Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abuse-deterrent formulations Maciej Gasior, Mary Bond & Richard Malamut To cite this article: Maciej Gasior, Mary Bond & Richard Malamut (2015): Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abusedeterrent formulations, Postgraduate Medicine, DOI: 10.1080/00325481.2016.1120642 To link to this article: http://dx.doi.org/10.1080/00325481.2016.1120642
Accepted author version posted online: 13 Nov 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Tufts University]
Date: 02 December 2015, At: 11:29
Publisher: Taylor & Francis Journal: Postgraduate Medicine DOI: 10.1080/00325481.2016.1120642
Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abusedeterrent formulations
Downloaded by [Tufts University] at 11:29 02 December 2015
Maciej Gasior, Mary Bond and Richard Malamut TEVA Pharmaceuticals, Frazer, PA, USA
Correspondence: Maciej Gasior MD PhD, Director Clinical Project Physician, TEVA Pharmaceuticals, 41 Moores Rd, PO Box 4011, Frazer, PA 193555, USA. Tel: + 1 (610) 727-3306; Fax: Fax: 610-786-7061; e-mail: [email protected]
Running title: Routes of abuse of prescription opioid analgesics
1
Abstract Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse, and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking, and vaping) and injection. However, reported routes of abuse
Downloaded by [Tufts University] at 11:29 02 December 2015
vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex, and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations aim to hinder extraction of the active ingredient, prevent administration through alternative routes, and/or make abuse of the manipulated product less attractive, less rewarding, or even aversive. There are currently five opioid analgesics with a Food and Drug Administration abusedeterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.
Keywords: Prescription opioid analgesics, abuse, manipulation, route of administration, abuse-deterrent formulation
2
Introduction Prescription opioid analgesics are an important treatment option for patients with chronic pain [1]; however, misuse, abuse, and diversion of these medications are a global public health concern [2]. Misuse is defined as the intentional therapeutic use of a prescription opioid analgesic in an inappropriate way, excluding events that meet the definition of abuse [3]. Abuse is the intentional, non-therapeutic use of a prescription opioid analgesic to achieve a desirable psychological or physiological effect, for example, euphoric, sedative, or
Downloaded by [Tufts University] at 11:29 02 December 2015
anxiolytic effects [3]. Diversion is any intentional act that results in transferring a prescription opioid analgesic from lawful to unlawful distribution or possession [3]. Results of a structured evidence-based review suggest that abuse develops in
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abuse-deterrent formulations Maciej Gasior, Mary Bond & Richard Malamut To cite this article: Maciej Gasior, Mary Bond & Richard Malamut (2015): Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abusedeterrent formulations, Postgraduate Medicine, DOI: 10.1080/00325481.2016.1120642 To link to this article: http://dx.doi.org/10.1080/00325481.2016.1120642
Accepted author version posted online: 13 Nov 2015.
Submit your article to this journal
Article views: 12
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Tufts University]
Date: 02 December 2015, At: 11:29
Publisher: Taylor & Francis Journal: Postgraduate Medicine DOI: 10.1080/00325481.2016.1120642
Routes of abuse of prescription opioid analgesics: A review and assessment of the potential impact of abusedeterrent formulations
Downloaded by [Tufts University] at 11:29 02 December 2015
Maciej Gasior, Mary Bond and Richard Malamut TEVA Pharmaceuticals, Frazer, PA, USA
Correspondence: Maciej Gasior MD PhD, Director Clinical Project Physician, TEVA Pharmaceuticals, 41 Moores Rd, PO Box 4011, Frazer, PA 193555, USA. Tel: + 1 (610) 727-3306; Fax: Fax: 610-786-7061; e-mail: [email protected]
Running title: Routes of abuse of prescription opioid analgesics
1
Abstract Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse, and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking, and vaping) and injection. However, reported routes of abuse
Downloaded by [Tufts University] at 11:29 02 December 2015
vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex, and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations aim to hinder extraction of the active ingredient, prevent administration through alternative routes, and/or make abuse of the manipulated product less attractive, less rewarding, or even aversive. There are currently five opioid analgesics with a Food and Drug Administration abusedeterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.
Keywords: Prescription opioid analgesics, abuse, manipulation, route of administration, abuse-deterrent formulation
2
Introduction Prescription opioid analgesics are an important treatment option for patients with chronic pain [1]; however, misuse, abuse, and diversion of these medications are a global public health concern [2]. Misuse is defined as the intentional therapeutic use of a prescription opioid analgesic in an inappropriate way, excluding events that meet the definition of abuse [3]. Abuse is the intentional, non-therapeutic use of a prescription opioid analgesic to achieve a desirable psychological or physiological effect, for example, euphoric, sedative, or
Downloaded by [Tufts University] at 11:29 02 December 2015
anxiolytic effects [3]. Diversion is any intentional act that results in transferring a prescription opioid analgesic from lawful to unlawful distribution or possession [3]. Results of a structured evidence-based review suggest that abuse develops in
