The introduction of tamper-resistant opioid tablets does not have an effect on rates of opioid use or harms at a population level, according to a new study published in The Lancet Psychiatry journal on 11 January 2018…

While the National Opioid Medication Abuse Deterrent (NOMAD) study found that people who inject drugs were less likely to tamper with the tablets, the lack of any significant effect on opioid use or harms highlights the need for a multifaceted approach to opioid misuse. 

Most comprehensive study

The study is the most comprehensive analysis of the impact of tamper-resistant opioid formulations to date. It was conducted in Australia, which is experiencing an opioid epidemic, but where the policy context is less complex than in the USA.

“Although the introduction of this tamper-resistant formulation resulted in less injection of that opioid among people who inject drugs, their introduction must be considered as part of a multifaceted response.

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“This includes increasing the availability of non-medication approaches to chronic pain, good clinical practice in long-term opioid treatment, and harm reduction among people who use opioids outside the recommendations of their prescriber,” says Dr Briony Larance, National Drug and Alcohol Research Centre, UNSW Sydney, Australia.

Opioid epidemic in USA and Australia

The opioid epidemic in the USA is widely documented and similar problems in Australia are emerging, with opioid use in 2012 15 times that reported in 1992. Pharmaceutical opioids cause more than 70% of opioid overdose deaths in Australia – similar rates to the USA.


In the USA, oxycodone was developed in a tamper-resistant formulation, making it harder to crush or dissolve the tablets. Early studies suggested the tamper-resistant formulations were associated with reduced recreational use, poisonings and sales, and increased heroin use and harm.

Writing in a linked Comment, Dr Nabarun Dasgupta, Injury Prevention Research Centre and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (NC), USA says: “…The NOMAD study leads us to consider whether abuse deterrence is an inherent property of the drug itself, or its intended effect lies in an interaction with social context.”

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