Crush-Resistant Opioids: Not All They’re Cracked Up to Be
Prevention & Treatment The CDC is calling today’s opioid overdose problem “the worst drug overdose epidemic in U.S. history.”
Once rare in the United States, opioid overdose deaths have led to the loss of more than 220,000 lives (175,000 from prescription opioids and 45,000 from heroin) since 1999. This death toll exceeds the number of American lives lost in Vietnam, Afghanistan and Iraq combined.
Where addiction begins
The Centers for Disease Control (CDC) has been perfectly clear about the cause of the prescription opioid and heroin crisis. They have shown that sharp increases in opioid prescribing led to parallel increases in opioid addiction and overdose deaths. The message from the CDC is that the medical community must prescribe more cautiously or we may not be able to bring the opioid addiction epidemic to an end.
"Patients taking opioids exactly as prescribed can still become addicted."
In recent years drug companies that make opioid analgesics have started to acknowledge the relationship between increased prescribing and rising rates of addiction and overdose deaths. But they do not agree with the CDC that a reduction in prescribing is necessary.
Conflict of interest
Instead, opioid manufacturers want policymakers to believe that the crisis can be addressed with re-formulated pills that have been made harder to crush for snorting or injecting. They are attempting to capitalize on concern about the opioid crisis to obtain increased federal payments for crush-resistant pills and inclusion of these products on state Medicaid formularies.
To control any disease epidemic, new cases of the disease must be prevented. Unfortunately, crush-resistant pills do not help prevent opioid addiction because they are just as addictive as the easy-to-crush formulations.
Easy to overdo it
Patients taking opioids exactly as prescribed can still become addicted and recreational users who become addicted most often develop the disease by taking pills orally. Once addicted, some will transition to snorting or injecting, but most stick with swallowing pills. If prescribers make the mistake of believing that these products are less addictive, they may continue to overprescribe, which would worsen the epidemic.
Rather than offering financial incentives for pharmaceutical companies to continue releasing crush-resistant pills, policymakers should use federal and state tax levy on efforts that produce more cautious prescribing and on efforts that expand access to effective addiction treatment for the millions of Americans who suffer from an opioid-use disorder.