Opioids with abuse-deterrent technologies: What role do they play in managing chronic pain in older adults?
Approximately 50% of older adults have chronic pain. Opioid analgesics play an important role in treating noncancerous chronic pain in older adults, but abuse of these agents is a growing problem in the United States. Although it is unclear what the prevalence of opioid misuse is among older adults, 1.4% of participants in one small study reported misusing pain relievers within a 1-year period. The US Food and Drug Administration (FDA) has encouraged the development of opioids with abuse-deterrent technologies (ADTs). A number of strategies have been used or are in development, but the FDA has not allowed any products containing ADTs to be marketed with claims that they prevent abuse or misuse, although it has allowed manufacturers to include data on the drug's label that demonstrate the agent's resistance to manipulation. Additionally, ADTs that are currently available or in development do not appear to prevent misuse in every way, and no studies to date have conclusively proven that they deter abuse or misuse. Because of the added cost of producing opioids that contain ADTs, careful patient selection is warranted, as these agents provide no benefit when prescribed to older adults who do not self-abuse, misuse, or divert their opioid medications. In this article, the authors review data on abuse, misuse, and diversion of opioids among elders and examine the role of ADTs in preventing such acts.