FDA's OK of Opioid Makes 'Diversion of Even One Tablet' Risky

by Judy Packer-Tursman

When a highly potent new opioid formulation was approved by his agency on Nov. 2, FDA Commissioner Scott Gottlieb, M.D., downplayed safety concerns about AcelRx's Dsuvia. He stressed the importance of the painkiller for military use and the "very tight restrictions being placed on the distribution and use of this product."

In general, PBM and health plan experts say such restrictions likely will hold and keep the drug within its proper niche, and the regulatory green light for Dsuvia shouldn't interfere with broad ongoing efforts to better manage opioid use in the U.S.

Dsuvia is a sublingual formulation of an established drug, sufentanil, that is delivered through a disposable, pre-filled, single-dose applicator. It's seen as ideally suited for certain special circumstances where patients may not be able to swallow oral medication, and where access to intravenous pain relief is not possible, including its potential use on the battlefield. Gottlieb notes that this opioid formulation, along with Dsuvia's delivery device, was "a priority medical product" for the Pentagon because it fills a specific, though limited, unmet medical need.

"A single-dose applicator could potentially prevent abuse due to the complexity of removing it [i.e., the medication] from the applicator," says Mesfin Tegenu, R.Ph., president of PerformRx, LLC. "However, because it is 10 times more potent than fentanyl and 1,000 times more potent than morphine, the diversion of even one tablet can be risky."

Tegenu adds that restricting the sites where Dsuvia can be administered "is a good step in preventing misuse. However, there is no guarantee that such a diversion will not occur and contribute to the opioid crisis."

Yet Sharon Jhawar, Pharm.D., chief pharmacy officer for SCAN Health Plan, doesn't anticipate a significant problem with diversion of the strong medication.

"Our perspective on Dsuvia is it's been approved only in specific health care settings by someone who is medically trained, and is really for severe, acute pain in which other opioids would not be enough," she says. "And because of the requirement of the setting and who needs to give it, this isn't a medication you're going to see insurers have on their formulary." 

From RADAR on Drug Benefits