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Webster L, Gudin J. Review of Opioid Abuse-Deterrent Formulations: Impact and Barriers to Access. J Pain Res 2024; 17:1989-2000. [PMID: 38854928 PMCID: PMC11162618 DOI: 10.2147/jpr.s457982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
The misuse and abuse of opioid analgesics continue to pose a serious public health concern, but for some patients, opioids remain an important analgesic option. Extended-release (ER) opioid formulations are effective for treating chronic pain and are supported by multiple 12-week efficacy studies. ER opioids often contain a high opioid content, and similar to immediate-release (IR) formulations, are subject to abuse, misuse, and diversion. Unintentional misuse may also occur when ER formulations are manipulated for medicinal administration, such as crushing a dose for easier oral intake. As part of a multipronged strategy designed to fight the opioid epidemic, abuse-deterrent formulations (ADFs) were developed to deter misuse, abuse, and diversion of opioids by making manipulation more difficult and nonoral routes of administration less rewarding. Although ADF opioids have been shown to decrease rates of abuse and diversion, they are not equally effective in terms of deterring manipulation for abuse or misuse. Xtampza ER utilizes DETERx technology, which allows it to retain ER characteristics when chewed or crushed, making it the only ER opioid without a boxed warning against these types of manipulation. OxyContin was also developed as an ADF but uses RESISTEC technology, making the tablet hard to crush and viscous in aqueous solutions. ADF utilization has been hampered by patient access issues, including high prices due to lack of insurance coverage. Postmarket real-world studies demonstrate lower rates of abuse, misuse, and diversion for ADF ER opioids compared with non-ADF formulations. However, similar studies comparing abuse-related effectiveness and health care costs for ADF opioids are warranted if clinicians are expected to utilize these potentially safer opioid formulations. These studies would support further education surrounding the benefits and utilization of ADFs and manipulation potential of different ADFs.
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Affiliation(s)
- Lynn Webster
- Dr. Vince Clinical Research, Overland Park, KS, USA
| | - Jeffrey Gudin
- Department of Anesthesiology and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
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Bérubé M, Côté C, Moore L, Turgeon AF, Belzile ÉL, Richard-Denis A, Dale CM, Berry G, Choinière M, Pagé GM, Guénette L, Dupuis S, Tremblay L, Turcotte V, Martel MO, Chatillon CÉ, Perreault K, Lauzier F. Strategies to prevent long-term opioid use following trauma: a Canadian practice survey. Can J Anaesth 2023; 70:87-99. [PMID: 36163458 PMCID: PMC9513000 DOI: 10.1007/s12630-022-02328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate how Canadian clinicians involved in trauma patient care and prescribing opioids perceive the use and effectiveness of strategies to prevent long-term opioid therapy following trauma. Barriers and facilitators to the implementation of these strategies were also assessed. METHODS We conducted a web-based cross-sectional survey. Potential participants were identified by trauma program managers and directors of the targeted departments in three Canadian provinces. We designed our questionnaire using standard health survey research methods. The questionnaire was administered between April 2021 and November 2021. RESULTS Our response rate was 47% (350/744), and 52% (181/350) of participants completed the entire survey. Most respondents (71%, 129/181) worked in teaching hospitals. Multimodal analgesia (93%, 240/257), nonsteroidal anti-inflammatory agents (77%, 198/257), and physical stimulation (75%, 193/257) were the strategies perceived to be the most frequently used. Several preventive strategies were perceived to be very effective by over 80% of respondents. Of these, some that were reported as not being frequently used were perceived to be among the most effective ones, including guidelines or protocols, assessing risk factors for opioid misuse, physical health follow-up by a professional, training for clinicians, patient education, and prescription monitoring systems. Staff shortages, time constraints, and organizational practices were identified as the main barriers to the implementation of the highest ranked preventive strategies. CONCLUSIONS Several strategies to prevent long-term opioid therapy following trauma are perceived as being effective by those prescribing opioids in this population. Some of these strategies appear to be commonly used in everyday practice and others less so. Future research should focus on which preventive strategies should be given higher priority for implementation before assessing their effectiveness.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit Research Unit (Trauma - Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC, G1V 1Z4, Canada. .,Faculty of Nursing, Université Laval, Quebec City, QC, Canada. .,Quebec Pain Research Network, Sherbrooke, QC, Canada.
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency–Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC G1V 1Z4 Canada ,Faculty of Nursing, Université Laval, Quebec City, QC Canada
| | - Lynne Moore
- Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency–Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC G1V 1Z4 Canada ,Department of Social Preventive Medicine, Université Laval, Quebec City, QC Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency–Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC G1V 1Z4 Canada ,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC Canada
| | - Étienne L. Belzile
- Division of Orthopedic Surgery, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montreal, Quebec Canada ,Research Centre of the CIUSSS du Nord-de-l’île-de-Montréal, Montreal, QC Canada
| | - Craig M. Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada ,University of Toronto Centre for the Study of Pain (UTCSP), Toronto, ON Canada
| | - Gregory Berry
- Department of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC Canada
| | - Manon Choinière
- Quebec Pain Research Network, Sherbrooke, QC Canada ,Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, QC Canada ,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
| | - Gabrielle M. Pagé
- Quebec Pain Research Network, Sherbrooke, QC Canada ,Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, QC Canada ,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency–Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC G1V 1Z4 Canada ,Quebec Pain Research Network, Sherbrooke, QC Canada ,Faculty of Pharmacy, Université Laval, Quebec City, QC Canada
| | - Sébastien Dupuis
- Department of Pharmacy, CIUSSS du Nord-de-l’île-de-Montréal, Montreal, QC Canada
| | - Lorraine Tremblay
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Valérie Turcotte
- Department of Nursing, CIUSSS du Nord-de-l’île-de-Montréal, Montreal, QC Canada
| | - Marc-Olivier Martel
- Quebec Pain Research Network, Sherbrooke, QC Canada ,Faculty of Medicine & Dentistry, McGill University, Montreal, QC Canada
| | - Claude-Édouard Chatillon
- Division of Neurosurgery, CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC Canada
| | - Kadija Perreault
- Quebec Pain Research Network, Sherbrooke, QC Canada ,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, QC Canada
| | - François Lauzier
- Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency–Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Quebec City, QC G1V 1Z4 Canada ,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC Canada ,Department of Medicine, Université Laval, Quebec City, QC Canada
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Vasiukhina A, Gad SF, Wellington EN, Wilmes DM, Yeo Y, Solorio L. PLA-PCL microsphere formulation to deter abuse of prescription opioids by smoking. Int J Pharm 2022; 626:122151. [PMID: 36037985 PMCID: PMC10729914 DOI: 10.1016/j.ijpharm.2022.122151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
Opioids are commonly prescribed across the United States (US) for pain relief, despite their highly addictive nature that often leads to abuse and overdose deaths. Abuse deterrent formulations (ADFs) for prescription opioids make the non-therapeutic use of these drugs more difficult and less satisfying. Although approximately one-third of surveyed abusers in the US reported smoking opioids, to our knowledge, no commercialized ADF effectively prevents opioid smoking. Here, we report a novel approach to deter smoking of a model prescription opioid drug, thebaine (THB), by using polymer blend microspheres (MS) comprising polylactic acid (PLA) and polycaprolactone (PCL). We utilized high-performance liquid chromatography (HPLC) and thermogravimetric analysis (TGA) to test the ability of PLA-PCL MS to limit the escape of vaporized THB. Additionally, we compared the abuse-deterrent potential of PLA-PCL MS to that of activated carbon (AC) and mesoporous silica (MPS), two materials with excellent drug-adsorbing properties. Our MS formulation was effective in reducing the amount of both active drug and thermal degradation products in the vapor generated upon heating of THB. These results support that PLA-PCL microspheres can be co-formulated in a tablet with common prescription opioids to deter their abuse via the smoking route.
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Affiliation(s)
- Anastasiia Vasiukhina
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Elyssia N Wellington
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Danielle M Wilmes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Yoon Yeo
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA; Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, IN 47907, USA
| | - Luis Solorio
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA; Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
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