title: The role of abuse-deterrent formulations in countering opioid misuse and abuse.
abstract: OBJECTIVE
  Pain is a prevalent, and due to the ageing population, increasing medical problem. Opioids are frequently prescribed to meet the unmet medical need. Unfortunately, with the increase in the legitimate use of opioids, there has been a corresponding increase in abuse. A practical way to retain the pain relief afforded by opioids while decreasing opportunities for abuse is to make it more difficult to extract the opioid from the product or to make it less desirable to do so by designing an abuse-deterrent formulation (ADF). We provide a brief overview of the strategies and early evidence related to opioid ADFs.
  
  
  METHODS
  Published and unpublished literature, websites, and other sources were searched for current opioid formulation options, including immediate-release and extended-release products. Each was summarized, reviewed and assessed.
  
  
  RESULTS
  The strategies that have been used to design the current opioid ADFs involve one or more of four approaches: a physical barrier; incorporation of an opioid receptor antagonist (e.g. naloxone) that self-limits opioid action when taken in excess amount; inclusion of a noxious agent that is released during inappropriate use; or a pro-drug.
  
  
  CONCLUSIONS
  Legitimate use of opioid analgesics carries with it certain risks, including the risk of abuse. The new ADFs utilize four major strategies and provide innovative additions to the armamentarium. They likely will become an important part of a comprehensive approach to limiting, although not eliminating, opioid misuse and abuse.
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Raffa
authors.affiliation: NEMA Research, Bonita Springs, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA.|Association of Chronic Pain Patients, Houston, TX, USA.
authors.forename: J V
authors.initials: JV
authors.lastname: Pergolizzi
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical / Q000379:methods; D006801:Humans; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid
keywords: abuse; abuse-deterrent formulation; opioids; pain management