Opioid painkillers are abused in a number of ways. These drugs can be abused by swallowing whole, crushing and swallowing, crushing and snorting, crushing and smoking, or crushing, dissolving and injecting. Abuse-deterrent opiod formulations target such expected or known routes of abuse. Some view it as a solution to curtailing the out-of-control abuse of opioid prescription painkillers.
According to the U.S. Food and Drug Administration (FDA), abuse-deterrent formulations can be generally categorized. A majority of the ways in which these abuse-deterrent drugs are formulated is presented here.
Physical and/or Chemical Barriers
An abuse-deterrent opioid formulation can present a physical barrier, such as making it resistant to cutting, crushing, chewing, grinding or grating.
A chemical barrier to abuse can make the opioid deterrent resist extraction of the opioid through common solvent use, such as alcohol, water, or other organic solvents.
Changing the physical from of the oral drug through the use of physical and chemical barriers can make is less abuse-friendly.
Agonist (causes an action) and/or Antagonist (blocks an action) Combinations
This method of abuse-deterrent formulation uses an opioid antagonist to reduce, defeat or interfere with the drug euphoria sought by the abuser. It can be formulated so that the opioid antagonist only activates when the drug is crushed for injection or snorting.
The aversion formulation method can combine substances to result in an unpleasant effect when a higher than directed dosage is used; or the drug is manipulated in some way prior to being taken.
Because the abuse-deterrent “prodrug” only activates opioid activity once it is changed in the gastrointestinal tract, it is thus intended to be undesirable for snorting or injecting.
A Combination of Methods
A combination of two or more methods detailed above is used to deter abuse.
Abuse-Deterrent Opioids and Addiction
According to a recent online Forbes article, pharmaceutical companies address the opioid epidemic by promoting abuse-deterrent opioids. (That pharmaceutical companies were the source of the highly addictive opioid prescription painkillers which inundated the medical field and created legions of addicts is the subject of another article.)
According to a Washington University School of Medicine study, abuse-deterrent opioid drugs can reduce prescription drug abuse.
The Journal of the American Medical Association (JAMA) published the report recently. According to that report, 25 percent of opioid abusers could still abuse abuse-deterrent OxyContin. Research results were based on survey of almost 11,000 drug users who were in 150 different drug-treatment facilities throughout 48 states.
The original formulation of OxyContin was altered to prevent abusers of the opioid drug from intensifying the high through crushing and snorting, or dissolving and injecting.
Dr. Wayne Winegarden of the Pacific Research Institute found in his study of abuse-deterrent formulations that opioid abuse could be reduced amongst Medicaid patients by 18 percent; and by 23 percent in commercially insured patients.
The Link to Heroin Abuse
A recent study published in the Journal of the American Medical Association reported 70 percent of those who stopped abusing OxyContin, switched to heroin. Economic reasons were cited by study respondents as the reason for their switch.
According to a professor of neuro-pharmacology, Theodore J. Cicero, while OxyContin abuse in individuals seeking treatment declined, “heroin use increased dramatically” during that same period of time.
According to the Forbes article, Dr. Sylvester Sviokla, director of a Warwick, Rhode Island substance abuse clinic, abuse-deterrent opioids such as Xtampza may be tougher to abuse. At the same time, he notes it does not mean “addicts won’t find a loophole.”