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Is Zohydro the next addiction creator?

I’m just as sick of writing about opioids as you are reading about them.

But the FDA’s approval of Zohydro, yet another highly-addictive, easily-abused opioid – the fourth in the last four years – requires our attention.

I’ve been trying to ignore the Zohydro story but today’s excellent piece in WorkCompCentral reminds us just how difficult the battle is. Zohydro is a very powerful, “extended release” opioid pill.  The problem is this; while the drug is formulated to allow the opioid to gradually “leak out” into the blood stream, abusers can get all the opioids into their system at once by crushing, dissolving, or melting the pill.

No one I have spoken with – or quoted in the WCC piece – understands why the FDA would approve Zohydro without tamper-resistance; some form of chemical or other method that prevents this crushing/dissolving/melting/burning process.  Many drugs on the market today have this type of modification.

But they did.  And we’re stuck with it.

So, what do we do?  Here are a few ideas.

  • Require all use of Zohydro is pre-authorized, and only allowed after failure on other, much less potent medications.
  • Require (where possible) substitution of one of the abuse-deterrent medications for Zohydro.
  • Monitor physician prescribing patterns, and intervene with docs/practices prescribing Zohydro.  Let them know you are watching, require proof of medical necessity, and constantly monitor their patients.  Require drug testing, opioid agreements, evaluation of pain and functionality.
  • Reach out to ALL docs who write scripts for Zohydro letting them know your policy. Do this early.

It comes down to the docs who treat your claimants.  If you have the right docs, this won’t be a problem.  If you have to work with all docs, monitor, manage, intervene.

Yes, it is a LOT of work.  But it is a LOT less work than dealing with more addicted claimants.

What does this mean for you?

Fortunately, most payers are far better prepared to deal with Zohydro than they were a few years ago.  Get ready, and measure how many claimants are taking Zohydro on a weekly basis.  That’s the metric to measure success.  

2 thoughts on “Is Zohydro the next addiction creator?”

  1. Joe, there is really only one other “abuse deterrent” long-acting opioid on the market, and that is Oxycontin. Opana ER is only crush resistant (but still crushable).
    I would suggest that this be the policy of ALL long-acting opioids, and not just Zohydro.

  2. Great recommendations Joe. I would suggest that companies stop this at first-fill. This should be challenged from the initial RX. Organizations should require the subscribing provider to document the medical necessity, why use this medication over abuse-deterrent medications. Many states have developed additional requirements for prescribing controlled substances and managing pain with narcotics, including drug monitoring requirements. In addition to EBM, this can be a resource for organizations questioning subscribing patterns. Go to The Federation of State Medical Boards (FSMB) to link to the individual state requirements.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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