An overview of abuse-deterrent opioids and recommendations for practical patient care

Figures & data

Figure 1 Drug overdose deaths involving opioids from 1999 to 2016.

Note: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999–2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999–2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at https://wonder.cdc.gov/controller/saved/D77/D38F188.³

Figure 2 Source where pain relievers were obtained for most recent misuse among people aged 12 years or older who misused prescription pain relievers in the past year. Respondents with unknown data for Source for Most Recent Misuse or who reported Some Other Way but did not specify a valid way were excluded. The percentages do not add to 100 percent due to rounding.

Note: Data from Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD. 2017. Available from: https://store.samhsa.gov/shin/content//SMA17-5044/SMA17-5044.pdf.⁶

Figure 3 Strategies for developing abuse-deterrent formulations of opioids.

Abbreviation: ER, extended-release.

Table

Considerations when choosing an ADF in appropriate opioid therapy patients

Risk stratification, using a validated tool that fits your practice setting (eg, Screener and Opioid Assessment for Patients with Pain [SOAPP], Opioid Risk Tool [ORT], Current Opioid Misuse Measure [COMM], the Aberrant Behavior Checklist [ABC], the Chemical Coping Inventory [CCI])

Consider the risk for diversion – both intentional and unintentional (eg, based on patient’s home environment); recognize that everyone has some potential to divert medication

ADF accessibility (eg, insurance coverage and legislative mandates)

Ensuring proper patient education

Potential for addiction

Emphasize risk of unintentional diversion (eg, access by family members, visitors, and lost medication)

Discuss options to secure medication to prevent unintended access by others (use of lock box)

Discuss risks of taking opioids previously prescribed, but no longer under health care professional supervision

Discuss risks of sharing pain medication with others to treat their pain or injuries

Proper disposal of any leftover medication (eg, drug take-back programs and safe disposal procedures at home)

Use of medications as prescribed, dangers of attempts to alter ADF drugs

Patient monitoring and follow-up

Prescription drug monitoring programs to identify doctor shopping

Evaluating high-risk behaviors (eg, taking more opioids than prescribed, calling in for early prescription refills, losing prescriptions, and consuming illicit substances) – risk stratification with a validated tool (eg, ORT, SOAPP, COMM, ABC, and CCI)

Urine drug monitoring

Pill counts

Timing of follow-up visits

Evaluate patients for reasonable pain relief, acceptable tolerability, and overall enhancement in their quality of life

Figure 4 Example handout for patients to help reduce diversion risks.

Centers for Disease Control and Prevention, National Center for Health StatisticsMultiple Cause of Death 1999–2016 on CDC WONDER Online Database, released December, 2017Data are from the Multiple Cause of Death Files, 1999–2016 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program Accessed from: https://wonder.cdc.gov/controller/saved/D77/D38F188Accessed April 13, 2018

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Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52)Rockville, MD2017 Available from: https://store.samhsa.gov/shin/content//SMA17-5044/SMA17-5044.pdfAccessed December 7, 2017

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