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Can the U.S. Win the War On Opioids?

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Remember the “War on Drugs”? This may conjure images of Mexican drug lords, packages of smuggled cocaine, or clandestine DEA agents. But now we all know that the real bandit is found right in our own home — in our bathroom medicine cabinets.

According to the Centers for Disease Control (CDC), 44 people in the United States die from an overdose of prescription opioid painkillers each day. Grandmothers, small children, someone’s son. Lost not because they went outside of the boundaries to use illicit drugs, but because they were caught inside a web of prescription drug addiction, accidental overdose, or suicide with a pain medication that was dispensed to someone with a valid, legal prescription.

Yes, we are all to blame: healthcare providers, policy makers, and patients.

Here are some sobering U.S. statistics:

Abuse-Deterrent Formulations

The answers aren’t easy, but there are many measures being put in place to address prescription opioid overprescribing, diversion, and addiction while still ensuring adequate pain coverage for those who really need it.

Novel ‘abuse-deterrent’ formulations of hydrocodone, morphine and oxycodone, are increasingly becoming available on the U.S. market. These formulations were developed as one method to fight back at the opioid abuse epidemic in the U.S.

Examples include:
Oxycontin (oxycodone [reformulated])
Embeda (morphine/naltrexone)
Hysingla ER (hydrocodone)
Targiniq ER (oxycodone/naltrexone)
Zohydro ER (hydrocodone)

But what exactly constitutes an ‘abuse-deterrent’ drug? ‘Abuse-deterrent’ means that the medication has been developed in line with FDA guidelines to exhibit properties that can lower, but not totally eliminate, the ability to abuse of the formulation. Chewing, crushing, snorting, or injecting are some of the more common ways these opioids are abused. Mechanisms that are being built into abuse-deterrent formulations to prevent these actions include:

By incorporating abuse-deterrent technology into dosage forms of commonly abused opioids, the immediate and intense high that can be achieved by unintended routes can be prevented.

Initial studies outlined in the package labeling have shown that these drugs can decrease ‘drug-liking’ and the desire to take the drug again; however, the FDA has mandated postmarketing studies, as well. The most common way that drugs are abused — simply by swallowing a handful of them — can’t be stopped.

Just how well are abuse-deterrent dosage forms working? Studies with Oxycontin show a 32 percent reduction in the rate of reported abuse at poison control centers, a 50 percent reduction in Oxycontin diversion, and a 66 percent decline in non-oral abuse. Some research suggests a link between elevated heroin abuse and overdoses occurring as users seek out alternatives due to lower availability of prescription opioids. However, a January 2016 review article in JAMA Internal Medicine suggests otherwise. Postmarketing studies of other products are forthcoming. But abuse-deterrent forms can’t work by themselves.

Hydrocodone Reschedule

In October 2014, the DEA changed hydrocodone from a schedule III to a schedule II controlled substance in an effort to combat overprescribing. In doing so, refills are now restricted unless the patient has a newly written prescription. Although hydrocodone prescriptions had already dropped by 8.4 percent in the three years prior the the reschedule, in the year after rescheduling, the number of prescription dropped dramatically by 22 percent, equal to 26 million fewer prescriptions and 1.1 billion fewer dispensed tablets.

What Else Can Be Done?

Winning the war on prescription opioid abuse and fatalities requires a multi-pronged approach:

Guidelines and Patient Engagement

In February 2016, the FDA called for a “far-reaching” action plan to reassess their approach to opioid medications. The goal is to focus on ways to reverse the epidemic while maintaining access to adequate pain relief for patients who require it.

The CDC has released a new guideline: Guideline for Prescribing Opioids for Chronic Pain, 2016. CDC developed the opioid guideline to provide recommendations about prescribing for primary care providers who are treating adult patients with chronic pain in outpatient settings, outside of active cancer treatment. The guideline also identifies important gaps in the literature where further research is needed.

The CDC has also launched a consumer campaign to listen to those whose lives have been affected by painkiller addiction or death of a loved one. Via social media, the CDC aims to engage those in need of treatment, those working to change their lives, or those taking charge to inspire their communities to have a deeper impact on the way we — that is, healthcare providers, policy makers, and patients — think about and treat pain.

Leigh Anderson, PharmD


Jones CM, Lurie PG, Throckmorton DC. Effect of US Drug Enforcement Administration’s Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing. JAMA Intern Med. Published online January 25, 2016. Accessed February 2, 2016 at

Compton W, Jones C, Baldwin G. Relationship Between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med 2016;374:154-163. DOI: 10.1056/NEJMra1508490. Accessed February 2, 2016 at

The Medical Letter on Drugs and Therapeutics. Abuse-Deterrent Opioid Formulations. Issue 1476, August 31, 2015.

Centers for Disease Control and Prevention. Social Media. When the Prescription Becomes the Problem: Resources. Updated August 18, 2015. Accessed February 1, 2016 at

Duffy S. One Year Later: The Impact of Hydrocodone Combination Product Rescheduling. EMPR Online. January 28, 2016. Accessed February 1, 2016 at Federal Register Notice: Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain. Posted December 14, 2015. (docket # CDC-2015-0112)

FDA. Abuse-deterrent Opioids: Evaluation and Labeling. Guidance for Industry. April 2015. Accessed February 2, 2016 at

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