What is the difference between an oxycodone (opioid analgesic) abuse deterrent tablet and a regular oxycodone tablet?

Differences Between Oxycodone Abuse-Deterrent Tablets and Regular Tablets

Abuse-deterrent oxycodone tablets are designed to make manipulation more difficult but do not prevent oral misuse (the most common form of abuse) and can still be abused through non-oral routes. 1

Key Physical and Functional Differences

Abuse-Deterrent Formulations (ADFs)

• Physical barriers: Employ technologies that make crushing, cutting, or breaking the tablet difficult
• Chemical barriers: Contain agents that reduce euphoria when manipulated
• High-viscosity formulations: Some ADFs (like REMOXY ER) use high-viscosity gel that resists extraction in common solvents 2
• Tamper-resistant properties: Designed to maintain extended-release properties even when physical manipulation is attempted
• Reduced extractability: Release significantly less oxycodone (2-22%) in common ingestible liquids compared to regular tablets (77-85%) 2

Regular Oxycodone Tablets

• Standard formulation: Can be easily crushed, dissolved, or otherwise manipulated
• No physical or chemical barriers: Lack protective features against misuse
• Higher extractability: More readily release active ingredient when manipulated
• Conventional pharmacokinetics: Predictable release patterns when tampered with

Clinical Implications

Efficacy and Safety

• Both formulations have the same active ingredient (oxycodone) and provide similar pain relief when taken as prescribed
• Both carry the same risk of dependence, addiction, and respiratory depression when used orally as directed
• The FDA explicitly notes that the "abuse-deterrent" label does not indicate there is no risk for misuse or opioid use disorder 1

Limitations of Abuse-Deterrent Formulations

• Do not prevent oral misuse: The most common route of opioid abuse remains unaffected 1
• No evidence of effectiveness: The CDC found no studies demonstrating that abuse-deterrent technologies actually reduce opioid misuse, opioid use disorder, or overdose 1
• Can still be abused: Despite barriers, determined individuals may find ways to defeat the protective mechanisms 1
• Do not prevent unintentional overdose: Offer no protection against taking too many pills orally 1

Prescribing Considerations

When to Consider Abuse-Deterrent Formulations

• For patients with history of substance abuse but requiring opioid therapy
• In settings where diversion risk is higher
• When extended-release formulations are indicated for around-the-clock pain management

Important Caveats

• Both formulations should be prescribed with caution
• Extended-release opioids (including abuse-deterrent versions) should not be used for acute pain 1
• Extended-release formulations should only be used in opioid-tolerant patients (those who have received 60 mg daily of oral morphine, 30 mg daily of oral oxycodone, or equianalgesic doses of other opioids for at least 1 week) 1

Cost and Availability Considerations

• Abuse-deterrent formulations are typically more expensive
• Limited availability of generic abuse-deterrent formulations may restrict insurance coverage 1
• Abuse-deterrent formulations represent a small percentage of total opioid prescriptions (<3%) 1

Despite the development of abuse-deterrent technologies, it's crucial to understand that these formulations do not eliminate the risk of opioid abuse or addiction. The CDC guidelines emphasize that there is insufficient evidence to recommend abuse-deterrent formulations as an effective risk mitigation strategy 1.