Diversion and illicit sale of extended release tapentadol in the United States

Richard C. Dart, Hilary L. Surratt, Marie Claire Le Lait, Yami Stivers, Vikhyat S. Bebarta, Clark C. Freifeld, John S. Brownstein, John J. Burke, Steven P. Kurtz, Nabarun Dasgupta

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objective. Prescription opioid analgesics are commonly prescribed for moderate to severe pain. An unintended consequence of prescribing opioid analgesics is the abuse and diversion of these medications. Tapentadol ER is a recently approved centrally acting analgesic with synergistic mechanisms of action: μ-opioid receptor agonism and inhibition of norepinephrine reuptake. We assessed the amount of diversion and related cost of obtaining tapentadol IR (Nucynta®) and tapentadol ER (Nucynta ER®) as well as other Schedule II opioid medications in street transactions in the United States using the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System. Methods. The Drug Diversion Program measures the number of cases opened by 260 drug diversion investigators in 49 states. StreetRx™ uses a crowdsourcing Website to collect the prices paid for licit or illicit drugs. Results. The population-based rates of diversion were 0.003 (tapentadol IR), 0.001 (tapentadol ER), and 1.495 (other Schedule II opioid tablets) reports per 100,000 population. The tapentadol ER rate was lower than the other Schedule II opioid tablets (P <0.001) and tapentadol IR (P=0.004). Diversion rates based on drug availability were 0.03 (tapentadol IR), 0.016 (tapentadol ER), and 0.172 (other Schedule II opioid tablets) per 1,000 prescriptions dispensed. The median street price per milligram was $0.18 (tapentadol IR), $0.10 (tapentadol ER), and $1.00 (other Schedule II opioid tablets). Discussion. Our results indicate that tapentadol ER is rarely sold illicitly in the United States. When sold illicitly, tapentadol ER costs less than other Schedule II opioid products.

Original languageEnglish
Pages (from-to)1490-1496
Number of pages7
JournalPain Medicine (United States)
Issue number8
StatePublished - Aug 1 2016

Bibliographical note

Publisher Copyright:
© 2015 American Academy of Pain Medicine.


  • Abuse
  • Diversion
  • Opioid
  • RADARS system
  • StreetRx
  • Tapentadol

ASJC Scopus subject areas

  • General Medicine


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