Abuse-Deterrent Opioid Formulations: Critical Information for Patients
Misuse and diversion can still occur with abuse-deterrent formulations, and all standard opioid monitoring and risk mitigation strategies remain necessary.
What Abuse-Deterrent Formulations Actually Do (and Don't Do)
The CDC guidelines explicitly state that abuse-deterrent technologies do not prevent opioid misuse or overdose through oral intake and can still be misused by nonoral routes 1. The "abuse-deterrent" label does not indicate there is no risk for misuse or opioid use disorder 1.
Key Limitations You Must Understand:
- Oral misuse remains unaddressed: Abuse-deterrent properties may provide marginal benefit against intranasal abuse but do not address oral misuse, which remains the predominant route 1
- No reduction in overdose risk: These formulations do not prevent unintentional overdose through oral intake 1
- Diversion still occurs: Available data show that while abuse-deterrent formulations may decrease rates of abuse compared to non-abuse-deterrent versions, they do not eliminate diversion 2, 3
Required Monitoring Remains Unchanged
All standard opioid prescribing precautions, monitoring requirements, and risk mitigation strategies apply equally to abuse-deterrent formulations 1. This means:
- Urine drug testing frequency: Cannot be reduced with abuse-deterrent formulations; regular screening remains necessary 4
- Patient-provider agreements: Annual review is still required and necessary 4
- Risk assessment: Evaluation of risks for medication misuse must be performed before prescribing, regardless of formulation type 4
- Ongoing monitoring: Benefits and harms must be evaluated within 1-4 weeks of starting therapy and reassessed every 3 months or more frequently 5
The Evidence Gap
The CDC found insufficient evidence that risk mitigation strategies, including use of abuse-deterrent formulations, improve outcomes related to overdose, addiction, abuse, or misuse 4. No studies have evaluated the effectiveness of abuse-deterrent formulations in reducing these harms in clinical practice 4.
Common Pitfall to Avoid
Do not assume that prescribing an abuse-deterrent formulation reduces the risk of opioid use disorder, overdose, or diversion compared to standard formulations 1. This false sense of security can lead to inadequate monitoring and increased patient harm.
What This Means for Your Care
While abuse-deterrent formulations represent an incremental step toward safer prescription opioids 6, they are not a substitute for comprehensive opioid risk management. You will still require:
- Regular urine drug screening 4
- Frequent clinical monitoring and reassessment 5
- Prescription drug monitoring program checks 4
- Ongoing evaluation for signs of misuse 4
- The lowest effective dosage, avoiding ≥50 morphine milligram equivalents per day when possible 5
The abuse-deterrent properties do not change the fundamental risks of long-term opioid therapy or reduce the need for vigilant monitoring and risk mitigation 1.