Would Changes in Opioid Formulation Help Deter Abuse?

As effective as opioids can be in the treatment of pain and other conditions, they also continue to be a target for abuse. According to an article in Monthly Prescribing Reference, scientific experts are examining whether or not opioids can be formulated to deter abuse.

This question was posted to a panel of presenters during the American Pain Society’s 29th Annual Scientific Session. The challenge in addressing this question is that routes of administration vary by agent which can make it difficult to determine the best way to deter abuse.

A database used to capture routes of administration of prescription opioids found that hydrocodone was mostly taken orally, while fentayl was primarily smoked. A study in this field found that a subset of people who abuse opioids often begin taking the drug orally, but tamper with the medication so it can be snorted.

The U.S. Food and Drug Administration issued a memo recently that cautioned, “that language in a product’s label for a claim of abuse resistance would require long-term epidemiological data from community-based observational studies that document changes in abuse and addiction and the consequences of those behaviors.”

At the same time, populations exposed to opioids happen to be very broad and human abuse liability studies, which are required for all opioid agents, must increasingly serve as surrogates for “real world” behaviors. This observation was made by Lynn Webster, MD, of Lifetree Clinical Research & Pain Clinic in Salt Lake City, Utah.

Robert Bianchi, of the Prescription Drug Research Center, Fairfax, Va., noted that the more difficult it is to extract an active ingredient from an opioid, the less likely people are to do so. One unpublished study found that 80 percent of subjects would spend a maximum of 3 to 10 minutes tampering with an agent with abuse as the goal.