For the millions of Americans affected by prescription drug abuse, 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 attempt to snort, inject or dissolve the pills in alcohol for recreational use. And now research suggests they may help to reduce overdose incidents.
For patients who can access them, that is.
As most Americans now realize, abuse of prescription pain medication presents a formidable challenge. But a solution seems to be slowly taking shape. Abuse-deterrent formulations are one part of that solution.
Health care providers can determine if abuse-deterrent pain formulations are appropriate for a given patient using the Risk Evaluation and Mitigation Strategy now required by the FDA. Providers who prescribe powerful pain-relieving medications for appropriate patients must perform this assessment, which they combine with patient education, informed consent and adherence monitoring. They consider both the patient and people close to the patient.
So while these new opioid analgesics cannot prevent the patient from overtaking a prescribed medication, they may aid a patient who requires pain medication but wants to limit abuse opportunities for those around him. This might be useful to patient who is, for instance, 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.
Making these medications available and affordable to patients is an integral step in reducing abuse – which is, after all, a goal of the FDA, the Office of National Drug Control Policy and the American public. But that requires insurers and pharmacy benefit managers to provide affordable coverage. Some current coverage policies actually limit access to abuse-deterrent products for the very patients who could benefit from them.
My home state of Maryland passed legislation to make abuse-deterrent products more readily available to patients. Several other states are considering similar measures. These bills prohibit insurers from offering more favorable coverage for a traditional form of the pain medication than for the abuse-deterrent form. The bills also stop insurers from requiring higher cost-sharing for abuse-deterrent formulations.
With fair access to abuse-deterrent medications, health care providers can determine on a patient-by-patient basis which individuals could benefit from these formulations. Access will minimize the risk of misuse or abuse, ultimately reducing health care costs and curtailing the prescription opioid abuse epidemic. But patients can only access this technology with fair payment policies in place.
And, without a doubt, patients do need this technology. The battle against prescription drug abuse is fierce, and we need to use every tool available to fight it.
Howard Hoffberg, MD, is a practicing physician and a member of the Alliance for Patient Access.