Abuse of immediate-release opioids and current approaches to reduce misuse, abuse and diversion

ABSTRACT

Deaths from opioid overdoses have increased dramatically over the past few years. Given that immediate-release (IR) opioids account for most of the U.S. market share, and that abusers generally prefer IR opioids over extended-release (ER) opioids, it is not surprising that rates of abuse are higher for IR than ER opioids. IR opioids are widely prescribed, often without consideration for risks of abuse, misuse, and diversion. Prescription opioid abuse and misuse often begins through oral administration and progresses into non-oral routes (e.g. snorting, injecting) as abusers gain more experience; non-oral routes carry heightened safety concerns. Current approaches used for reducing opioid abuse include U.S. Food and Drug Administration regulations, state legislation, insurance company policies, the use of multimodal analgesic therapy, patient risk assessment and monitoring, limiting access to opioids by reducing IR opioid prescription quantity and length, prescription drug monitoring programs, patient education on proper disposal of unused medication and risks of diversion, as well as abuse-deterrent formulations. Albeit, most abuse-deterrent formulations have focused on ways to prevent the circumvention of ER characteristics rather than placing obstacles to abuse of IR opioid formulations. Reducing opioid abuse requires the combined efforts of multiple stakeholders, including prescribing clinicians, patients, pharmacists, nurses, insurance companies, government agencies, and pharmaceutical companies.

KEYWORDS:

• Abuse
• misuse
• diversion
• immediate-release
• opioids

Acknowledgments

Medical writing support was provided by Kelly Cameron, PhD, CMPP, of JB Ashtin (funded by Daiichi Sankyo, Inc.), who developed the first draft based on an author-approved outline and assisted in implementing author revisions. Daiichi Sankyo had the opportunity to review the manuscript draft for factual accuracy; the authors maintained full control of the manuscript and determined the final content.

Declaration of interest

SR Nalamachu has received funding/grant support from Collegium and honorarium for consultancy from BDSI, Daiichi, Collegium, Depomed, Pernix, Purdue, and Pfizer. B Shah has received honoraria for consultancy from Collegium, Purdue, and Salix. A PGM peer reviewer on this manuscript has an association with the RADARS System, which provides post-marketing surveillance to various pharma companies and U.S. FDA; that peer reviewer has no direct relationship with any company. Other PGM reviewers on this manuscript have no relevant disclosures.

Author contributions

Both authors were involved in developing the concept/design of the manuscript, interpreting the literature, critically reviewing the manuscript, approving the final version for submission, and accepting overall responsibility for the accuracy of the data, its analysis, and this report.

Additional information

Funding

The medical writing support for this work was funded by Daiichi Sankyo, Inc.