AUSTIN, Texas—Opioid medications can be misused through both oral and nonoral routes of administration, such as smoking, snorting or injecting. These nonmedical uses (NMUs) are associated with a significantly higher risk of life-threatening events, including overdose and death. 
One potential strategy to reduce the misuse of opioids through nonoral routes is the development and use of abuse-deterrent formulations (ADFs). These formulations are designed to make it more difficult or less rewarding to misuse the drug.
A team of investigators presented new data during the American Academy of Pain Medicine 2025 PainConnect conference, evaluating the proportion of nonoral routes of administration reported with NMU of non-ADF opioids versus the proportion of nonoral routes reported with NMU of ADF opioids.

Each participant completed the Addiction Severity Index-Multimedia Version, a self-administered, structured computerized assessment tool for adults evaluated or entering treatment for substance use that measures the severity of problems associated with drug and alcohol use and collects product-specific information of past 30-day use and NMU of prescription medication. The assessments were conducted between July 1, 2016, and Dec. 31, 2023, and included self-reported data on the past 30 days of prescription opioid NMU and the routes of administration. The study focused on three groups of opioids: Xtampza ER (Collegium; an ADF of oxycodone), other oxycodone extended-release (ER) formulations and oxycodone immediate release (IR). Nonmedical use was defined as any deviation from legitimate medical use, including misuse and abuse.
A total of 341,851 assessments were included in the study. Of these, 141 participants reported using Xtampza ER, 4,935 used other oxycodone ER products and 20,394 used oxycodone IR. Many participants also reported using other prescription opioids during the study period.
According to the results, 25.6% of participants reported nonoral routes of administration for Xtampza ER NMU and 27.7% reported nonoral routes of administration for any prescription opioid NMU. 

Among individuals who reported other oxycodone ER NMU (n=4,935), 53.9% reported nonoral routes of administration for other oxycodone ER NMU and 37.7% reported nonoral routes of administration for any prescription opioid NMU.
For participants reporting oxycodone IR NMU (n=20,394), 64.2% reported nonoral routes of administration for oxycodone IR NMU and 38.7% reported nonoral routes of administration for any prescription opioid NMU.

“The proportion of nonoral XTAMPZA ER NMU [nonmedical use] was lower than that of other oxycodone ER and oxycodone IR,” the authors wrote. “Nonoral use of any prescription opioid was also lowest in the XTAMPZA ER group. While these data do not determine a causal relationship between an ADF and reduction of other nonoral prescription opioid NMU, they suggest additional investigation of this potential relationship is warranted.”


—Kenny Walter