Mitigation of IV Abuse Through the Use of Abuse-Deterrent Opioid Formulations: An Overview of Current Technologies.
Providers who treat patients with chronic pain face a dual challenge: providing adequate access to opioid therapies for appropriate pain management while adopting strategies to minimize the risk of abuse. Commonly prescribed opioids have substantial abuse potential when administered intravenously and extended-release (ER)/long-acting (LA) opioids may be targeted for intravenous abuse because of the higher per-dose medication level. The consequences of intravenous opioid abuse are severe and increase the risks of adverse outcomes, including mortality due to acute health events, serious infections, and deep vein thrombosis, to name a few. To reduce the potential for abuse of prescription opioids by both recreational and experienced drug abusers, abuse-deterrent formulations (ADFs) of opioid medications employ either physical/chemical barriers or agonist-antagonist combinations. This article reviews the development and use of opioid ADFs as a harm-reduction strategy and their potential for mitigating intravenous opioid abuse. The approved ER/LA opioids with ADF labeling in the United States include formulations of oxycodone, hydrocodone, and morphine. Findings from in vitro laboratory tests of abuse deterrence for opioid ADFs are described herein, as are data from human abuse potential studies for intravenous abuse of those ADF products for which such studies are feasible (ie, abuse-deterrent agonist-antagonist formulations). The available ADF opioids may decrease both the attractiveness and the feasibility of intravenous abuse. The adoption of ADF opioids represents one tactic for providing access to needed medication for patients with chronic pain, while potentially reducing the risk of opioid abuse, in a comprehensive effort to combat the opioid epidemic. This article is protected by copyright. All rights reserved.