Opioid formulations with sequestered naltrexone: A perspective review

In response to good-intentioned efforts to correct the traditional undertreatment of pain, opioid prescribing experienced a dramatic increase over the past decade. But there is now concern that the pendulum has swung too far in the opposite direction, with a rise in morbidity and mortality associated with prescription opioid misuse and abuse. Yet despite potential problems, opioids are a mainstay for the treatment of pain and are an important component of a comprehensive pain management strategy. Therefore, the overall goal of pain management is to decrease pain and to improve patient functioning and quality of life, while monitoring for adverse effects or aberrant behaviors. That is, to balance effective chronic pain management with appropriate use of opioids. Toward this end, several abuse deterrent strategies (formulations) have been, and continue to be, developed. Several major ones are reviewed here. These products should be a first step in trying to address diversion and abuse in a manner that does not discriminate against any particular patient and aligns with universal prescribing precautions. They should also comprise only one aspect of an overall opioid risk management plan.