Abuse-Deterrent Opioids: What You Need to Know

Lauri R. Graham; Laurie Scudder, DNP, NP; Douglas Throckmorton, MD


August 25, 2016

Editorial Collaboration

Medscape &

Education Is the Cornerstone

Medscape: What are the key points that clinicians should be aware of in educating their patients about opioids?

Dr Throckmorton: The FDA's work to improve the safe use of opioids is taking place within a larger policy framework aimed at addressing opioid abuse while ensuring appropriate access to pain treatment. The FDA has undertaken several efforts that can be helpful to clinicians. The Extended-Release and Long-Acting Opioid Analgesics Risk Evaluation and Mitigation Strategy (ER/LA REMS) is a program required by the FDA for all companies who make these products. The goal of the ER/LA REMS is to reduce serious adverse outcomes of inappropriate prescribing, misuse, and abuse of ER/LA opioid analgesics while maintaining patient access to pain medications. Adverse outcomes of concern include addiction, unintentional overdose, and death.

As part of the REMS, all ER/LA opioid analgesic companies must provide:

  • Education for prescribers of these medications through accredited continuing education activities supported by independent educational grants from ER/LA opioid analgesic companies; and

  • Information that prescribers can use when counseling patients about the risks and benefits associated with ER/LA opioid analgesic use.

It is critically important for clinicians to understand that all currently approved abuse-deterrent opioid products are still capable of being abused.

The FDA developed core messages to be communicated to prescribers in the Blueprint for Prescriber Education. The content is directed to prescribers of ER/LA opioid analgesics but also may be relevant for other healthcare professionals (eg, pharmacists). The ER/LA Opioid Analgesics REMS Program Companies provides a list of REMS-compliant continuing education activities.

Furthermore, it is critically important for clinicians to understand that all currently approved abuse-deterrent opioid products are still capable of being abused. Their abuse-deterrent properties are expected to deter, but do not wholly prevent, abuse. Because opioid medications must in the end be able to deliver the opioid to the patient, there will probably always be potential for abuse of these products.

Clinicians should counsel their patients on the following:

  • Keep medicines in a secure location, out of the reach and sight of children and pets. Put medicines away after every use. Accidental exposure to medicine in the home is a major source of unintentional poisonings in the United States.

  • If medicines are no longer needed, it's important to dispose of them properly. Disposing of all unused opioid analgesics reduces access to these medications by family members and household guests seeking opioids for abuse.

  • We recommend returning most prescription medications through a local or US Drug Enforcement Administration (DEA)-sponsored take-back program or DEA-authorized collector. For a small number of drugs, we recommend immediate removal from the home by flushing them down the toilet or sink.