Researched Abuse , Diversion And Addiction-Related Surveillance Research Articles

Postmarketing Analysis of Misuse, Abuse, and Diversion of Xtampza ER

ObjectiveTo evaluate abuse, misuse, and diversion of Xtampza ER, an extended-release (ER) abuse-deterrent formulation (ADF) of oxycodone.MethodsAbuse, misuse, and diversion of Xtampza ER were assessed using Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System data sources. Xtampza ER was compared with immediate-release (IR) oxycodone, other ADF ER products combined, and non-ADF ER products combined.ResultsXtampza ER prescriptions increased 50-fold during the study period. In contrast, cases from poison centers, substance abuse treatment centers, and diversion were infrequent and did not increase. Adjusted for prescriptions dispensed, poison center exposures were greater for IR oxycodone (rate ratio [RR] = 2.3, P = 0.008), other ADF ER opioids (RR = 5.2, P < 0.001), and non-ADF ER opioids (RR = 2.5, P = 0.004) than for Xtampza ER. In Treatment Center Programs Combined, past-month abuse prevalence for other ADF ER opioids (odds ratio [OR] = 7.4, P < 0.001) and non-ADF ER opioids (OR = 2.0, P = 0.002) was greater than Xtampza ER; IR oxycodone was not significantly different (OR = 1.2, P = 0.349). In the Drug Diversion Program, rates for IR oxycodone (RR = 3.7, P = 0.003), other ADF ER opioids (RR = 4.2, P = 0.002), and non-ADF ER opioids (RR = 3.4, P = 0.007) were greater than Xtampza ER. Adjustment using morphine equivalents provided similar results, except that IR oxycodone in Treatment Center Programs Combined became higher than Xtampza ER. Nonoral abuse cases involving Xtampza ER were infrequent; Web monitoring data support findings that Xtampza ER is difficult to abuse nonorally.ConclusionXtampza ER abuse, misuse, and diversion and tampering are low relative to other prescription opioid analgesics. Abuse and diversion did not increase over the study period.

An Online Survey for Pharmacoepidemiological Investigation (Survey of Non-Medical Use of Prescription Drugs Program): Validation Study.

BackgroundIn rapidly changing fields such as the study of drug use, the need for accurate and timely data is paramount to properly inform policy and intervention decisions. Trends in drug use can change rapidly by month, and using study designs with flexible modules could present advantages. Timely data from online panels can inform proactive interventions against emerging trends, leading to a faster public response. However, threats to validity from using online panels must be addressed to create accurate estimates.ObjectiveThe objective of this study was to demonstrate a comprehensive methodological approach that optimizes a nonprobability, online opt-in sample to provide timely, accurate national estimates on prevalence of drug use.MethodsThe Survey of Non-Medical Use of Prescription Drugs Program from the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System is an online, cross-sectional survey on drug use in the United States, and several best practices were implemented. To optimize final estimates, two best practices were investigated in detail: exclusion of respondents showing careless or improbable responding patterns and calibration of weights. The approach in this work was to cumulatively implement each method, which improved key estimates during the third quarter 2018 survey launch. Cutoffs for five exclusion criteria were tested. Using a series of benchmarks, average relative bias and changes in bias were calculated for 33 different weighting variable combinations.ResultsThere were 148,274 invitations sent to panelists, with 40,021 who initiated the survey (26.99%). After eligibility assessment, 20.23% (29,998/148,274) of the completed questionnaires were available for analysis. A total of 0.52% (157/29,998) of respondents were excluded based on careless or improbable responses; however, these exclusions had larger impacts on lower volume drugs. Number of exclusions applied were negatively correlated to total dispensing volume by drug (Spearman ρ=–.88, P<.001). A weighting scheme including three demographic and two health characteristics reduced average relative bias by 31.2%. After weighting, estimates of drug use decreased, reflecting a weighted sample that had healthier benchmarks than the unweighted sample.ConclusionsOur study illustrates a new approach to using nonprobability online panels to achieve national prevalence estimates for drug abuse. We were able to overcome challenges with using nonprobability internet samples, including misclassification due to improbable responses. Final drug use and health estimates demonstrated concurrent validity to national probability-based drug use and health surveys. Inclusion of multiple best practices cumulatively improved the estimates generated. This method can bridge the information gap when there is a need for prompt, accurate national data.

The diversion of nonscheduled psychoactive prescription medications in the United States, 2002 to 2017.

Systematic studies of the diversion of nonscheduled drugs, except for gabapentin, are not apparent. We searched diversion case reports of all other nonscheduled psychoactive prescription drugs in the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System. Case report data are drawn from a quarterly survey of prescription drug diversion completed by a national sample of law enforcement and regulatory agencies. Rates of diversion per 100000 population were calculated for each year from 2002 to 2017 for prescription medications with greater than 400 reported cases during the period. Cyclobenzaprine, quetiapine, and trazodone met criteria for analysis. We found a significant and steady increase in the diversion of each drug over the period. The 2017 annual rates of diversion per 100000 population for the three medications range from 0.0428 to 0.0726. Although these rates of diversion are much lower than the rate for total opioid analgesics, they are all more than five times higher in 2017 compared with 2002. While diversion rates for opioids have decreased in recent years, rates for cyclobenzaprine, quetiapine, and trazodone have continued to increase. A common attribute of the three nonscheduled drugs studied here is that all are used for the treatment and/or self-treatment of opioid withdrawal symptoms, and the increasing diversion of these drugs may be related to the ongoing opioid epidemic and to increasing levels of control over pharmaceutical opioid availability in the United States. Prescribers need to be aware of illicit markets for these medications and prescribe to their patients with appropriate caution.

Changes in drug use patterns reported on the web after the introduction of ADF OxyContin: findings from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System Web Monitoring Program.

The primary objective was to study online posts that endorsed continued use of OxyContin or a switch from OxyContin to another formulation of oxycodone or another substance altogether following the introduction of the ADF. A secondary objective was to determine whether posts revealed that the ADF led to cessation of OxyContin use. Data were collected with the Researched Abuse, Diversion, and Addiction-Related Surveillance System Web Monitoring Program, an online surveillance system that collects and organizes posts about prescription drugs from social media websites, blogs, and forums from 3Q2009 to 4Q2014 using a commercially available web platform. Posts were categorized by whether they conveyed a switch to drugs other than reformulated OxyContin or a continuation of reformulated OxyContin abuse. "Switch posts" primarily discussed switching to immediate-release opioids. "Continue abusing" posts identified tampering strategies for alternate routes of administration, oral use, and continued use although post authors were generally unhappy with the experience. No reference to OxyContin cessation as a function of the introduction of the ADF was found; however, discontinued use was discussed. Web Monitoring data are useful for capturing cross sections of Internet conversation reflecting reactions to new drug formulations. These data support the notion that users will gravitate to non-ADFs generally, and to immediate-release non-ADF opioid formulations, specifically, as long as these options remain on the market.

Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration

BackgroundPrescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. MethodsThis retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. ResultsWhile the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. ConclusionAnalysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.

Analysis of the Abuse and Diversion of the Buprenorphine Transdermal Delivery System.

Prescription opioid abuse and diversion are major causes of morbidity and mortality in the United States. The buprenorphine transdermal delivery system (BTDS) is indicated for the treatment of moderate to severe chronic pain and provides a continuous dose of 5, 7.5, 10, 15, or 20μg/h buprenorphine for 7days. Quarterly rates of abuse and diversion of BTDS were compared with 4 comparator groups: 1) other buprenorphine products, 2) fentanyl patches, 3) extended-release (ER) opioid tablets/capsules, and 4) ER tramadol. Data were obtained from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center, Drug Diversion, Treatment Programs Combined (Opioid Treatment and Survey of Key Informants' Patients Programs), and College Survey Programs. Rates were calculated using case counts per population and mentions per prescriptions filled. Poisson regression analysis was used to compare mean rates over time across drug groups after allowing for drug group-specific dispersion parameters. Population adjusted abuse rates were low for BTDS in all of the RADARS System programs compared with the other comparator groups. Findings were similar for the prescription adjusted rates, with BTDS reported at the lowest rates in all programs. Route of abuse differed slightly for BTDS and the comparator groups depending on the program. BTDS was abused and diverted at low rates compared with the other opioid groups in 5 programs of the RADARS System using either population-based rates or prescription dispensed rates. Data from the RADARS System show the BTDS is abused and diverted at low rates compared with other opioid groups including other forms of buprenorphine, fentanyl patches, ER opioid formulations, and ER tramadol.

Trends in Opioid Analgesic Abuse and Mortality in the United States

BackgroundThe use of prescription opioid medications has increased greatly in the United States during the past two decades; in 2010, there were 16,651 opioid-related deaths. In response, hundreds of federal, state, and local interventions have been implemented. We describe trends in the diversion and abuse of prescription opioid analgesics using data through 2013.MethodsWe used five programs from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System to describe trends between 2002 and 2013 in the diversion and abuse of all products and formulations of six prescription opioid analgesics: oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol. The programs gather data from drug-diversion investigators, poison centers, substance-abuse treatment centers, and college students.ResultsPrescriptions for opioid analgesics increased substantially from 2002 through 2010 in the United States but then decreased slightly from 2011 through 2013. In general, RADARS System programs reported large increases in the rates of opioid diversion and abuse from 2002 to 2010, but then the rates flattened or decreased from 2011 through 2013. The rate of opioid-related deaths rose and fell in a similar pattern. Reported nonmedical use did not change significantly among college students.ConclusionsPostmarketing surveillance indicates that the diversion and abuse of prescription opioid medications increased between 2002 and 2010 and plateaued or decreased between 2011 and 2013. These findings suggest that the United States may be making progress in controlling the abuse of opioid analgesics. (Funded by the Denver Health and Hospital Authority.)

SY01-2 * BENDING THE CURVE OF OPIOID ANALGESIC ABUSE IN THE UNITED STATES

BACKGROUND: Abuse of prescription drugs is the leading cause of accidental death in the United States. In response, hundreds of federal, state and local interventions have been implemented. We describe trends in the diversion and abuse of prescription opioids using data through 2013. METHODS: We used 5 different programs from the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System to describe trends in diversion and abuse of 6 opioid analgesics: oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol. The programs include law enforcement agencies, poison centers, substance abuse treatment centers and college students. RESULTS: RADARS System programs reported large increases in opioid diversion and abuse rates from 2002 to 2010, but then rates flattened or decreased 2011 through 2013. Poison Center fatality rates also rose and fell with a similar pattern. CONCLUSIONS: Considered with other data sources, it seems possible that the long period of increasing prescription opioid abuse may be abating. The reasons for this observation are unclear but generate several alternatives that could affect the public policy debate regarding prescription opioid analgesics. Language: en

The Downside of Upscheduling

Intercontinental Marketing Services (IMS) data estimate 130 million hydrocodone prescriptions were written in 2006, up approximately 50% from 88 million in 2000 [1]. This greater availability is thought to have contributed, at least in part, to hydrocodone's illicit use. In 2012, hydrocodone ranked 1st on the RADARS poison center list and the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System college survey list [2]. The January 2012 Drug Abuse Warning Network (DAWN) report showed, among pain reliever-related emergency department (ED) visits involving drug misuse or abuse by adolescents, oxycodone and hydrocodone were the most commonly involved opioids [3]. On March 20, 2012, legislation was proposed to reschedule hydrocodone products and the Food and Drug Administration (FDA) Drug Safety and Risk Management Advisory Committee voted “yes”, recommending rescheduling of hydrocodone from Schedule 3 to Schedule …

Crowdsourcing Black Market Prices For Prescription Opioids

BackgroundPrescription opioid diversion and abuse are major public health issues in the United States and internationally. Street prices of diverted prescription opioids can provide an indicator of drug availability, demand, and abuse potential, but these data can be difficult to collect. Crowdsourcing is a rapid and cost-effective way to gather information about sales transactions. We sought to determine whether crowdsourcing can provide accurate measurements of the street price of diverted prescription opioid medications.ObjectiveTo assess the possibility of crowdsourcing black market drug price data by cross-validation with law enforcement officer reports.MethodsUsing a crowdsourcing research website (StreetRx), we solicited data about the price that site visitors paid for diverted prescription opioid analgesics during the first half of 2012. These results were compared with a survey of law enforcement officers in the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System, and actual transaction prices on a “dark Internet” marketplace (Silk Road). Geometric means and 95% confidence intervals were calculated for comparing prices per milligram of drug in US dollars. In a secondary analysis, we compared prices per milligram of morphine equivalent using standard equianalgesic dosing conversions.ResultsA total of 954 price reports were obtained from crowdsourcing, 737 from law enforcement, and 147 from the online marketplace. Correlations between the 3 data sources were highly linear, with Spearman rho of 0.93 (P<.001) between crowdsourced and law enforcement, and 0.98 (P<.001) between crowdsourced and online marketplace. On StreetRx, the mean prices per milligram were US$3.29 hydromorphone, US$2.13 buprenorphine, US$1.57 oxymorphone, US$0.97 oxycodone, US$0.96 methadone, US$0.81 hydrocodone, US$0.52 morphine, and US$0.05 tramadol. The only significant difference between data sources was morphine, with a Drug Diversion price of US$0.67/mg (95% CI 0.59-0.75) and a Silk Road price of US$0.42/mg (95% CI 0.37-0.48). Street prices generally followed clinical equianalgesic potency.ConclusionsCrowdsourced data provide a valid estimate of the street price of diverted prescription opioids. The (ostensibly free) black market was able to accurately predict the relative pharmacologic potency of opioid molecules.

Comment on: “Cost-Utility Analysis of Duloxetine in Osteoarthritis: A US Private Payer Perspective”

Dear Editor, We would like to alert you to the fact that, after careful review of the article by Wielage et al. [1] published recently in the journal, we noticed several data inaccuracies. The pain level of patients in the different publications is not mentioned. We know from clinical trial experience with tapentadol that patients had moderate to severe pain (most even severe pain). The pain level of patients in studies with duloxetine, naproxen and celecoxib might have been lower; at least we would extrapolate this from the dosages used. Based on this, we doubt if the comparators are appropriate. The patient who uses naproxen (or even cyclooxygenase [COX]-II) is not similar to someone who uses strong opioids. The article does not make clear whether tapentadol immediate release (IR) or extended release (ER) is being compared. In Sect. 2.2, the authors mention comparisons between tapentadol ER and oxycodone controlled release (CR) (similar efficacy, better tolerability for tapentadol, lower discontinuation rate than oxycodone [2, 3]). The ER formulation of tapentadol would be the right one to use in the chronic condition osteoarthritis (OA). However, the high dosage shown in Table 1 indicates that this does not refer to tapentadol ER (according to the Summary of Product characteristics [SmPC], the highest dosage recommended is 500 mg). The dosage mentioned in Table 1 seems to reflect the tapentadol IR dose for pricing purposes. This very high dosage leads to the unfavourably high result for tapentadol in the cost-effectiveness plane, which we cannot accept. The dosing for oxycodone ER is not comparable with the dosing for tapentadol. Comparing the World Health Organization Defined Daily Dose (WHO-DDD), which is 400 mg for tapentadol and 75 mg for oxycodone, this would be a factor of 5.3 (which is also reflected in the clinical trials where oxycodone was used as active comparator [3]). The very low dosage used for oxycodone (10–30 mg) would be suitable for patients with mild to moderate pain, whereas the dosage of 600 mg for tapentadol is beyond even that used in severe pain and therefore these are not comparable. As a follow-up to the above, Table 1 uses some results from the tapentadol ER trials (e.g. “initial 3 months discontinuation” [3]) but the data presented in the table are mixed with inappropriate assumptions (utility measures are the same as for tramadol). Table 1: proton pump inhibitor (PPI) use for all opioids is high: 21 %. Why is this higher than for nonsteroidal anti-inflammatory drugs (NSAIDs) and what is the source of these data? As the main adverse events for opioids are nausea, vomiting and constipation (which cannot be treated with PPIs), we do not see a causal relationship between opioid treatment and use of PPIs at all. Table 1: How are “discontinuation drug costs” defined? Why are they so high for tapentadol compared with other therapies? In our clinical trials, the percentage of patients discontinuing the study are lower than for oxycodone [2]. This should lead to lower costs, not to higher. Table 1 shows the same opioid abuse rates for tapentadol and oxycodone—data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) system [4] suggest otherwise. Table 3 indicates that opioid abuse costs approx. $US5,471 based on data from 2003 to 2007. If the model used tapentadol IR, rather than tapentadol ER, as the comparator, it fails to account for the fact that tapentadol ER is available as a tamper-resistant formulation in the USA and the opioid abuse costs (penalty for tapentadol in the model) are not accurately reflected. There are inconsistencies within the text. The authors state, in the Discussion section, that data for tapentadol are assumed to be the same as for oxycodone because “No studies were available for tapentadol […]”. However, publications for tapentadol (Afilalo et al. [1], Lange et al. [1] and Wild [1]) are listed in the reference list (references [36–38] in the original paper). The available data should be reflected appropriately in the analysis. Importantly, these data inaccuracies have led to very negative results for tapentadol, a strong opioid analgesic that was included in the study. We respectfully would like to ask the journal to comment on these inaccuracies and their effects on the research results and conclusions. We would kindly ask that a revised analysis be conducted and/or that a correction/erratum be published in accordance with International Committee of Medical Journal Editors (ICMJE) requirements.

Reduced Abuse, Therapeutic Errors, and Diversion Following Reformulation of Extended-Release Oxycodone in 2010

This study evaluated changes in abuse exposures, therapeutic error exposures, and diversion into illegal markets associated with brand extended-release oxycodone (ERO) following introduction of reformulated ERO. Original ERO and reformulated ERO street prices also were compared. Data from the Poison Center and Drug Diversion programs of the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System were used. Quarterly rates 2 years prior to introduction of reformulated ERO (October 2008 through September 2010) were compared to quarterly rates after introduction (October 2010 through March 2012) using negative binomial regression. Street prices were compared using a mixed effects linear regression model. Following reformulated ERO introduction, poison center ERO abuse exposures declined 38% (95% confidence interval [CI]: 31–45) per population and 32% (95% CI: 24–39) per unique recipients of dispensed drug. Therapeutic error exposures declined 24% (95% CI: 15–31) per population and 15% (95% CI: 6–24) per unique recipients of dispensed drug. Diversion reports declined 53% (95% CI: 41–63) per population and 50% (95% CI: 39–59) per unique recipients of dispensed drug. Declines exceeded those observed for other prescription opioids in aggregate. After its introduction, the street price of reformulated ERO was significantly lower than original ERO. PerspectiveThis article indicates that the abuse, therapeutic errors, and diversion of ERO declined following the introduction of a tamper-resistant reformulation of the product. Reformulating abused prescription opioids to include tamper-resistant properties may be an effective approach to reduce abuse of such products.

Surveillance of Diversion and Nonmedical Use of Extended-Release PrescriptionAmphetamine and Oral Methylphenidate in the United States

This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Nonmedical use data were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Drug Diversion Program and Poison Center Program. Drug diversion trends nearly overlapped for extended-release amphetamine and extended-release oral methylphenidate. Calls to poison centers were generally similar; however, calls regarding extended-release amphetamine trended slightly lower than those for extended-release oral methylphenidate. Data suggest similar diversion and poison center call rates for extended-release amphetamine and extended-release oral methylphenidate.

Post-marketing Surveillance of Methadone and Buprenorphine in the United States

There have been recent increases in the use of methadone and buprenorphine in the United States. Methadone is increasingly being used for pain management, and buprenorphine use has expanded to include treatment for opioid addiction, leading to exposures of these drugs in new populations. There is a debate about the relative safety of these two drugs in routine outpatient medical use. Data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Programs were used to analyze rates of abuse, misuse, and diversion using the Drug Diversion, Key Informant, Poison Center and Opioid Treatment Programs, 2003-2007. National rate and rate ratios were calculated using population and person-time exposed denominators. Detailed data are presented on severity of medical outcome and drug formulations. Between 2003 and 2007, there were steady increases in the rates of abuse, misuse, and diversion of both methadone and buprenorphine. Rate ratios (per 100,000 population per quarter) of abuse, misuse, and diversion were consistently higher for methadone than buprenorphine. RADARS System poison centers received 7,476 calls for methadone and 1,117 calls for buprenorphine. After accounting for availability, there were higher rates of calls for methadone misuse, abuse, and diversion than buprenorphine in three of the four programs. The numbers of exposures requiring medical attention correspond to 46.8% and 25.8% of all calls, for methadone and buprenorphine, respectively. The most commonly diverted form of methadone was solid oral tablets (which are typically dispensed at pharmacies, not at opioid treatment programs), comprising 73% of cases. Buprenorphine appears to have a better safety profile than methadone during routine outpatient medical use. However, both medications have roles in the treatment of pain and opioid addiction, and further research into their respective benefits and risks should be conducted.

The Underrecognized Toll of Prescription Opioid Abuse on Young Children

The impact of prescription opioid abuse on young children is underrecognized and poorly documented. We hypothesize that poisoning of young children from prescription opioids occurs regularly in the United States and is associated with serious health events, including death. Using data from poison centers participating in the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, exposures in children younger than 6 years, involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone (January 2003 to June 2006), were quantified and described. We identified 9,179 children exposed to a prescription opioid. The median age was 2.0 years (range newborn to 5.5 years), and 54% were boys. Nearly all exposures involved ingestion (99%) and occurred in the home (92%). Exposures to any opioid were associated with 8 deaths, 43 major effects, and 214 moderate effects. Of 51 patients who experienced a major effect or death, 35 were treated with naloxone: a beneficial response was documented in 34 patients. All 5 exposures to buprenorphine associated with a major effect were treated with naloxone, and a beneficial response was recorded in all 5. Nearly all exposures were to medications prescribed for adults in the household. The number of prescriptions filled for an opioid in an area correlated well with exposures in young children in the same area; children have access to household members' prescription drugs. Young children are exposed to prescription opioids, typically prescribed for other patients, resulting in major health effects and death.

The Development of a Comprehensive Risk-Management Program for Prescription Opioid Analgesics: Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®)

OBJECTIVE. Beginning in the late 1990's a marked increase in abuse of OxyContin emerged, which led to the development and establishment of a proactive surveillance program to monitor and characterize abuse, named the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System. The main goal of RADARS was to develop proactive, timely and geographically sensitive methods to assess the abuse and diversion of OxyContin, along with a number of other Schedule II and III opioids with the aim of using this information to guide risk reduction interventions. Thus, its major focus was the detection of abuse of OxyContin and other commonly prescribed opioid analgesics at the three-digit ZIP code level across the country utilizing a number of different detection systems. The detection systems selected were: (1) Quarterly-surveys of drug abuse experts who are knowledgeable about cases of prescription drug abuse; (2) Surveys of law enforcement agencies that detect diversion of prescription drugs; and (3) Poison Control Center reports of intentional misuse or abuse of prescription opioids. Collectively, the three systems provide overlapping coverage of over 80% of the nation's 973 three-digit ZIP codes. Preliminary results indicate that prescription drug abuse is prevalent nationwide, but it seems to be heavily localized in rural, suburban and small urban areas. Our results also indicate that hydrocodone and extended and immediate release oxycodone products are by far the most widely abused drugs in the country, but the abuse of all prescription opioids seems to have grown over the 14 quarters since the inception of RADARS. The next step in these studies is to develop regionally specific, risk-minimization-strategies, which is the goal of all risk-management programs. If successful, RADARS will serve as a prototype of such programs for any new drug approved that has measurable abuse potential.