Pain-management market grows, but resistance to new abuse-deterrent technologies is widespread

Data Resources study finds mixed reaction to new formulations—and little optimism for new drugs; meanwhile, abuse problems remain a public health concern

A flurry of studies has come out over the past few weeks, highlighting the slim progress made in countering the problems associated with abuse of prescription painkillers, especially opioids. According to a Data Resources study of physician preferences, the new formulations of Purdue Pharma’s Oxycontin (extended-release oxycodone), which features enhanced crush resistance (and also a first-of-its-kind allowed claim for abuse resistance on its label), and Endo Pharmaceutical’s Opana (extended-release oxymorphone; this did not get the allowed claim for abuse resistance), will be mostly ignored by just over half of pharmacists and medical directors at managed care organizations (MCOs), in preference of generic products. Among pain specialists surveyed, however, nearly three-quarters will be prescribing the new formulations. MCOs will prescribe the abuse-deterrent versions when there is a history of drug abuse by the patient. Primary care physicians (PCPs) fall somewhat between where MCOs and pain specialists are.

Physicians have long wished for an alternative to opioids for chronic pain, but the outlook is not bright for getting one soon. "Although the responses of surveyed physicians suggest that efficacy and safety/tolerability are the most important factors influencing treatment decisions for chronic pain, these physicians anticipate that patient out-of-pocket costs and reimbursement constraints will directly influence their prescribing of emerging chronic pain therapies," said Decision Resources analyst Natalie Taylor, PhD. In particular, Pfizer’s tanezumab, an expensive monoclonal antibody, is still working through FDA approval—but when it does, it may see significant market resistance.

On top of the potential resistance to new therapies, healthcare providers have proven to be lukewarm recipients of the training services being offered under the class-wide Risk Evaluation & Mitigation Strategy (REMS) now required for extended-release opioids; Data Resources’ survey shows that only a minority of providers have taken the training, and nearly a quarter of them expect never to do so (the training is voluntary).

Meanwhile, in early July the Centers for Disease Control and Prevention noted that, while more men than women die of prescription painkiller abuse in the US, since 1999 the rate of increase of this problem has been greater among women than men (a 400% increase among women, and a 265% increase among men between 1999 and 2010). “Prescription painkiller deaths have skyrocketed in women (6,600 in 2010), four times as many as died from cocaine and heroin combined,” said CDC Director Tom Frieden, MD, MPH. “Stopping this epidemic in women — and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”

All this is occurring in an environment of higher pain medication use. In a new report, Kalorama Information (New York), World Market for Pain Management Drugs and Devices, pegs the worldwide market for pain management at $34.9 billion in 2012, growing at a rate of 2.9% annually over the past three years. And a new report from Transparency Market Research (New York), Pain Management Devices Market, estimates the global device market at $2 billion in 2011, growing at 13.1% CAGR through 2013, when it will reach $5 billion. Pain management devices include electrical stimulators, radiofrequency ablation, analgesic pumps and neurostimulation devices.