ORIGINAL REPORT Scoring the best deal: Quantity discounts and street price variation of diverted oxycodone and oxymorphone Jacob A. Lebin 1 | David L. Murphy 1 | Stevan Geoffrey Severtson 2 | Gabrielle E. Bau 2 | Nabarun Dasgupta 2 | Richard C. Dart 2,3 1 University of Colorado, School of Medicine, Aurora, CO, USA 2 Rocky Mountain Poison and Drug Center, Denver Health Hospital Authority, Denver, CO, USA 3 Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, USA Correspondence J. A. Lebin, Harborview Medical Center, Department of Emergency Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104‐2499, USA. Email: lebin@uw.edu Present Address Jacob A. Lebin and David L. Murphy, Department of Emergency Medicine, University of Washington, Seattle, WA, USA Funding information The RADARS System (Denver, Colorado, USA) Abstract Background: Diverted prescription opioids are significant contributors to drug overdose mortality. Street price has been suggested as an economic metric of the diverted prescription opioid black market. This study examined variables that may influence the street price of diverted oxycodone and oxymorphone. Methods: A cross‐sectional study was conducted utilizing data from the previously validated, crowdsourcing website StreetRx. Street price reports of selected oxyco- done and oxymorphone products, between August 22, 2014 and June 30, 2016, were considered for analysis. Geometric means and 95% confidence intervals were calcu- lated comparing prices per milligram of drug in US dollars. Univariate and multivariable regressions were used to examine the influence of dosage strength, drug formulation, and bulk purchasing on street price. Results: A total of 5611 oxycodone and 1420 oxymorphone reports were analyzed. Across various dosages and formulations, geometric mean prices per milligram ranged between $0.12 and $1.07 for oxycodone and $0.73 and $2.90 for oxymorphone. For a2‐fold increase in dosage strength, there is a 24.0% (95% CI: -28.1%, -19.6%, P < 0.001) and a 22.5% (95% CI: -24.2%, -20.8%, P < 0.001) decrease on average in price per milligram for oxycodone and oxymorphone, respectively. Lower potency, high dosage strength, crush‐resistant opioids, and those purchased in bulk were significantly cheaper. Conclusion: Street prices for diverted oxycodone and oxymorphone are influenced by multiple factors including potency, dosage, formulation, and bulk purchasing. Buyers who purchase large quantities of low potency, large dosage, crush‐resistant formulation prescription opioids can expect to achieve the lowest price. KEYWORDS drug abuse, drug diversion, pharmacoepidemiology, prescription opioids, quantity discounts, RADARS system, street price 1 | INTRODUCTION Prescription opioids have markedly contributed to the drug overdose epidemic in the United States. In 2016, prescription opioids were involved in nearly half of all opioid related deaths, 1 which now account for the majority of drug poisoning mortality. 2 Rising trends in overdose mortality have been paralleled by increases in drug availability and prescription opioid diversion. 3 In nearly a quarter of prescription opioid overdose decedents, diverted drugs were obtained through illicit methods of acquisition. 4 Received: 19 December 2017 Revised: 21 March 2018 Accepted: 17 April 2018 DOI: 10.1002/pds.4558 Pharmacoepidemiol Drug Saf. 2018;1–6. Copyright © 2018 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/pds 1