Second video in our series about pain management during the coronavirus (COVID-19) pandemic
The opioid epidemic is just that…an epidemic – it’s widespread and affects everyone. Here are some interesting statistics.
The United States comprises only 4.6% of the world’s population but we consume 80% of the world’s opioids.
The United States consumes 99% of the world’s Vicodin.
We spend $300,000,000,000 (that’s billion) on pain-related medical costs each year, much of that is on medications.
According to the CDC, in 2013, nearly 2 million Americans abused prescription drugs. 
Each day, 7000 people are treated in Emergency Rooms across the United States for overdose or complications related to prescription drugs.
Abuse Deterrent Formulations (ADF) are a good attempt to help curb the epidemic, but since insurance companies charge patients an arm and a leg for them over generics, addicts have a valid reason to ask for something that’s cheaper and abusable. More importantly, these ADFs are only one small part of the puzzle. The biggest piece is education – as long as doctors are prescribing these medications in mass quantities and with complete disregard for the consequences, populations of addicts are going to continue to grow.
ADFs are great in theory, but as alluded to above, no doctor can ever really prescribe them because they are so expensive to the patient. The real issue, however, is that ADFs give the average doctor (who is likely uneducated about the risks and realities of addiction) a false sense of security and the ability to think “I’m fine…as long as I’m writing prescriptions for these new, more expensive medications, I’m not creating an addict.”
ADFs do not prevent a person from becoming addicted, they only prevent them from abusing a given medication in specific ways. Some formulations are supposed to prevent crushing so someone can’t snort the medication, others are insoluble in water to prevent someone from trying to inject it like heroin. It still does nothing to prevent someone from being addicted in the first place.
What we need are all the existing medications on the market to have ADFs for generic versions and make those generic formulations covered under all insurance plans, including Medicare. Also we need to make those medications part of the lowest tier, so it costs the patient the same as any other generic pain medication. We do not need new medications coming out attempting to capitalize on this growing epidemic of prescription drug addicts while masquerading as patriots who are flying the flag of the greater good. They are anything but.
Take for example the newest and worst drug to get approved by the FDA – Xtampza ER(TM) by Collegium Pharmaceutical, Inc. They have invented yet another form of Oxycodone, which they claim to be better than OxyContin by Purdue (the medication currently available in the marketplace for extended release Oxycodone). OxyContin (which our practice avoids prescribing at all costs whenever possible) is an extended release Oxycodone that you cannot crush, which prevents addicts from snorting it.
You won’t have to crush Xtampza, because it is already crushed! BUT IT HAS AN ADF FORMULATION!!! So in the eyes of the FDA, it’s safe. This company claims there are 11 million patients in chronic pain that have trouble swallowing, so it is necessary to make a version that arrives pre-crushed. You can just sprinkle it on your food, in your nose, on a countertop to snort it, etc. So in the eyes of the FDA, it’s necessary.
This company will now march their reps into every doctor’s office in the United States claiming Xtampza is safer and better than OxyContin, or whatever other medication is on the market, and say it fills a need. Collegium Pharmaceutical, Inc is only interested in making money on the growing epidemic of addicts by pandering to the very people are perpetuating it – doctors. They will tell doctors they are preventing addiction, when the real way to prevent it is to write less medication.
The answer is not to come out with 100 new pain medications with ADFs. The answer is to retrain doctors to stop writing all these medications, and to follow suit with the rest of the world and find other ways to treat pain. We need a new philosophy about treating pain, not another drug that pretends to fix it. We need new restrictions and legislation on who can write addictive medications and what kind of training that person needs to have. What we don’t need is another pharmaceutical company pretending to be a part of the solution when in fact they are just throwing gasoline on an open flame.