Journal of medical toxicology : official journal of the American College of Medical Toxicology
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The increased use of opioid pain medication has been mirrored by the increased misuse and abuse of these drugs. As part of a multidisciplinary approach to this epidemic, pharmaceutical companies, with the encouragement of the Food and Drug Administration, have increased the development of abuse-deterrent formulations. While all have the goal of treating pain while mitigating misuse and abuse, there are different technologies utilized to impart the abuse-deterrent properties. The goal of this paper is to review the basis of abuse-deterrent formulations, the different types and approaches of some of the abuse-deterrent products, and their current regulatory status in the USA.
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Nonmedical use of prescription opioid analgesics is associated with epidemic levels of morbidity and mortality. There are several factors that affect the abuse liability of the various opioids, including likability or the pleasurable subjective effects. Due to rising public health concerns over escalating prescription opioid abuse, we sought to examine the literature about abuse liability with a specific focus on likability studies. ⋯ Oral oxycodone has an elevated abuse liability profile compared to oral morphine and hydrocodone.
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In 2010, the American College of Medical Toxicology established its Case Registry, the Toxicology Investigators Consortium (ToxIC). ToxIC is a prospective registry, which exclusively compiles suspected and confirmed toxic exposure cases cared for at the bedside by medical toxicologists at its participating sites. The Registry aims to fulfill two important gaps in the field: a real-time toxicosurveillance system to identify current poisoning trends and a powerful research tool in toxicology. ⋯ At the end of 2011, over 10,000 cases had been entered into the Registry. As demonstrated by the trends identified in psychoactive bath salt and synthetic cannabinoid reports, the Registry is a valuable toxicosurveillance and research tool. The ToxIC Registry is a unique tool for identifying and characterizing confirmed cases of significant or potential toxicity or complexity to require bedside consultation by a medical toxicologist.
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Prescription opioid analgesic misuse and addiction are a significant public health concern in the USA. Through their concurrent roles as prescribers and public health stewards, medical toxicologists (MTs) have a unique perspective on this issue. They represent a physician group with a particular interest in prescription drug monitoring programs (PDMPs) because of their subspecialty knowledge of the negative consequences of opioid overprescribing in terms of misuse, diversion, addiction, and overdose death. ⋯ Barriers to use included time and complexity required to access relevant information. MTs prescribe opioids primarily to patients in the Emergency Department (ED) for acute pain or acute exacerbations of chronic pain. MTs are generally aware of PDMPs, although many were unaware of or not using their state-based PDMPs when prescribing opioids in clinical practice.