Yale experts question push for ‘abuse-deterrent’ Rx opioids

In response to the rise in opioid overdose deaths nationwide, pharmaceutical companies have developed formulations of prescription opioids designed to prevent tampering or abuse. These “abuse-deterrent” forms, however, are expensive and may not actually have the intended effect, say experts from Yale School of Medicine.  

In a Perspective piece published in the New England Journal of Medicine (NEJM), Drs. William Becker and David Fiellin explore the potential pitfalls and benefits of moving toward greater prescribing of abuse-deterrent opioids. This approach, they said, may distract physicians from the goal — stated by the Centers for Disease Control and Prevention — of pursuing alternatives to opioids to treat pain, especially long-term. These alternatives include evidence-based treatments like cognitive behavioral therapy, structured exercise programs, yoga, and mindfulness-based stress reduction, they said.

Taking opioids at a higher dose than prescribed is the most common way the drugs are misused. But the abuse-deterrent formulations, which include extended release pills and gels that are difficult to inject, don’t prevent patients from taking higher-than-prescribed doses, the authors noted. Additionally, the new formulations do not address the many adverse effects of taking opioids, which include a higher risk of death from using the drugs long-term. 

As physicians and policymakers wrestle with how to reduce opioid overdose deaths, Becker and Fiellin encourage them to expand access to addiction treatment and focus on the evidence, which fails to show benefit for many patients from long-term use of opioids — abuse-deterrent or not.

“Unfortunately, the hope that long-term opioid therapy would be effective for chronic pain has not born out,” said Becker. “Expensive endeavors to make ‘abuse-deterrent’ formulations are not what the field and, most importantly, patients need.”