Issue link: http://viewer.e-digitaledition.com/i/472042
SINCE 1999, THE UNITED STATES' RAPIDLY ESCALATING EPIDEMIC OF PRESCRIPTION DRUG ABUSE HAS DIRECTLY CORRELATED WITH A NEARLY 300 PERCENT UPTICK IN PRESCRIPTION PAINKILLER SALES, ACCORDING TO THE CDC. ABUSE-DETERRENT FORMULATIONS OF SOME OF THESE DRUGS ARE NOW AVAILABLE, BUT WHAT PROBLEM ARE THEY ADDRESSING? IN 2008, PRESCRIPTION PAINKILLERS — opioid pain relievers — were involved in nearly 15,000 overdose deaths — more than the combined death count attributed to cocaine and heroin, the CDC notes. Nonetheless, in 2012, providers wrote 259 million prescriptions for these pain relievers for a broad range of conditions, the CDC reports. As one strategy to curtail misuse, pharmaceutical companies are producing abuse-deterrent formulations of opioid pain relievers such as hydrocodone and oxycodone. In late 2014, the FDA approved Hysingla ER (hydrocodone bitartrate) to treat severe pain that requires daily, long-term opioid treatment. Abuse-deterrent formulations, such as the one marketed in Hysingla ER, essentially prevent manipulating the drug, by crushing or chewing it, to deliver the maximum dose of the opioid immediately. The pills also form a thick hydrogel that inhibits preparing a crushed pill for injection. Yet even as it announced approval of Hysingla ER, the FDA included disclaimers about the potential for misuse of abuse-deterrent opioids. While abuse-deterrent formulations may reduce overdose deaths resulting from injection or snorting, the strategy does not address oral consumption, the most common method of prescription drug abuse. "My chief concern about abuse-deterrent opioids is that when you make pills harder to crush, snort or inject, you're not making them less addic- tive," says Andrew Kolodny, MD, Director of Physicians for Responsible Opioid Prescribing and Chief Medical Officer at Phoenix House, a drug and alcohol abuse treatment provider. "Almost everyone who develops the disease of opioid addiction — whether they're the recreational user or pain patient — develops the disease through oral abuse." This is particularly evident in patients who are prescribed opioids for chronic pain but fail to gain sufficient relief, notes Lynn Webster, MD, Vice President of Scientific Affairs at PRA Health Sciences Abuse-deterrent Opioids: A Fraught Approach to an Epidemic By Michael Ferguson 1 2 | Minnesota MD NEWS ■ M D N E W S . CO M