MoxDuo IR (morphine + oxycodone) / QRxPharma, AbbVie - LARVOL DELTA

Prevalence and Patterns of Off-Label Transmucosal Immediate-Release Fentanyl Use in French General Practice: A Mixed-Methods Study Based on a Voluntary Online Survey. (PubMed, Pain Ther) - "This study confirms widespread off-label TIRF use in well-defined clinical situations. While many GPs report positive outcomes, important concerns remain, including limited training, difficulty with dose titration, and the risk of use disorder. Targeted education and clearer prescribing guidelines could help ensure a safer and more appropriate use of TIRF in GPs practice."

Journal • Otorhinolaryngology • Pain • Rheumatology

Pivotal phase 3 trial of neridronate in Complex Regional Pain Syndrome Type 1: CRPS-RISE study design and methodology (ASRA-FALL 2025) - P3 | "For example: • Analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, opioids ≤ 45 morphine equivalents/day, and neuropathic therapies (e.g., gabapentinoids) • Physical therapy, occupational therapy, rehabilitation modalities, psychological or psychiatric modalities Rescue Treatment • Rescue medications are permitted to treat pain and include: • 1st line: Acetaminophen, with a total daily dose ≤ 4 grams/day • 2nd line: For moderate to severe pain (e.g., > 4 on 0-10 scale) that persist 30 min after acetaminophen was taken as rescue, oxycodone 5 mg immediate release may be taken (up to 4 times/day) Prophylaxis of Acute Phase Reaction • Short-term use of IV bisphosphonates, as in the case of this trial, is generally well-tolerated, with the most common adverse event expected to be acute phase reaction...• Given the progressive nature of CRPS and the different subtypes, it is important to consider a precision medicine approach that targets the right..."

P3 data • CNS Disorders • Musculoskeletal Pain • Pain • Psychiatry • Rare Diseases • Sleep Disorder

Post-caesarean analgesia - a multicentre retrospective analysis comparing practices in Queensland, Australia (2019-2022). (PubMed, Int J Obstet Anesth) - "Use of long-acting neuraxial opioid and oral atypical opioids increased, while commonly prescribed slow-release opioid declined with time. Compliance with opioid-sparing principles can be significantly improved."

Journal • Retrospective data • Anesthesia • Pain

Appropriateness of oxycodone use for acute pain in surgical and obstetric departments using a clinical data warehouse. (PubMed, Br J Clin Pharmacol) - "The majority of patients treated with oxycodone in surgery had inappropriate prescribing. Considering the known risk of developing opioid use disorder after a first administration in surgery, important educational effort seems needed."

Clinical data • Journal • Addiction (Opioid and Alcohol) • Obstetrics • Pain • Substance Abuse

Impact of oxycodone for the treatment of acute postoperative pain in cesarean section: A review. (PubMed, Medicine (Baltimore)) - "These included documents disputed oral oxycodone and patient-controlled intravenous analgesia (PCIA) morphine, compared oral oxycodone and intravenous morphine, investigated sustained-release oral oxycodone and intrathecal morphine, investigated slow release tapentadol and controlled-release oxycodone, investigated ketoprofen, combination of acetaminophen + oxycodone, acetaminophen, and placebo, evaluated oral oxycodone and epidural ropivacaine + sufentanil, evaluated oral oxycodone and PCIA piritramide, evaluated the combination oxycodone + acetaminophen and separately administered oxycodone/acetaminophen, compared the immediate-release oxycodone and controlled-release oxycodone, compared the oral and intravenous oxycodone, disputed PCIA oxycodone or morphine, compared epidural oxycodone and morphine, evaluated PCIA oxycodone, sufentanil or their combination. Oxycodone showed superior or similar postoperative analgesic efficacy compared with other opioids in various..."

Journal • Review • Pain

Restrictive Domains in Healthcare Opioid Legislation in Low- and Middle-Income Countries (IASP 2024) - "While analyses of associations of restrictive domains and HDI and QDI are ongoing and results are pending, this scoping review preliminarily calls attention to the specific restrictive domains of the legislative language that may negatively influence access to quality pain management.Individual models of success in facilitating access to opioids and developing palliative care programs were identified in Nepal, Mongolia, and Uganda."

Pain • Palliative care

Postoperative opioids administered to inpatients with major or orthopaedic surgery: A retrospective cohort study using data from hospital electronic prescribing systems. (PubMed, PLoS One) - "In patients hospitalised with major/orthopaedic surgery, 4 in 6 patients were administered an opioid. We observed a high frequency of administered MR opioids in adult patients and initial oxycodone IR in the ≤70 age group. Patients prescribed with ≥50MME/day ranged between 13-22.9%. This is the first published study evaluating UK inpatient opioid use, which highlights opportunities for improving safer prescribing in line with latest recommendations."

Journal • Retrospective data • Surgery • Orthopedics • Renal Disease

Temporal trends and patterns in initial opioid prescriptions after hospital discharge following colectomy in England over 10 years. (PubMed, BJS Open) - "Over the 10 years studied, there was a changing pattern of opioid prescribing following colectomy, with a decrease in the proportion of opioid-naive patients prescribed postdischarge opioids."

Journal • Pain

Differences in severity of poison centers exposures involving XTAMPZA ER versus other opioid analgesics. (PubMed, Pain Manag) - "Xtampza ER was compared with other ADF opioids, non-ADF extended-release opioids, single-entity oxycodone immediate-release, unspecified oxycodone and unspecified morphine. Results & No Xtampza ER exposures involved unintended routes of administration. Xtampza ER exposures were less likely to be abuse, misuse or suspected suicidal, and medical outcomes were less severe than comparators."

Journal • Pain

Sustained Risk Reduction of Severe Clinical Outcomes Following Misuse/Abuse of XTAMPZA ER as Compared to Other Prescription Opioids (PAINWeek 2023) - " Using NPDS data (01January2019 - 31December2022), frequency of misuse/abuse exposures and clinical outcomes were compared between XTAMPZA ER, other ER oxycodone (oral solid dosage forms of ER oxycodone excluding XTAMPZA ER), other ER opioids for analgesia (oral solid dosage forms of ER formulations of hydrocodone, oxymorphone, hydromorphone, morphine), and IR oxycodone (oral solid dosage forms)... This study suggests that XTAMPZA ER (an ADF ER oxycodone medication) may have a reduced risk of misuse/abuse than opioid medications compared in this study. Exposures to XTAMPZA ER reported to US poison centers were less likely to involve misuse/abuse than the opioid medications included in the other three study groups and no XTAMPZA ER exposure reported use by a nonoral route of administration, the routes associated with the highest risk for severe clinical outcomes. Life-threatening events and death were significantly less likely to occur with exposure to XTAMPZA ER than for..."

Clinical • Clinical data • Addiction (Opioid and Alcohol) • CNS Disorders • Pain

Differences in the severity of medical outcomes of exposures reported to poison centers involving XTAMPZA® ER and other opioid analgesics (PAINWeek 2023) - " There were 189 XTAMPZA ER exposures that were followed to a known outcome, of which, 19 (10.05%) were intentional (abuse/misuse/unknown) and 60 (31.75%) were suspected suicidal...All intentional exposures accounted for 2,815 (72.05%) cases reporting ADF extended-release (ER) opioids, 15,387 (77.78%) for not otherwise specified (NOS) oxycodone, 3,694 (61.45%) for immediate-release oxycodone, 3,569 (68.02%) for NOS morphine, and 1,190 (55.22%) for other ER opioids... XTAMPZA® ER was involved in fewer intentional abuse/misuse/unknown exposures and exposures overall reported to poison centers compared to other opioid analgesics. Across all exposure groups, XTAMPZA® ER resulted in less severe medical outcomes, which may be explained by lower numbers of intentional exposures and the effect of its ADF properties. No unintended routes for XTAMPZA® ER were reported."

Addiction (Opioid and Alcohol) • CNS Disorders • Pain • Psychiatry

Association between per capita prescribing and abuse of tapentadol and other opioids among individuals entering treatment for opioid use disorders (PAINWeek 2023) - "The odds of endorsing abuse were statistically significantly greater for oxycodone (OR= 12.9, p< 0.001), hydrocodone (OR= 2.0, p=0.0068), hydromorphone (OR= 22.7, p< 0.001), morphine (OR= 24.5, p< 0.001), oxymorphone (OR= 35.7, p< 0.001) and tramadol (OR= 3.0, p=0.0038) than for tapentadol... Though the scheduling of tapentadol indicates greater abuse potential than other atypical opioids, we observed that among respondents entering treatment for opioid use disorder, abuse of tapentadol is less frequent than for other atypical opioids. Local drug availability was related to drug abuse for all opioids studied except tapentadol. The odds of abuse of other comparator drugs were much higher than for tapentadol."

Clinical • Addiction (Opioid and Alcohol) • CNS Disorders • Pain • Psychiatry • Substance Abuse

Efficacy and tolerability of oral morphine versus oxycodone/acetaminophen for analgesia in the emergency department. (PubMed, J Opioid Manag) - "Oral morphine is a feasible alternative to oxycodone/acetaminophen for analgesia in the ED."

Journal • Back Pain • Musculoskeletal Pain • Pain

Morphine Versus Oxycodone for Cancer Pain Using a Catechol-O-methyltransferase Genotype Biomarker: A Multicenter, Randomized, Open-Label, Phase III Clinical Trial (RELIEF Study). (PubMed, Oncologist) - "Using the COMT rs4680 genotype alone is not recommended for selecting between morphine and oxycodone for pain relief."

Biomarker • Journal • P3 data • Oncology • Pain • Palliative care

Differences in the severity of medical outcomes of exposures reported to poison centers involving XTAMPZA® ER and other opioid analgesics (PAINWeek 2022) - "Data from cases involving 1) XTAMPZA ER, 2) immediate-release (IR) single-entity (SE) oxycodone 3) other ADF extended-release (ER) opioids, 4) non-ADF ER opioids 5) unspecified oxycodone, and 6) unspecified morphine were analyzed... We observed that a smaller percentage of XTAMPZA ER exposures reported to poison centers are categorized as either intentional misuse/abuse/unknown intentional or suspected suicidal compared to other opioids. Both the lower number of intentional exposures and lack of manipulation may explain the lower severity of medical outcomes for XTAMPZA ER across all exposures. Among intentional exposures involving XTAMPZA ER, no differences relative to other opioids were observed."

Addiction (Opioid and Alcohol) • CNS Disorders • Cognitive Disorders • Pain • Psychiatry

Prescribing Trend of Tapentadol in a Sydney Local Health District. (PubMed, Br J Clin Pharmacol) - "In a Sydney LHD, tapentadol prescriptions increased significantly to become the preferred opioid analgesic. At the hospital's surgical units, off-label prescriptions of tapentadol sustained-release for acute post-operative pain were observed."

Journal • Neuralgia • Pain

Oxycodone for cancer-related pain. (PubMed, Cochrane Database Syst Rev) - "The conclusions have not changed since the previous version of this review (in 2017). We found low-certainty evidence that there may be little to no difference in pain intensity, pain relief and adverse events between oxycodone and other strong opioids including morphine, commonly considered the gold standard strong opioid. Although we identified a benefit for pain relief in favour of CR morphine over CR oxycodone, this was not clinically significant and did not persist following sensitivity analysis and so we do not consider this important. However, we found that constipation and hallucinations occurred less often with CR oxycodone than with CR morphine; but the certainty of this evidence was either very low or the finding did not persist following sensitivity analysis, so these findings should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that, while the reliability of the evidence base is low, given the absence of..."

Journal • Review • Addiction (Opioid and Alcohol) • Constipation • Gastroenterology • Gastrointestinal Disorder • Oncology • Pain

The Relationship Between Postoperative Opioid Analgesia and Sleep Apnea Severity in Patients Undergoing Hip Arthroplasty: A Randomized, Controlled, Triple-Blinded Trial. (PubMed, Nat Sci Sleep) - P4 | "Secondary outcomes included the oxygen desaturation index, postoperative pain scores and intravenous morphine consumption...Oral oxycodone did not increase sleep apnea severity measured using respiratory polygraphy compared with oral tramadol on the first postoperative night after hip arthroplasty. Clinicaltrials.gov - NCT03454217 (date of registration: 05/03/2018)."

Journal • Anesthesia • CNS Disorders • Depression • Obstructive Sleep Apnea • Orthopedics • Pain • Psychiatry • Respiratory Diseases • Sleep Apnea • Sleep Disorder

Association of partial systemic exposure and abuse potential for opioid analgesics with abuse deterrence labeling claims supporting product-specific guidance. (PubMed, EClinicalMedicine) - "Extensive pharmacokinetic (PK) and subjective response data from 11 clinical abuse potential trials in recreational opioid users following oral and nasal administration of intact and manipulated oxycodone, hydrocodone and morphine products from the FDA internal database were utilized for the present analysis...Our findings support FDA's recommendation of comparative PK studies with early partial AUCs as a supportive PK metric for the assessment of abuse deterrent properties of generic opioid drug products in the general and product-specific guidance's of ADFs. The study was partially funded by Fiscal Year 2017 Critical Path of the Center for Drug Evaluation and Research at the U.S. Food and Drug Administration."

Journal • Pain

Abuse and misuse of XTAMPZA® ER relative to other opioid analgesics (PAINWeek 2021) - "ADF ER opioids included OxyContin®, Embeda®, Hysingla® ER, Arymo® ER, and MorphaBond™ ER... Abuse and misuse exposures involving XTAMPZA ER reported to poison centers and XTAMPZA ER abuse cases among individuals entering treatment for opioid use disorders are infrequent relative to comparators. No abuse or misuse of XTAMPZA ER via unintended routes of administration was reported in the Poison Center Program. The proportion of cases involving use via unintended routes of administration was lower for XTAMPZA ER than for comparator drug groups among individuals entering treatment for opioid use disorders."

Addiction (Opioid and Alcohol) • CNS Disorders • Pain • Psychiatry • Substance Abuse

Diversion and street price of XTAMPZA® ER relative to other prescription opioids (PAINWeek 2021) - "ADF ER opioids included OxyContin®, Embeda®, Hysingla® ER, Arymo® ER, and MorphaBond™ ER... Diversion of XTAMPZA ER was observed, though it comprised a smaller number of cases than would be expected based on prescription volume and drug potency. One appropriate comparator is IR oxycodone because it contains the same active ingredient in an easy to manipulate form. IR oxycodone had the highest number of cases."

Addiction (Opioid and Alcohol) • CNS Disorders • Pain • Psychiatry

[VIRTUAL] Dashboard development to identify and track clinical and operational outcomes associated with high-cost/high-utilization medications (ASHP 2020) - "Medications tested included: sugammadex, vasopressin, pembrolizumab, albumin, everolimus, propofol, acetaminophen, fentanyl, oxycodone immediate-release, and morphine injection...Operations focused variables will include incremental changes in drug expenditure and utilization, compared to internal benchmarks and peer institutions within the network. The dashboard with comparative reporting will be utilized to identify areas where cost savings may occur through changes in utilization or in purchasing practices."

Clinical • Anesthesia • Infectious Disease • Novel Coronavirus Disease • Obesity • Oncology • Pain • Septic Shock

Measuring Prescription Opioid Misuse and Its Consequences. (PubMed, Br J Clin Pharmacol) - "The rapid expansion of opioid prescribing was accompanied by increasing misuse and mortality. Interventions such as prescription drug monitoring programs (PDMP), increased law enforcement and abuse deterrent formulations have been followed by decreases in misuse of most opioid analgesics."

Journal • Pain • Substance Abuse

[VIRTUAL] Gastrointestinal adverse events in hospitalized patients following orthopedic surgery: Tapentadol immediate release versus oxycodone immediate release (ASHP 2020) - "Tapentadol IR is associated with similar GI ADEs occurrence compared with oxycodone IR in patients with orthopedic postoperative pain during hospitalization. There was also no significant difference with regard to other ADEs or post-operative opioid consumption. However, these results need to be replicated in clinical trials."

Adverse events • Clinical • Constipation • Gastroenterology • Gastrointestinal Disorder • Hepatology • Oncology • Orthopedics • Pain • Renal Disease

Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. (PubMed, Am J Emerg Med) - "MSIR provides similar analgesic efficacy as Percocet for short-term pain relief in the ED, similar rates of nausea/vomiting, and lower rates of likeability of the drug."

Clinical • Journal • Pain