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By Keith M. Krause and U.S. Rao

Keith Krause-finalU.S. Rao-finalPrescription drug abuse is an epidemic in the United States. For instance, the Center for Disease Control and Prevention reports that 44 people die every day from prescription opioid pain medication overdose. According to the Drug Abuse Warning Network (DAWN), prescription drug abuse in 2011 was the cause for approximately 1.5 million emergency room visits. The estimated cost from opioid abuse alone was $55.7 billion in 2007, which is steadily increasing without any sign of decline.

Recognizing the gravity of drug abuse, the National Association of Boards of Pharmacy (NABP) President Edward G. McGinley has urged fellow pharmacists to take an active role in educating colleagues and the community about the dangers of prescription drug abuse and misuse as well as steps to take when diversion is suspected. At its annual meeting in May 2015, he encouraged pharmacists to take the “Pharmacist Pledge to Make a Difference” in the battle against prescription drug abuse.

As concerned healthcare professionals involved in dispensing and medication therapy management, we write this perspective about new formulations of prescription pain medications already available and to stimulate interests in developing newer formations that would augment these efforts of controlling drug diversion and abuse.

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Capsaicin has been tested as an abuse deterrent.

Toward this end, the Food and Drug Administration (FDA) has been increasingly encouraging the pharmaceutical industry to develop formulations that would deter drug abuse. There have been several new pain medication formulations that include OxyContin (Oxycodone CR), Targiniq ER (oxycodone/naloxone) and Hyslinga ER (hydrocodone ER), Embeda (morphine/naloxone), and Zohydro ER (hydrocodone ER) that are abuse-resistant approved by FDA. These products have been shown to be difficult to alter for abuse for all common forms of abuse such as crushing, injecting, and snorting. While the data concerning the effectiveness of these new formations in preventing drug abuse is yet to come, studies have estimated that the annual savings in direct medical costs is approximately $430 million with the new OxyContin formulation alone. Taken together, the newer technology incorporating drug abuse deterrents in the pain medication will help with drug abuse and save overall costs.

Other possible abuse deterrents were also investigated. A recently conducted randomized, double-blind study showed significant results with niacin, a nasal irritant, in an immediate release oxycodone formulation as abuse deterrent. Similarly, capsaicin has been tested as an abuse deterrent and this technology is available at many sources. These well-known deterrents may be used as newer preparations that could prove to be useful for other indications. These and other newer formulations may prove to aid in the fight against drug diversion and abuse. With the creation of abuse-resistant pharmaceuticals, we are finally making progress to fight drug abuse in the United States, and we look forward to seeing further progress with the development of new formulations in the future.

Keith M. Krause is pursuing a Pharm.D. degree at the Appalachian college of Pharmacy.
U.S. Rao, Ph.D., is a professor and director of research at the Appalachian College of Pharmacy.