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Tamper-resistant drugs may not solve opioid addiction epidemic

Tamper-resistant drugs cannot solve the opioid addiction crisis, according to Pamela Leece, MD, MSc, of the University of Toronto, and colleagues.

“Tamper-resistant formulations are designed to prevent tampering in different ways: some release an opioid antagonist such as naloxone to counteract drug activity, and others produce an unpleasant side effect, form a viscous substance when combined with liquid or retain their controlled-release properties,” Leece and colleagues wrote in CMAJ.

Despite recently published evidence that tamper-resistant drugs did not increase rates of dispensed generic non-tamper-resistant long-acting oxycodone, Leece and colleagues feel that evidence of advantages of tamper-resistant formulations is lacking.

Since the long-acting formulation of oxycodone was replaced with a tamper-resistant formulation in 2010 and 2012, overall rates of opioid-related deaths have continued to increase, according to researchers.

Further, Leece and colleagues report there is growing evidence that individuals begin to use other opioids, such as heroin, when availability of prescription opioids changes.

According to researchers, there are a number of reasons why tamper-resistant drug formulations will not curtail the opioid epidemic overall, including:

• Many tamper-resistant formulations include naloxone, which counteracts opioid effects if administered intravenously, thus, the medication has little effect on psychoactive properties when chewed;
• Formulations that deter crushing can be consumed other ways, defeating the tamper-resistant mechanism;
• Tamper-resistant formulations are more expensive than generic opioids and may not be covered by some private or public insurers, and as a result, prescription of non-tamper-resistant opioids may continue; and
• If tamper-resistant formulations are marketed as safe, opioid prescribing may increase.

“Regulations requiring tamper resistance represent an expensive, technical approach that is influenced by pharmaceutical interests and cannot solve the opioid crisis,” Leece and colleagues wrote. “An evidence-based, multifaceted strategy is needed — one that has real potential to curb opioid-related harms at a population level. Tamper-resistant formulations are a gimmick, and health professionals should not be fooled by them.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.