Pain Management: Balance and Adoption of Abuse-Deterrent Opioid Formulations

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. It’s all about pain management and the balance and adoption of Abuse-Deterrent Opioid (ADO) formulations.

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 the 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. At least, we won’t run risks like surgeons that practice with self-designed EMRs.

Introduction

Recent advances in pharmaceutical product formulation have led to the development of opioid analgesic medications with abuse-deterrent properties. Many clinics and hospitals take tentative steps not only with EMRs but also with abuse-deterrent opioids for qualifying patients Only a few such products have already been approved for use or are near approval, but many products are in the development pipeline.

If the promise of these abuse-deterrent opioids (ADOs) is fulfilled, healthcare professionals should become more confident in the provision of pain medications to patients, leading to improvement in the quality of pain management as well as a reduction in the abuse of prescription drugs. Prescription drug monitoring is a great tool for pharmacists but other healthcare providers will also benefit.

This following posts that will be published over the course of the next few months, consider clinical, regulatory, and ethical implications of using ADOs for the treatment of pain. Building on the published work of Mayday Scholars in Pain Policy, and other investigators, the article examines how ADOs can be effectively incorporated into the practice of pain management. More about the Mayday Project in a later post.

The articles will conclude with a call for balanced and explicit regulatory standards specifying the circumstances when ADOs should be used, as well as those circumstances when they need not be used. For example, if a patient’s pain caused by noise on the workplace is severe, even when it has led to a loss of hearing, adequate medication could be the proper answer. In the absence of clear standards, fear of regulatory noncompliance may lead clinicians to overuse ADOs when they are not appropriate or necessary from a clinical perspective.

In the face of regulatory uncertainty, risk avoidance considerations may induce prescribers to use ADOs when they are not clinically warranted, while third-party payment policies may induce clinicians not to use ADOs when they are appropriate and necessary from a public health perspective. See also this post: Blood Glucose Meters – How to choose the right one? Many diabetes patients suffering from unbearable pain, could also benefit as long as we’ll be very careful and restrictive with prescriptions.

Regulatory agencies across the globe with responsibilities for assuring opioid medications’ safety have long been struggling to come up with the appropriate balance between the right policies to allow access to pain medications to those who need it and denying access to those medications to those who don’t have any legitimate need. For many patients, a simple step like taking antioxidants to improve their health may already be the solution. Not in all cases should we prescribe medication.

The techniques that are used by healthcare professionals for minimizing the chance for illegal acquisition of opioid medication by individuals or organizations who don’t have any medical need are including pill counts, urine drug testing, agreements regarding medication, survey instruments, as well as reviewing prescription reports.

The fact of the matter is, though, that regardless of how conscientious out nation’s healthcare workers may be in preventing diversion, there will always be a certain amount of illicit and illegal drug acquisition if we want to make sure that legitimate patients will not be deprived of the necessary medication. Many health problems are related to weight problems. Many weight loss experts tackle the ups and downs of pills and dieting as well and overly aggressive drug diversion prevention will not lead anywhere.

The recent development of abuse-deterrent opioids (ADOs) is challenging the tradition in which controlled substance abuse is inevitable and accepted if those substances are diverted. Recent developments seem to have made it possible that the abuse potential of controlled substances can be reduced. So far this introduction post. During the next few months, I’ll be addressing various field related to this topic. I’ll keep you posted!

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