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Comment & Response
August 2015

Abuse Deterrent Formulations of Prescription Opioids—Reply

Author Affiliations
  • 1Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
JAMA Psychiatry. 2015;72(8):850-851. doi:10.1001/jamapsychiatry.2015.0674

In Reply We appreciate the opportunity to comment on the points raised by Ruan et al and Dart et al. Starting with the latter, Dart et al replicated our findings and came to the same conclusion that we did: abuse-deterrent formulations (ADFs) of opioid drugs are quite effective in reducing abuse of the active drug moiety; however, they are not, to quote Dart et al, the “panacea.” We reported that past-month OxyContin abuse fell from 46% of individuals entering treatment for opioid use disorder to 25% following the introduction of the ADF. However, as we and Dart et al found, some stable residual abuse has persisted for the past 2 years. The purpose of our article was to explore what happened to those who stopped abusing OxyContin (eg, did they switch drugs) and what factors led to the sustained lower level of abuse we have both observed. Given this level of concordance, it would seem that Dart et al are reacting not to our report, but to the press distortions of our data, particularly the inference that ADFs alone are responsible for much of the overall increase in heroin abuse over the past 5 years or so. As we have tried to clarify in our responses to media inquiries, this is not an appropriate characterization of our data. To be as clear as possible: while the ADF may have hastened a known transition from prescription opioids to heroin for some users,13 it is a relatively small factor in the overall increase in heroin abuse, most of which has been fueled by practical factors such as price, purity, and availability.46

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