Current status and evolving role of abuse-deterrent opioids in managing patients with chronic pain

Lynn Webster, MD; Barbara St. Marie, NP; Bill McCarberg, MD; Steven D. Passik, PhD; Sunil J. Panchal, MD; Eric Voth, MD

doi:10.5055/jom.2011.0066

Authors

Lynn Webster, MD
Barbara St. Marie, NP
Bill McCarberg, MD
Steven D. Passik, PhD
Sunil J. Panchal, MD
Eric Voth, MD

DOI:

https://doi.org/10.5055/jom.2011.0066

Keywords:

opioid, abuse, abuse resistant, abuse deterrent, chronic pain, risk evaluation

Abstract

Opioids are widely used for the treatment of patients with chronic pain; yet, the increase in their abuse, misuse, and diversion is an ongoing focus of regulatory, governmental, and legal scrutiny. As a consequence, clinicians are faced with numerous challenges in an effort to use opioids in appropriate patients with pain while minimizing the potential for opioid abuse, misuse, and diversion. Policies and programs such as state prescription monitoring programs, which have been in existence for decades, are but one attempt to address some of the issues regarding the prescribing of opioids. Another is a risk evaluation and mitigation strategy for opioids under consideration by the US Food and Drug Administration. At the clinical level, a universal precautions and risk management package that includes risk assessment and patient monitoring is a recommended approach. This approach can also include the use of abuse-deterrent and abuse-resistant formulations designed to reduce the nonmedical use of opioids. Several of these opioid formulations have been approved or should soon be on the market for use in the United States; however, their role and other questions regarding their use remain unanswered. The authors offer their clinical perspective on several of these key questions.

Author Biographies

Lynn Webster, MD

Medical Director, Lifetree Clinical Research and Pain Clinic, Salt Lake City, Utah.

Barbara St. Marie, NP

Fairview Health Services, University of Minnesota, Fairview Ridges Hospital, Burnsville, Minnesota.

Bill McCarberg, MD

Founder, Chronic Pain Management Program, Kaiser Permanente San Diego, Escondido, California.

Steven D. Passik, PhD

Associate Attending Psychologist, Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, New York.

Sunil J. Panchal, MD

President, National Institute of Pain, Lutz, Florida.

Eric Voth, MD

Medical Director of Clinical Practice, Stormont-Vail HealthCare, Topeka, Kansas; Chairman, The Institute of Global Drug Policy, Topeka, Kansas.

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