Three Facts: 1- There is absolutely no question that when it comes to moderate or severe pain, opioid medicines are one of the safest and most effective means to relief. 2- There is also absolutely no question that misuse and abuse of opioid medicines is a significant public health problem. 3- That because of number 2, there is significant undertreatment of pain in America. Prescribers are enormously hesitant to prescribe opioid medicines for fear of contributing to the problem of abuse. A huge part of that hesitancy is also the fear of law enforcement or medical board investigation and sanction. All it takes is one failure or even one complaint that someone is inappropriately prescribing for the physician to be under investigation. Who wants to risk that?
One strategy to help address this problem is the development of so-called tamper resistant opioid medications. Three versions are in or headed into the FDA approval process. One, which was developed by Pain Therapeutics/King Pharmaceuticals, is called Remoxy. Another, developed by Alpharma which is now owned by King Pharmaceuticals, is called Embeda. The third is a product developed by Purdue Pharma. The principle is the same for each though the methods of deterring abuse/misuse of the medicine are different. The principle is that efforts to tamper with the medicine in order to get high will result in negating the properties of the medicine that cause the high. For example, Embeda uses a technology that sequester a substance called naltrexone which is only released when the pill is tampered with----crushed, chewed, or dissolved. Naltrexone basically prevents the morphine, the opioid analgesic, from producing any semblance of a high.
It is important to know that these new formulations are still opioid medicines and have the same inherent benefits and risks of other opioid medicines. The big advantage is that they cannot be deliberately altered or tampered with to produce the high that some people seek and for that reason, will not be attractive to the person to abuse the drug. Therefore, from the prescriber's perspective, there is a degree of security in knowing that these pills cannot be deliberately altered to produce a high. People can still mistakenly or deliberately take too much of the medicine and suffer harm. It is extremely important that patients and healthcare providers do not have the mistaken belief that these medicines are harmless. The best case scenario is that physicians will feel more confident in prescribing these medicines which they know are resistant to deliberate alteration and abuse.