This document discusses StreetRx.com, a crowdsourced platform that collects anonymous street price data on diverted pharmaceutical drugs. It has received over 42,000 referrals to health organizations since 2010. The document examines whether abuse-deterrent drug formulations (ADFs) can be distinguished from original formulations based on their street prices. Analysis of over 49,000 price entries found that most ADFs had significantly higher street prices than their non-ADF counterparts, indicating the black market can potentially discriminate between different abuse-deterrent technologies and formulations.

1. Crowdsourcing abuse deterrent
formulation street price differentials
Nabarun Dasgupta
Chief Data Scientist
Epidemico, Inc.
RADARS SAB
May 4, 2015

2. StreetRx.com
StreetRx (streetrx.com) is a collection of databases, websites, and citizen reports enabling real-time collection,
organization, and display of street price data on diverted pharmaceutical controlled substances. Based on
principles of crowdsourcing for public health surveillance, the site allows users to anonymously submit prices
they paid or heard were paid for diverted prescription drugs.

4. External Referrals
Find Addiction Treatment
SAMSA, ADIN, DroguesInfoService.fr,
L’ANAPAA, DBDD
Overdose Prevention
Medication safety sites, HRC, naloxone
Safe Storage, Disposal & Takeback
FDA, Health Products Stewardship
Association
Safe Pain Management & Advocacy
Canadian Pain Coalition,
PainAustralia.org, RBK Stuttgart
Harm Reduction
HRC, EuroHRN
Public health, pain patient advocacy, proper disposal

5. 42,058 Referrals to Health OrganizationsFrom November 1, 2010 through March 31, 2015
Drug Treatment & Harm Reduction
Substance abuse treatment locators,
overdose prevention
Chronic Pain
Advocacy and support organizations
Proper Disposal and Storage
DEA and non-profit organizations
1,750
1,438
1,318
1,420
4,565
1,356
1,432
2,062

6. Cross-Validation of Black Market Prices
6
Dasgupta et al. Journal of Medical Internet Research. 2013

7. Dasgupta et al. Journal of Medical Internet Research. 2013

8. Events per 100,000 population (overall public health burden)
Events per 10,000 unique recipients (adjusted for drug availability)
RADARS® System Drug Diversion (law enforcement)

9. Can the Black Market Discriminate betweenADFs?Do different deterrence strategies and platforms result in discernible street price differences?
STEP1
STEP3
STEP2
STEP4
USA Data in USD
Nov 1, 2010 through Mar 31, 2015
Solid oral formulations
Compare 14 ADF to
unprotected street price per
milligram, within active
ingredient
Geometric means and 95% CI
N = 49,995
Non-parametric Wilcoxan
rank-sum (Mann-Whitney)
tests
(Partial-) Antagonists: Subutex vs. Suboxone
Prodrugs: morphine vs. codeine; Vyvanse vs. amphetamines
Phyical barriers: Zohydro vs. Hysingla ER vs. IR hydrocodone; OxyContin OP vs. OC;
Opana ER reformulation vs original; Xartemis XR vs. IR oxycodone;
Exalgo vs. IR hydromorphone; Concerta vs. Ritalin LA vs. methylphenidate, Nucynta ER vs. IR tapentadol
Not enough data to evaluate yet:
Embeda,Targin(iq), Oxytrex, Oxecta, Quillivant XR, Talwin NX, Amrix

10. Descriptive Results Abuse/tamper deterrent formulation
Original unprotected formulation
95% Confidence interval of the geometric mean

11. Percent Discount for ADF Versions
Putative abuse-deterrent formulation versus unprotected formulations with same active ingredient, using statistical comparison that is less influenced by outliers.
Physical Barrier Prodrug(Partial-)
Antagonist
Concerta
Exalgo
OpanaER
OxyContinOP
Zohydro
Vyvanse
codeine
Suboxone
tablet
XartemisXR
p<.01
z -38
p<.01
z -38
p<.01
z -3.0
p<.01
z -3.7
p=.78
z 0.3
p<.01
z -8.6
p<.01
z -13
p=.34
z -0.9
p=.24
z -1.2
TBD
?
OROSOROSINTAC INTAC PolyOx
RitalinLA
p<.01
z -3.9
SODAS
NucyntaER
p=.10
z -1.6
INTAC
HysinglaER
p=0.46
z -0.7
INTAC INTAC

12. Thank You & Contact Info
Boston, MA nabarun@epidemico.com
@street_rx
@epidemico
epidemico.com