The proper treatment of patients can take on a variety of challenges, but in all things physicians are guided by the Hippocratic Oath that includes the phrase, “I will prevent disease whenever I can, for prevention is preferable to cure.”
There are approximately 116 million Americans diagnosed with chronic, non-malignant pain. It is the most common reason patients seek medical care, resulting in $635 billion annually in both medical costs and decreased work productivity. Treating these patients in a manner that alleviates their pain yet protects against untoward consequences, such as abuse, has offered limited options. The need to consider “prevention” of abuse while treating pain has left many physicians in a Catch-22.
Those who are diagnosed with non-malignant chronic pain need, and deserve, to be properly medicated in order to enjoy their activities of daily living to the best of their ability. For most patients, it is a quality of life issue and the relief offered through practitioner provided prescription medication is essential. Opioid based analgesics, in pill form, are the primary source of their relief.
However, drug abusers are commonly manipulating opioids by crushing, grinding, or melting the tablets then either injecting or sniffing the drug. The rapid absorption offers a quick “high” and gives the abuser an immediate, greatly increased blood level of the drug versus that achieved by ingesting the pill through swallowing. The Center for Disease Control reports 46 people die each day from an overdose of prescription pain killers.
Additionally, there is a growing epidemic of heroin use. In far too many cases this started with the abuse of prescription opioids and advanced to the less expensive and easier obtained opiate, heroin. Benign beginnings that lead to a catastrophic end.
Physicians must guard against drug-seeking behavior in patients for the sake of non-medical needs or the abuse of prescribed medication by others than the patient, while properly treating chronic pain patients. The pharmaceutical industry has been equally involved in the search for a solution. The goal has been to produce a drug that is safe and effective for the intended population yet would safely deter abuse by potential abusers and is economically feasible.
Finally, we have a technology called Abuse Deterrent Formulations (ADF) that removes the ability for manipulation of these medications, thereby significantly reducing the ability for abuse. This technology presents no change in the efficacy of the medication for the treatment of pain but the abuse potential is extremely diminished.
Within ADF technology there are a variety of formulations that deter abuse. In one type, if the medication is crushed, ground or melted the transmission of the opioid effect is blocked, rendering it without the desired result to the abuser. In another, the pill is coated in a substance that prevents the extraction of the interior of the pill, the opioid within, disallowing melting or crushing.
The statistics on non-malignant chronic pain and opioid abuse demand a response to the need of physicians to properly treat patients with chronic pain, while preventing intentional abuse. Abuse Deterrent Formulations should be readily available to decrease clinical concerns while providing patients the analgesia required. The use of ADF technology in treating and prescribing medication allows physicians the ability to treat patients and maintains the sanctity of our pledge and the belief that “…prevention is preferable to cure.”
– Todd Levine is co-director of the neurophysiology department at Banner Good Samaritan Medical Center and a clinical assistant professor at the University of Arizona in Neurology.