Balance and the Adoption of Abuse-Deterrent Opioid Formulations in Pain Management Practice

Abstract

The increase in unintended deaths attributed to the use of prescription opioid analgesics has led to the development of drug formulations that incorporate abuse-deterred technologies.  The prescribing of abuse-deterrent opioids (ADOs) has the potential to reduce unintended deaths, but may produce the unintended consequence of increasing drug costs or stigmatizing patients as drug abusers.  This article contends that ADOs should be used only when they are appropriate and necessary to address identified risks of diversion or abuse.  In the absence of clear standards for the use of these products, risk minimization considerations may induce prescribers to use ADOs when they are not warranted.  The choice of whether to prescribe an ADO product requires that the clinician balance potential benefits to society versus potential detriments to the individual patient.  Guidance from the pain management literature suggests a three step process to determine when a patient is at high risk of drug diversion or abuse.  This article includes a call for regulators to incorporate existing standards of clinical practice in the development of regulatory standards that specify circumstances under which ADOs should be prescribed and those circumstances in which ADOs are considered elective or unnecessary.