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Morphine sulfate and naltrexone hydrochloride extended release capsules for the management of chronic, moderate-to-severe pain, while reducing morphine-induced subjective effects upon tampering by crushing

Introduction: Public concern over the increased incidence of prescription opioid abuse has prompted the development of products designed to be less attractive for abuse. This article characterizes morphine sulfate and naltrexone hydrochloride extended release capsules (MS-sNT), the first long-acting opioid approved in the USA for the management of chronic, moderate-to-severe pain that is also designed to reduce drug liking and euphoria if tampered with by crushing. Areas covered: This article reviews the pharmacokinetics, pharmacodynamics, efficacy and safety of MS-sNT when taken as directed by patients with chronic, moderate-to-severe pain and when tampered with by crushing. A literature search was conducted using Medline, Embase and Biosis for the years from 1995 to January 2011, limited to humans and the English language. Search terms varied with the structure of the databases, and included ‘naltrexone’ and ‘morphine’, ‘delayed-action preparations’, ‘drug combinations’, ‘extended-’, ‘slow-’ or ‘controlled-release’, ‘combinations’ and ‘EMBEDA’. Also included were congress presentations available from the manufacturer. Expert opinion: Although no product is likely to be abuse-proof in the hands of clever and determined abusers, new opioid products, such as MS-sNT, may potentially help physicians provide analgesia while at the same time providing a potential way to address the risk of misuse, abuse and diversion. Epidemiological studies are required to determine the impact of such products on real-world abuse.