Prescription Opioid Misuse: Effective Methods for Reducing the Epidemic

Prescription opioid misuse has been a significant epidemic during the past decade. Formulations of prescription opioids with different mechanisms of abuse-deterrence have been developed or are currently under development. Given that these medications are substantially more difficult to use in an illicit fashion and minimize the potential for euphoria and/or create an aversive experience when over-ingested, they represent an important next step in pharmacological innovation. Immediate decreases in nonmedical use and in associated overdose mortality and adverse events have been observed after a highly abused opioid, OxyContin, was changed into an abuse-deterrent formulation. However, this reduction in OxyContin use may have simply shifted the drug of choice towards other more easily misused opioids, suggesting that a change in formulation alone will not be sufficient in controlling the epidemic. To control prescription opioid misuse requires treating populations with opioid use disorder and preventing the development of opioid abuse or dependence in unaffected populations. Buprenorphine with naloxone has been designed as an abuse-deterrent formulation, while also demonstrating significant efficacy in treating opioid use disorder. Thus, the dissemination of buprenorphine treatment can be a helpful step in reducing the current epidemic. Other strategies to reduce the epidemic include limiting the availability of leftover prescription opioids through drug take back programs, monitoring physician prescriptions through state prescription monitoring programs, and implementing evidence-based practices in pain management. Increased referral of patients with chronic nonmalignant pain to comprehensive pain rehabilitation programs can also reduce healthcare utilization while improving patient outcomes. Also, routine screening for prescription misuse and referral for addictions treatment must become a standard practice in order to ensure patient safety and create early opportunities for intervention.