Abuse-deterrent opioid formulations: are they a pipe dream?

The continued need for opioids to treat pain and their unavoidable link to abuse and addiction create a need for risk mitigation approaches that optimize their risk-benefit ratio. Abuse-deterrent formulations (ADFs) have emerged as a means for supporting opioid access while limiting abuse and its consequences. Several different types of ADFs have emerged including physical barriers to tampering, agonist-antagonist formulations, aversion, prodrugs, and alternative methods of administration. Each of these types has the potential to reduce specific forms of prescription opioid abuse. ADFs have the potential to reduce the public health burden of prescription opioid abuse, but they will require not only technically successful formulations, but also appropriate scientific assessment, widespread market penetration, and rational expectations of their benefits.