| One-Minute Clinician

Abuse Deterrent Formulations: Part of the Opioid Balancing Act

Certainly the idea of making an opioid safer is very desirable, and the current approach has been to address certain components of the way that these drugs are abused. Most of the products we have currently are focused at abuse through nasal snorting or through injection. We have technologies that resist crushing. So if somebody seeks this type of medication through illegitimate pathways, the hope is that they won’t be able to powderize it and then snort it or inject it. Then there are ways that make the tablets more difficult to manipulate. We can add gelling agents so that the products will form a substance that’s not easy to snort or inject. We have drugs that have antagonists within them that can be released upon manipulation and therefore, either reduce the euphoria or the desirability of the products. We have some irritant substances that can just make them less desirable for people to manipulate and abuse.

So I think we’re headed in the right direction, and the engineers are hard at work to try to come up with new technologies to improve the safety of these medications while keeping them available for those patients who really need them. There are some parallels to the auto industry and the number of motor vehicle fatalities when the industry started out. But the automakers introduced technologies, such as brake assist and seatbelts and airbags and crush resistant zones and third lights, that all had a positive effect. But what’s important is that these technologies are not replacing the need to pick people who can operate vehicles safely and they don’t stop vehicles from crashing. In terms of opioids, I think we are moving in that direction as well; the industry is doing what they can do on their end to engineer products that are less manipulatable and less desirable. It’s very important though that we as healthcare professionals remember that we still have to pick the right patients to provide these products to, that our patient selection is still is paramount and we have to take into account the whole patient assessment process and risk stratification when we’re utilizing opioids of any sort. So although these technologies exist, they don’t replace our responsibility in patient selection.