Battling the Opioid Epidemic: Do Abuse-Deterrent Formulations Work?

Abuse-deterrent opioid formulations may not be the most effective solution to the opioid crisis, according to an editorial published in the New England Journal of Medicine.¹

There is a trend toward higher drug-overdose deaths in middle-aged adults in the United States, attributed largely to the misuse and abuse of opioid medications. Despite the rise of opioid abuse across the nation, pharmaceutical companies are continuing to work toward influencing both state and federal opioid policies.

Because standard opioid drugs can be manipulated to achieve a heightened euphoric effect, drug manufacturers suggest that newer abuse-deterrent formulations may help reduce misuse while making opioids safer for their approved indications.

According to William C. Becker, MD, and David A. Fiellin, MD, opioid manufacturers are using recent industry-funded research to suggest that abuse-deterrent opioid formulations may be the answer to the current opioid crisis.

A Cochrane review conducted to assess the safety and efficacy of long-term opioid therapy for chronic noncancer pain that included 4768 patients concluded that insufficient evidence was available to establish the effectiveness of such treatments.² Conclusions from this and other studies raise concerns regarding the validity of chronic opioid therapy, and highlight the need for additional research to identify alternate treatments.

In the current editorial, the authors pointed that abuse-deterrent drugs “may distract prescribers, patients, and policymakers from considering the limited evidence supporting the benefits of long-term opioid use for most patients with chronic pain.”

In addition, they noted that “opioids with abuse-deterrent properties are not abuse-proof.” The emerging science behind abuse-deterrent opioid formulations still presents challenges that require immediate attention.

Instead of continuing to prescribe opioids, even abuse-deterrent forms, the researchers argue for the need to look toward non-opioid therapies and to consider prevention and treatment for addiction: “We believe clinicians, researchers, and policymakers should invest in alternative chronic-pain treatments…as well as strategies for avoiding opioid dose escalation.”

References

1. Becker WC, Fiellin DA. Abuse-deterrent opioid formulations – putting the potential benefits into perspective. N Engl J Med. 2017;376:2103-2105.
2. Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010;1:CD006605.

This article originally appeared on Clinical Pain Advisor