1. The document analyzes the impact of abuse-deterrent opioids on street prices by comparing prices per milligram of unprotected formulations to abuse-deterrent formulations within the same active ingredients using US street price data from 2010 to 2016. 2. Statistical analyses found that abuse-deterrent formulations had significantly lower street prices compared to unprotected formulations for many opioids, with discounts ranging from 3% to 57%. 3. Some abuse-deterrent formulations like Suboxone films and codeine prodrugs did not have significantly different street prices compared to their unprotected counterparts.

1. Impact of Abuse Deterrent Opioids on
Street Prices
Nabarun Dasgupta
Chief Data Scientist
Epidemico, Inc.
RADARS System
Annual Meeting
Washington, DC
May 6, 2016
Slides at
@epidemico

3. External Referrals
Find Treatment
SAMHSA, ADIN, DroguesInfoService.fr,
L’ANAPAA, DBDD
Overdose Prevention
Medication safety sites, HRC, naloxone
Safe Storage, Disposal & Takeback
FDA, Health Products Stewardship
Association
Safe Pain Management & Advocacy
Canadian Pain Coalition,
PainAustralia.org, RBK Stuttgart
Harm Reduction
HRC, EuroHRN

4. Unique Visitors per Day
250
1641
2439
3252
Mobile
Accounts for 74%
of visits
Search
87% of visits come
from organic search
1.2 Million visitors per year
2013
2016

5. Visitor DemographicsBased on 58% of known demographics from Google account users
19%
Male
35+ years-old
40%
Male
18-34 years-old
16%
Female
35+ years-old
23%
Female
18-34 years-old
As captured by Google Analytics. January 1 through March 31, 2016

6. 7.0%
6.4%
5.8%
4.6%
Who is Likely to Submit a Price?
Percent of visitors, 58% of known Google Account users, 1Q2016
18-24 years-old
25-34 years-old
35-44 years-old
45+ years-old

7. MethodsDo different deterrence strategies result in discernible street price differences?
STEP1
STEP3
STEP2
STEP4
USA Data in USD
Nov 1, 2010 through Apr 30, 2016
Solid oral formulations
Compare unprotected to ADF
price per milligram, within
active ingredient
Geometric means and 95% CI
N = 139,434
Non-parametric Wilcoxan
rank-sum (Mann-Whitney)
tests
(Partial-) Antagonists: Subutex vs. Suboxone
Prodrugs: morphine vs. codeine; Vyvanse vs. Adderall
Phyical barriers: Zohydro vs. IR hydrocodone vs. Hysingla ER; OxyContin OC vs. OP;
Opana ER original vs. reformulation; Xartemis XR vs. IR oxycodone;
IR hydromorphone vs. Exalgo; Ritalin vs. Concerta; morphine
Not enough data to evaluate yet:
Targin(iq), Oxytrex, Oxecta, Quillivant XR, Talwin, Amrix, Xtampza ER, MorphaBond

8. Hydromorphone
$2.63/mg

9. Oxymorphone
$1.47/mg

10. Hydrocodone
$0.79/mg

11. Oxycodone
$0.92/mg

12. Morphine
$0.36/mg

13. Buprenorphine
$2.12/mg(Suboxone)

14. Tapentadol
$0.15/mg

15. Methylphenidate
$0.36/mg

16. Amphetamine
$0.36/mg

17. Percent Discount for ADF Versions
Putative abuse-deterrent formulation versus unprotected formulations with same active ingredient, using statistical comparison that is less influenced by outliers.
Physical Barrier Prodrug(Partial-)
Antagonist
Concerta
Exalgo
OpanaER
OxyContinOP
ZohydroER(1st)
Vyvanse
codeine
Suboxone
tablet
XartemisXR
p<.01
Z 24
p<.01
Z 57
p<.01
Z 5.9
p<.02
Z 2.4
p=.02
Z 2.4
p<.01
Z 9.1
p<.01
Z 19
p=.58
Z 0.5
p=.48
Z .71
Suboxone
Film
3%
RitalinLA
p<.01
Z 4.1
NucyntaER
p=.05
Z 1.9
HysinglaERp<.01
Z 4.0
p=.67
Z .43