Abuse-deterrent opioids may reduce long-term healthcare costs, according to a new paper released today by the American Legislative Exchange Council. The paper, “Optimizing the Abuse-deterrent Opioids Market,” written Dr. Wayne Winegarden, finds that abuse-deterrent formulations (ADFs) of opioids treat pain and help prevent abuse.
Prescription opioid abuse accounted for an estimated $55.7 million in healthcare, workplace and criminal justice costs in 2008, with an estimated 15.7 million people aged 12 or older having used prescription drugs non-medically in the past year.
“The health challenge is to balance the legitimate need for opioid medications for pain patients while minimizing problems created by prescription opioid abuse,” wrote Dr. Winegarden in the report.
According to the report, more Americans suffer from chronic pain than from diabetes, heart disease, cancer and stroke combined. An estimated 100 million Americans live with some form of chronic pain.
Patients with untreated chronic pain make more emergency room visits and incur higher treatment costs (including medication, therapy and surgeries) than people without chronic pain. Health care costs for chronic pain are estimated between $261 billion and $300 billion.
Chronic and temporary pain cost Americans even more in lost productivity and reduced quality of life. Pain accounts for 50 million sick days per year, and lost productivity and workplace expenses due to chronic pain cost between $299 billion and $335 billion.
Abuse Deterrent Formulations (ADFs) could be part of a cost-efficient solution. Prescription opioids are powerful pain killers and doctors may recommend them to patients along with other patient-specific treatment methods. People with severe chronic pain tend to pay thousands of dollars more on healthcare than people with moderate pain. The possibility of managing severe pain with a single medication that deters abuse is profound.
The report finds that abuse-deterrent prescription opioids may help protect patients from addiction. ADFs are designed with one of three defenses: the “fortress approach,” the “neutralizing approach” and the “aversive approach.” The first two approaches delay or neutralize the opioid in case of tampering. The aversive approach releases an unpleasant agent into the body in case of overdose.
The report identifies three reasons that ADF usage has been slow to take off. As patented medication, most ADFs are currently more expensive than non-patented, non-deterrent pain treatments. Legal barriers prohibiting the use of abuse-deterrent opioids also make the medicine more expensive, and could keep prescription opioids out of the hands of patients who might benefit from them. Regulatory requirements often require a patient to begin treatment with a non-deterrent opioid, only if the first opioid fails do they qualify for an ADF.
States can help provide abuse-deterrent opioids to people who need them by removing the requirement that a patient begin treatment with a non-deterrent opioid. Requiring a written permission from a healthcare professional before the prescription can be switched is also a potential solution.
“Effective and targeted legislation can address these disincentives, allowing the abuse-deterrent opioids to compete in the medical marketplace based on their medical efficacy,” write Dr. Winegarden in the report. “Correcting the disincentives that discourage appropriate use of abuse-deterrent opioids is a reform opportunity that addresses an important health need, reduces overall healthcare expenditures, lowers criminal justice costs, and beneficially impacts overall workplace productivity.” The full report can be found here.
Mia Heck is Director of Health policy at the American Legislative Exchange Council (ALEC).