Abuse-Deterrent Formulations (ADFs): Crush Resistance

The rapid and widespread abuse of prescription medications within the United States from the late 1990s through the mid- 2000s reached epidemic levels based on several national studies [1]. The largest contributor to this problem has been the use of opioid analgesics for nonmedical purposes. These powerful medications became overly prescribed, diverted, and popular among abusers. One product, Oxycontin®, became the most prescribed brand name medication for moderate-to-severe pain in 2001, and ranked high on the abused drug list due to its fast heroin like high [2]. To enhance these effects, this extended release product was frequently tampered with to release large amounts of drug all at once. Despite warning labels that such rapid release could be fatal, the drug was typically tampered by swallowing a chewed tablet, crushing to a powder followed by snorting, or extraction in water followed by injection [3]. It has also been shown overall that opioid pain medications are frequently tampering with and are most commonly abused by orally ingesting, injecting, snorting, or smoking [4]. Abusers may not only physically manipulate a drug product for abuse, but also co-ingest or combine with other substances to produce greater euphoria or other subjective effects. In one study looking at deaths associated with oxycodone, almost 97% of deaths were associated with another substance including other prescription drugs, cocaine, marijuana, or alcohol [5]. Therefore, preventing or decreasing prescription abuse involving all such activities will require multiple approaches and methods to obtain the greatest impact to public health.