by Howard Hoffberg, MD
As most Americans now realize, abuse of prescription pain medication presents a formidable challenge. Yet while many lament America’s prescription drug abuse problem, too few have brought viable solutions to the table. New pain pill designs offer a glimmer of hope.
Known as “abuse-deterrent,” these pills resist crushing or melting. Their design makes it extremely difficult for abusers to snort, inject or dissolve the pills in alcohol for recreational use.
This technology is not a panacea. It’s a piece of a much larger, more complex solution. One important part of that solution is educating patients, health care providers and pharmacists. The Food and Drug Administration, for instance, now mandates a Risk Evaluation and Mitigation Strategy for extended release opioid formulations.
Providers who prescribe these powerful pain-relieving medications for appropriate patients need to perform a thorough risk assessment combined with patient education, informed consent and adherence monitoring. They must also consider both the patient and the people around that patient. Depending upon that assessment, health care providers may determine abuse-deterrent pain formulations to be appropriate.
These new opioid analgesics cannot prevent patients from overtaking their prescribed medication. But the formulations may aid, for example, a patient whose condition requires pain medication but who is married to a former prescription drug abuser. Patients who live with current or former addicts may also be candidates for abuse-deterrent formulations. So too may those with teenagers living at home who might seek pain pills for recreational use.
As these examples illustrate, abuse-deterrent formulations allow health care providers to get appropriate medical relief to legitimate patients without increasing the potential for abuse and diversion.
But abuse-deterrent formulations can help only if patients can access them. Current insurance policies actually limit access to abuse-deterrent products for the very patients that can benefit from them.
Now, several states (including my home state of Maryland) could help the situation by making abuse-deterrent products more readily available to patients. Several state bills prohibit insurers from offering more favorable coverage for a traditional form of the pain medication than for the abuse-deterrent form. Others stop insurers from requiring higher cost-sharing for abuse-deterrent formulations.
With the help of legislation like this, health care providers can determine on a patient-by-patient basis which individuals would benefit from abuse-deterrent medications. Those patients can then have access to the formulations their health care provider prescribes.
And that access will minimize the risk of misuse, abuse or diversion, ultimately reducing health care costs and equipping us to curtail the prescription opioid abuse epidemic.
Howard Hoffberg, MD, is a practicing physician in Maryland and a member of the Alliance for Patient Access’ Pain Therapy Access Physicians Working Group.