Development of a scale to address “ease of extractability” of active product from modified-release opioids

Purpose (i) To understand in a qualitative manner how key stakeholders view the concept of "ease of extractability" of active product from various modified-release opioids (MROs) and (ii) to determine the feasibility of developing a scale that could reliably differentiate the ease of extractability of active product from various MROs. Methods Interviews using structured qualitative methods were conducted with nine key stakeholders, including opioid abusers with experience extracting active product from MROs, opioid abuse specialists, former DEA personnel, and substance abuse counselors. Content analysis of individual interview data was conducted to (i) identify similarities and differences between users who chew and/or swallow opioid medications and others who prepare opioids for snorting or intravenous use; (ii) define the components of extractability; and (iii) define boundaries of the ease of extractability rating scale. Results Content analysis revealed that (i) a majority of users preferred oral intake over injection, smoking, and inhalation; (ii) individuals may use more elaborate methods of extraction as they become more experienced with the drug and build up tolerance; (iii) extraction techniques are shared by word of mouth or through the Internet; and (iv) extractions are performed mostly by opioid abusers (as opposed to street chemists) and donʹt require high-tech or special equipment or knowledge in chemistry. Stakeholders defined extraction of the active ingredient from MROs as the process of manipulating a product (e.g., by biting, crushing, cutting open, cooking) to extract the active ingredient or prepare it for administration. Conclusion Stakeholders agreed on specific dimensions to include as part of the ease of extractability rating scale. Results suggest the feasibility of developing a scale to differentiate the extractability of various MROs.