‐world, postmarket setting to address the thinking behind Category 4 labeling by the FDA. Methods: Data from an observational cross‐sectional study of the general adult population (2022) was used under a causal framework to estimate the confounding‐adjusted odds of tampering oxycodone after exposure to two types of ADF ER oxycodone. The tampering behaviors of those who used only single entity immediate‐release (SE‐IR) oxycodone was used as a comparison. The tampering outcome was defined as use by snorting, smoking, or injecting any oxycodone (ER or SE‐IR). A directed acyclic graph was used to identify covariates. Average treatment effect among the treated was estimated using inverse propensity score weighting combined with survey weights in a regression. Results: In 2022, 0.14% and 3.0% among the general population reported using the two ER oxycodone groups, while 2.4% used SE‐IR oxycodone. Propensity score analyses with both comparators (common support > 98%) balanced demographic, health, and drug use covariates. After adjustment for selection and confounding bias, among those who used ER oxycodone group 1 the odds ratio of tampering with any form of oxycodone was elevated but not statistically significant (2.25; 95% CI: 0.94, 5.39). The odds ratio of tampering by users of ER oxycodone group 2 was significantly elevated (1.90; 95% CI: 1.08, 3.19). Conclusions: Tampering of ER oxycodone products by individuals was rare. We found evidence suggestive of elevated odds of tampering behaviors with use of an ADF ER oxycodone. [ABSTRACT FROM AUTHOR]