OPIOIDS, SUBSTANCE ABUSE & ADDICTIONS SECTION Original Research Articles Measuring Attractiveness for Abuse of Prescription Opioids Stephen F. Butler, PhD,* Kathrine C. Fernandez, MPH,* Alan Chang, BA,* Christine Benoit, BA,* Leslie C. Morey, PhD, † Ryan Black, PhD,* and Nathaniel Katz, MD, MS ‡ *Inflexxion, Inc., Newton, Massachusetts † Texas A&M University, College Station, Texas ‡ Analgesic Research, Needham Heights, Massachusetts, USA Reprint requests to: Stephen F. Butler, PhD, Inflexxion, Inc., 320 Needham Street, Suite 100, Newton, MA 02464, USA. Tel: 603-673-1317; Fax: 603-672-3162; E-mail: sfbutler@inflexxion.com. Abstract Objective. Prescription opioids are the second most misused/abused drug in the United States behind only marijuana. Recreational prescription opioid users appear to prefer some products over others; however, the extent to which attributes of any particular formulation account for such prefer- ences has yet to be determined. The Opioid Attrac- tiveness Technology Scaling was developed to identify the particular features of a prescription opioid that are relevant to its attractiveness for rec- reational use, and to use these features to model attractiveness for recreational use of particular pre- scription opioid formulations. Design. Four hundred and ninety-one self-reported recreational prescription opioid users identified 43 product features as being relevant to determining whether a product is “attractive” or “unattractive” for recreational use. Average ratings were used to determine appropriate weights to be applied to the features. A factor analysis yielded 10, highly differ- entiated factors. Five hundred and sixty-four pre- scription opioid abusers were then asked to rate the extent to which the 43 features identified in Study 1 were relevant to specific prescription opioid prod- ucts they had used. Results. Respondents provided an overall prefer- ence rating of these products and a model was created. A random intercept model yielded a signifi- cant pseudo R 2 of 0.14 (chi-square = 310.02, degrees of freedom [df] = 10, P < 0.001). The model fit least well, albeit significantly, for abusers who preferred to swallow the drug (pseudo R 2 = 0.06; chi- square = 55.52, df = 10, P < 0.001) and best for those who preferred to inject (pseudo R 2 = 0.37; chi- square = 199.34, df = 10, P < 0.001). Conclusions. The relevance of the model is dis- cussed along with possible modifications that might allow prediction of “attractiveness” of “abuse deter- rent” formulations that have not yet been marketed. Key Words. Prescription Opioids; Attractiveness; Abuse Introduction Second only to marijuana, prescription opioids are among the most misused/abused drugs in the United States [1]. Since 1992, nonmedical use of prescription opioids among teens is up an astounding 542% [2] and, with 2.2 million first-time prescription opioid users over the past year, prescription opioid abuse has, for the first time, become the drug most often associated with first-time illicit drug use [3]. Nonmedical use of prescription opioids is related to a vast array of health and societal problems including increased risk of disease, significant morbidity and mortality among its users, and an increased incidence of crime. Prescription opioids are not only drugs of abuse but also have a legitimate medical value (e.g., [4]). The goal of balancing the need for prescription opioids for legitimate reasons while eliminating abuse of such prod- ucts has lead to calls for investigation into the specific factors associated with prescription drug use in order to provide a better understanding of how to minimize the likelihood of nonmedical use, abuse, and addiction of these drugs [5]. Pain Medicine 2010; 11: 67–80 © American Academy of Pain Medicine 67