How Abuse-Deterrent Opioids Give Doctors and Patients More Options
By: Sarah Galbally, Secretary of Policy and Planning
October 11, 2016
While many people become addicted to opioids by simply swallowing pills, others crush pills to snort or smoke.
Drug manufacturers, with encouragement and guidance from the U.S. Food and Drug Administration, are rapidly developing new technologies to prevent this kind of abuse. Some of these drugs are uncrushable, even with a hammer, while others are formulated with naloxone so the more an individual takes, the less effective it is in creating a high and limiting the potential for overdose. Others turn into a gel when they are crushed, making them impossible to put into a syringe to inject.
Recently, Governor Wolf sent a letter to the FDA encouraging their expedited approval of generic forms of opioids with abuse-deterrent formulations which will ultimately make these drugs more affordable and more accessible for the people who need them.
Governor Wolf believes that insurance companies should be required to cover abuse-deterrent opioids. HB1698, which has passed in the House and is sponsored by Rep. Heffley, would require health insurance plans and carriers to provide access to abuse-deterrent opioids. In no way would this bill require doctors to prescribe abuse-deterrent opioids. Rather, it would give doctors additional decision making tools and create more opportunities for doctors and patients to collaborate on the best clinical path forward in treating pain.
In 2010, OxyContin (OC) was reformulated to be abuse-deterrent. Following this reformulation, rates of abuse, misuse, overdose, death, and drug diversion all decreased. By 2013, “abuse of OxyContin decreased 48% in national poison center surveillance systems, decreased 32% in a national drug treatment system, and decreased 27% among individuals prescribed OC in claims databases. Doctor-shopping for OC decreased 50%,” according to a study published in the summer of 2016. While this study was limited to analyzing the effects of reformulated OC on OC-specific abuse, it adds to a growing body of evidence that justifies expanding access to opioids with abuse-deterrent properties for doctors and patients.
According to the American College of Preventive Medicine, almost 60% of prescription medications that are used for nonmedical purposes are obtained from family or friends. Imagine a mother of teen children who was prescribed opioids for pain management following a car accident. Why wouldn’t we want to give this mother the option of having opioids that cannot be snorted or injected in her home?
The disease of addiction often begins with swallowing pills. However as the severity of abuse and an individual’s tolerance increases, people suffering from addiction can quickly move to injecting and snorting opioids in order to achieve a stronger high.
Furthermore, many also believe that the risk of addiction increases substantially with snorting or injecting. By making abuse-deterrent opioids more widely available, we can help to curb the likelihood of accelerating the severity of a person’s addiction and instead connect them with treatment services earlier in their addiction.
Abuse-deterrent opioids are not a cure-all for the opioid epidemic, but taking steps to ensure that pills cannot be altered into forms that make them more potent is a positive step forward and one we wholeheartedly endorse in Pennsylvania.
HB1698 requires that insurance companies over which the state has regulatory oversight (typically large and small group plans) provide coverage for three opioids with abuse deterrent properties in the event they currently offer a non-abuse deterrent opioid on their formulary. Neither Pennsylvania’s Medicaid program, Medical Assistance, nor the Commonwealth’s employee benefits plan, PEBTF, are covered under the purview of this legislation and yet both currently cover multiple abuse-deterrent opioids on their formularies. Private insurance companies should do their part to fight the opioid epidemic and model this coverage to create a pathway for meaningful consumer choice.
Abuse-deterrent opioids, if crafted properly, can be important tools to prevent against intentional or unintentional misuse, abuse, or overdoses.
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