Comparison of abuse, suspected suicidal intent, and fatalities related to the 7-day buprenorphine transdermal patch versus other opioid analgesics in the National Poison Data System

Figures & data

Table 1. Absolute counts and prescription-adjusted rates of abuse, cases of suspected suicidal intent, and fatalities by opioid type (National Poison Data System, 3Q2012–2Q2014).

Opioid	Cases (N)	Prescriptions (N)	Cases per 1,000,000 prescriptions^a	Rate ratio^b	95% CI	p-Value
Intentional abuse^c
Methadone	1255	7,653,314	164	35.2	14.63–84.76	<0.0001
ER oxycodone	379	11,278,171	34	7.2	2.99–17.4	<0.0001
ER oxymorphone	203	1,882,585	108	23.2	9.53–56.2	<0.0001
ER morphine	182	14,226,318	13	2.7	1.13–6.68	0.0258
Fentanyl patch	663	13,237,727	50	10.8	4.46–25.9	<0.0001
BTDS	5	1,073,812	5	Ref	Ref	Ref
Suspected suicidal intent^d
Methadone	1891	7,653,314	247	22.1	12.53–39.0	<0.0001
ER oxycodone	782	11,278,171	69	6.2	3.51–11.0	<0.0001
ER oxymorphone	164	1,882,585	87	7.8	4.34–14.0	<0.0001
ER morphine	596	14,226,318	42	3.7	2.12–6.64	<0.0001
Fentanyl patch	409	13,237,727	31	2.8	1.56–4.91	0.0005
BTDS	12	1,073,812	11	Ref	Ref	Ref
Fatality
Methadone	51	7,653,314	7	5.1	2.99–8.98	<0.0001
ER oxycodone	13	11,278,171	1	0.9	0.44–1.85	0.7693
ER oxymorphone	3	1,882,585	2	1.2	0.36–4.23	0.7304
ER morphine	11	14,226,318	1	0.6	0.28–1.29	0.1898
Fentanyl patch	17	13,237,727	1	Ref	Ref.	Ref.
BTDS	0	1,073,812	0	n/a	n/a	n/a

^aNumbers displayed are rounded up from two decimal points.

^bRate ratio: the ratio of the prescription adjusted incidence rate of the opioid comparator to the prescription-adjusted incidence rate of BTDS (reference). For fatality, fentanyl patch was used as a reference since there were no cases associated with BTDS.

^cIntentional abuse: an exposure resulting from the intentional, improper, or incorrect use of a substance in order to gain a high, euphoric effect or some other psychotropic effect.

^dSuspected suicidal Intent: inappropriate use of a substance for self-destructive or manipulative reasons.

All p-value comparisons are to the reference (Ref) opioid.

BTDS: buprenorphine transdermal system; n/a: not applicable.

Figure 1. (a) and (b) Intentional abuse and suspected suicidal intent rates for BTDS as compared to other extended-release/long-acting opioids, adjusted for estimated number of prescriptions. Methadone exposures were limited to tablet/capsules only. (National Poison Data System, 3Q2012-2Q2014).