the timed-release formulation (though still a part of it, due to the timed-release effect being inactivated depending how pills were ingested), and more about overzealous marketing (which we all know is/was a problem across the pharmaceutical and nutraceutical domain in general, not just pertaining to pain medications).

But regarding their utility... I think the continued support for timed-release/abuse-deterrent formulations hinges on them specifically targeting acute mortality risk. Meaning... with so many people dying due to accidental overdose, why not try to literally prevent (or at least delay) the timepoint of 'fatal' toxicity, starting from the moment one ingests the medicine.

Perhaps such formulations should really be referred to as overdose-deterrent though, not abuse-deterrent, because they only address a small proportion of mortality risk and do so "pharmacokinetically." And evidently, while the medical community was so focused on the alleged benefits of timed-release opioids, little was done to address the subjective pain experience, patient behaviors, clinician behaviors, accessibility etc.... which feeds into some of the criticisms you and Handle have shared.

That said, I still think it's dangerous to view the opioid issue through one lens (be it patient, provider, marketplace, legislative), since the problem is multifactorial.

It's kind of scary how clumsy the response has been, though. Tampering with the levels of pain experienced by individuals is such an extraordinarily delicate endeavor, and it tip-toes on multiple ethical concerns. Then, add in the market effects at play such as the marketing --> overprescription dynamic, and insurance companies manipulating prescription opioid coverage in a way that also shapes prescription practices, etc.? This whole thing's a mess.

But some effort is better than none.

You're probably familiar with some of the articles below, but just posting since relevant to the topic in general:


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411218/

http://painmedicine.oxfordjournals.org/content/12/suppl_2/S26.long

http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031914-122957

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370920/

http://painmedicine.oxfordjournals.org/content/12/3/415.long