As a primary care doctor who cares for many patients with opioid-use disorder, I am invested in timely and effective strategies to curb our nation’s opioid epidemic. Because so many instances of opioid addiction and overdoses begin with or involve commonly prescribed opioids, we need multiple strategies that address the significant harms associated with prescription opioids.
I am skeptical of one strategy, however: The President’s Commission and the Food and Drug Administration are promoting development of abuse-deterrent prescription opioids as the solution to our opioid problem. These technologies target common methods of opioid abuse, such as crushing, snorting, dissolving or injecting prescription opioids. Currently, ten FDA-approved abuse-deterrent prescription opioids are available. Many of these new and expensive formulations incorporate physical and chemical barriers to make manipulation of the drug difficult or to decrease its subsequent effects. Other formulations combine the opioid with an opioid blocker that — if abused — may interfere with or reduce the opioid’s effect.
Making it more difficult to modify prescription opioids sounds like a simple, elegant answer to the opioid epidemic. And, shouldn’t pharmaceutical companies develop these kinds of safe prescription opioids anyway? The problem is, abuse-deterrent prescription opioids will not change the risks inherent to opioids, and will likely mislead patients and providers into thinking that they present safe alternatives.
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