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    Abuse-Deterrent Opioids Aren’t Effective

    New research suggests that the latest trend in opioids may not be so helpful.

    Abuse-deterrent Formulations (ADFs) have gained popularity as a part of the solution to end the ongoing opioid crisis. Massachusetts, Maine, Maryland, Florida, and West Virginia have passed legislation mandating coverage for ADFs, and more than 20 other states are considering similar bills. But a review of 10 ADFs shows that the health gains from ADFs are uncertain and the costs are high. So are they worth it?

    That’s the question the Institute for Clinical and Economic Review (ICER), an independent, non-profit research organization, attempted to answer in their recent report on the effectiveness and value of ADFs. ICER looked at the available data on 10 different ADFs to determine the value of ADFs on health and to perform a cost-benefit analysis. ICER evaluated:

    • Hysingla ER (hydrocodone, Purdue)
    • Vantrela (hydrocodone, Teva)
    • Arymo ER (morphine, Egalet)
    • Embeda (morphine + naltrexone, Pfizer)
    • Morphabond (morphine extended release, Inspirion Delivery Technologies)
    • OxyContin TR (oxycodone, Purdue)
    • Xtampza ER (oxycodone, Collegium)
    • Targiniq (oxycodone + naloxone extended release, Purdue)
    • Troxyca ER (oxycodone + naltrexone, Pfizer)
    • RoxyBond (oxycodone immediate release, Inspirion) 

    Of the 10, nine are extended release while only one, RoxyBond, is instant release.

    Purdue’s reformulation of Oxycontin was released in 2010 and was the first ADF and now holds 90% of the ADF market, according to ICER. ADFs are generally made more difficult to crush, which inhibits chewing, injecting, or snorting the medication. However, ADFs do not inhibit swallowing the pills, which is the most common method of abuse.

    Related article: Abuse-Deterrent Opioid Rexista Makes Misusers Blue—Literally

    The current research on the efficacy of ADFs in reducing abuse is uncertain and limited. Pre-market studies showed that recreational drug users said that both crushed and intact ADFs are less useful to them than non-ADF forms, and that they were less likely to take the ADF version again. However, no threshold exists for measuring abuse potential, and according to ICER this means that the clinical significance of these findings are unclear. In post-market studies, it was found that after OxyContin was reformulated, drug users were less likely abuse the drug. But, other studies showed an increase in the abuse of other opioids, indicating that abusers simply shifted to another drug. Currently, there is limited data available on ADFs other than OxyContin—in fact, there is no real-world evidence for any ADF other Purdue’s drug.  

    The evidence led ICER to determine that OxyContin TR provided “moderate certainty” of a net health benefit for patients prescribed an opioid. Reports on other ADFs were “promising but inconclusive,” and overall the evidence was “insufficient to determine a net health benefit of ADFs.”

    Up next: What the data mean

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