Opioids are used to treat cases of acute and chronic pain that arise from a variety of causes, ranging from trauma to palliative care for advanced illness. Every year, 100 million people in the United States suffer from pain, 9-12 million of whom have chronic or persistent pain. Although opioid therapy is an important component of pain management for many patients, the addictive and euphoric properties of these drugs make them liable to misuse, abuse, addiction, and diversion.

Date of Review: July 2017

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In an effort to help tackle the public health crisis of opioid dependence, misuse, and addiction that has emerged over the last decade, drug manufacturers have begun to develop abuse-deterrent formulations of opioid medications (ADFs). ICER reviewed available evidence on the comparative clinical effectiveness and comparative value of ADFs in order to inform decision-making by patients, clinicians and policy-makers, within the context of multiple efforts being undertaken to combat the opioid crisis. ICER’s review analyzed the potential of ADFs to reduce the burden of prescription opioid abuse by evaluating their benefits and market penetration based on coverage policies and legislation.

The report recommends re-designating new opioid formulations as “tamper-resistant;” and recognizes role in clinical practice, but advises cautious consideration of the financial and public health impact of broad substitution mandates. 

Interventions of Interest:

  • Hysingla® ER (Hydrocodone, Purdue)
  • Vantrela® (Hydrocodone , Teva)
  • Arymo® ER ( Morphine, Egalet)
  • Embeda® (Morphine + naltrexone, Pfizer)
  • Morphabond® (Morphine extended release, Inspirion Delivery Technologies)
  • OxyContin® TR (Oxycodone, Purdue)
  • Xtampza®ER (Oxycodone, Collegium Pharmaceutical Inc)
  • Targiniq® (Oxycodone + naloxone extended release, Purdue)
  • Troxyca® ER (Oxycodone + naltrexone, Pfizer)
  • RoxyBond® (Oxycodone, Inspirion Delivery Technologies)

Final Documents

Below you will find the final documents from the assessment review process:

ICER’s Chief Scientific Officer Dan Ollendorf, PhD stated:

“Those opioid formulations today being identified as “abuse-deterrent” – which our report suggests should more accurately be called “tamper-resistant” — will certainly be part of broader strategies to combat the opioid epidemic. However, while some evidence suggests that prescribing OxyContin, the first opioid to be produced in ADF form, did reduce the abuse risk among individual patients and decreased diversion of the drug into other hands, the New England CEPAC voted that the evidence is not sufficient to demonstrate that it or other ADF opioids are effective in reducing overall abuse of opioids on a population level.”