The buzz about abuse-deterrent opioids (no pun intended) in some camps seems to view these products as a panacea for the prescription drug abuse problem. In my view, that is far from the reality of the problem and clearly miles from the solution. This morning, I read an interesting article written by Carly Weeks (here) about our neighbors to the north that outlines the other factors that must be addressed in order to gain a foothold on the prescription drug abuse problem and it renewed my concern about how the USA is approaching the prescription drug abuse epidemic.
Changing the drug products to make them more difficult to abuse does not address the underlying issues associated with drug abuse. I have blogged about the issue of abuse-deterrent products on a number of occasions (here, here, and here) and even FDA has said that abuse-deterrent product cannot preventabuse. Remember that FDA approves drug products as safe and effective for their intended use in accordance with their labeled instructions. People are in pain and those people should have access to drugs that relieve pain. The pain treatment community suffered through years of turmoil to reduce the stigma of treating severe pain and to reach modern day pain treatment guidelines. So, should FDA concentrate on a mandate that abuse-deterrent technology always be used for drugs of abuse?
While abuse-deterrent products may deter some abusers from their pursuits, they may also make it more difficult for those with severe recalcitrant pain to obtain the treatment they need. Abuse-deterrent product may also drive abusers to other non-abuse-deterrent prescription products or more likely to illicit drugs, such as heroin (as noted by Ms. Weeks and other who have written extensively about this problem).
There is a surefire way to prevent abuse of opioid prescription drug product and that is to keep them out of the hands of abusers. While easier said than done, the nation needs to wake up to this fact and relook at its enforcement efforts, monitor healthcare providers, pharmacists, and have a nationwide system that would help healthcare providers monitor individual patients prescription use of opioid products.
The FDA has revised labeling for prescription opioid use and now, hopefully, the medical community will adjust the way it prescribes these products to be more alert to signs of abuse and use them for the indications for which they are approved. The idea that making a product more difficult to crush or more difficult to inject is going to solve the prescription drug abuse problem is naïve at best, as most abusers simply use the oral route as a preferred method of abuse.
So as the book title “It Takes a Village” implies, there needs to be help from many facets of society, as well as multiple disciplines in the enforcement, treatment, and healthcare arena to address the problem ,while at the same time keeping narcotic products accessible, affordable, and useful (you can’t crush an abuse-deterrent product designed not to be crushed to treat a person with an nasogastric tube or that can otherwise not swallow a tablet) to treat the millions of patient in intractable pain. I usually don’t like to editorialize in my blog, but I must say that the views expressed in this edition represent my personal views and not necessarily the views of others. I am not saying I am right or “they” are wrong, I am saying that together we need to be able to craft a policy that protects the patient, get the abuser the help they need, and cut off the illegal use of prescription opioid products. This is a big ask for certain with lots of what ifs. Let’s hope that a workable national policy can be developed, implemented, adequately and equitably applied, and enforced to address the problem of opioid prescription drug abuse.