Opioid Formulations Designed to Resist/Deter Abuse
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Opioid Formulations Designed to Resist/Deter Abuse Robert B. Raffa1 and Joseph V. Pergolizzi Jr 2,3 1 Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA 2 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 3 Department of Anesthesiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
Contents Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Opioid Abuse in the US . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Formulations Designed to Resist or Deter Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 Extended-Release Morphine with Sequestered Naltrexone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 Controlled-Release Oxycodone in a High-Viscosity Hard Gelatin Capsule . . . . . . . . . . . . . . . . . 2.3 Immediate-Release Oxycodone with Subtherapeutic Niacin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Can These Novel Formulations Prevent Abuse?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abstract
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Physicians who prescribe opioid analgesics for patients with moderate to severe chronic pain face a balancing act in the wake of the current publicity regarding abuse (nonmedical use) of prescription pain killers. There is a spectrum of opioid abuse ranging from those who misuse the drug by not following doctor’s orders to those who take the drugs to achieve a high or divert the drugs to the street market for profit. Formulations of opioid analgesics designed to resist or deter abuse have been proposed, and are now either on the market or in the pipeline. These are innovative formulations that make the drug less convenient or less desirable to abusers. This article examines three such new products along with clinical studies that report on their safety and effectiveness. These drugs include extended-release morphine with sequestered naloxone (Embeda), controlled-release oxycodone in a highviscosity hard gelatin capsule (Remoxy) and an immediate-release oxycodone tablet with subtherapeutic niacin as an aversive agent (Acurox with niacin tablets). Extended-release morphine with sequestered naltrexone offers a pharmacological barrier in that pellets of morphine surround an internal core of naltrexone (ratio 100 : 4 of morphine : naltrexone), which is released if the tablet is compromised by chewing or crushing. The hard gelatin capsule of controlled-release oxycodone was designed to resist tampering and the drug cannot be extracted with a
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