Nearly everyone has experienced some kind of pain—a serious issue faced by medical providers every day. Long-lasting pain, in particular, poses major challenges in finding sustainable treatment options. Currently, opioid drugs like OxyContin are used to treat moderate-to-severe pain that lasts all day. The problem is that these drugs can be abused—with risks for addiction and deaths due to overdose—which has led to the rising public health issue of the opioid epidemic.
Drug companies are attempting to combat the opioid problem by developing technologies that reduce risks for drug abuse with drugs that have abuse-deterrent properties. The U.S. Food and Drug Administration (FDA) defined these properties and how to prove abuse deterrence in clinical trials by showing that it is harder to abuse drugs via snorting, injecting, or chewing. Drug makers also must show that their new drug is liked less than other currently available opioids in subjects who are recreational drug users. Below are just a few of the exciting technologies being developed with the hope of reducing prescription drug abuse.
Extended release (ER)
Several opioids being developed to treat chronic pain have extended-release properties, which means these drugs can last longer in the body (meaning fewer daily pills) and are less likely to produce immediate pleasurable effects of opioids, thus reducing risk for abuse. Special coatings or membrane layers can give pills extended-release properties by controlling the rate at which the drug is released.
Physical barriers and gel-forming properties
New drugs can be formulated with external coatings or special materials that make it difficult to crush the pill into a powder, which makes it harder to snort or mix into solution for injection. These materials, such as a polymer matrix, can also become a thick gel when crushed or put into solution. The gel makes it harder to pull up into a syringe for injection. The gel can also surround the opioid drug, giving it extended-release properties.
Examples: Arymo ER, Remoxy
If activating opioid receptors produces pleasurable opioid effects, then blocking those receptors could prevent opioid abuse and overdose. That is exactly the idea behind new drugs with naltrexone hydrochloride (an antagonist or receptor blocker) hidden in the pill. The antagonist is only released if people try to tamper with the pill by crushing or chewing, thus cancelling the euphoric high sought by people abusing drugs.
Examples: Embeda, Troxyca ER
Ligand-activated therapy, prodrugs, and new molecules
These new drugs are designed to reach the central nervous system more slowly. One way to slow the opioid is to make the opioid drug inactive until it reaches the gut inside the body. Enzymes in the gut or other gut environment conditions will break down the pill and release the opioid for pain relief. If the drug is crushed and snorted or injected, the opioid is still inactive and won’t have any pleasurable or pain-killing effects.
Examples: KP201, NKTR-181
The biggest challenge is reducing oral drug abuse. None of the methods above can stop a person from taking more than the prescribed dosage or several pills at one time. Technologies in pills that prevent overdose can help in those cases. Other scientists are looking at non-opioid treatments for chronic pain, such as new drugs and physical therapies. There is a big push to find creative solutions for the opioid epidemic, which will hopefully lead to innovative technologies and better treatments.
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