We appreciate the thoughtful commentary on our article by Dr. Jamison. He raises several points that deserve to be highlighted. As pointed out in his commentary, despite our early findings of less abuse overall and less nonoral abuse of reformulated OxyContin (ORF), abusers can be inventive in finding ways to misuse substances, and abuse of this or any reformulated opioid analgesic is still possible by swallowing the tablets whole. We certainly agree with these points and are currently engaged in further monitoring abuse of ORF in the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) system by any route, abuse by oral and nonoral routes, as well as abuse by specific routes of administration. It should be noted that, as shown in Figs. 1 and 2 of our report, rates of abuse of ORF have remained remarkably stable in the first 20 months after its introduction. This may reflect an inability of abusers to find a way to defeat the reformulation. Results of ongoing observations will be published in a follow-up analysis. Furthermore, in the larger context of opioid risk management, Jamison goes on to call for continued research directed toward assessing opioid abuse risk in patients and identifying patients at risk for misuse of opioids. Although not the focus of the present article, several of the authors have been and continue to be centrally involved in research around identifying at-risk patients and in working on technological solutions to assist specialists and nonspecialists in more effectively treating chronic pain.1"3 This point highlights the importance of seeing new medication formulations as one part of a more encompassing strategy toward minimizing the abuse risks associated with the treatment of chronic pain.
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