OBJECTIVES: This meta-analysis was conducted to compare pain intensity and adverse event (AE) outcomes between opioids formulated with technologies designed to deter or resist tampering (tamper-resistant technologies [TRTs]) and non-TRTs for commonly prescribed long-acting opioids (LAOs) and short-acting opioids (SAOs) for treatment of non-cancer pain in adults.  METHODS: Sixteen journal articles [13 non-TRT vs. placebo, 3 TRT vs. placebo] from a systematic literature review (9/1/2001-8/31/2011) meeting eligibility criteria were included in the meta-analyses.  Summary estimates of standardized pain intensity outcomes [difference in mean change of pain intensity from baseline to end of study (DMCPI), difference in sum of pain intensity difference over the study period (DSPID)] and of odds ratios (OR) of 7 AEs were computed through random effects meta-analyses using DerSimonian-Laird method.  Additional analyses included stratified analyses by treatment duration (<2 months, 2-3 months, ≥3 months) and by LAO/SAO, and indirect comparisons to contrast TRTs vs. non-TRTs.  RESULTS: Summary estimates for standardized DMCPI and for standardized DSPID indicated that TRTs and non-TRTs showed significantly greater efficacy than placebo in reducing pain intensity [(Standardized DMCPI) Non-TRT versus placebo: -0.59(95% CI: -0.94,-0.24), TRF vs. placebo: -0.21(-0.35,-0.07); (Standardized DSPID) Non-TRT versus placebo: 0.73(0.26,1.20), TRF versus placebo: 0.51(0.30,0.72)]. TRTs and non-TRTs had similar safety profiles—both were associated with higher odds of AEs than placebo. ORs from indirect analyses comparing AEs for TRTs vs. non-TRTs were not significant different [nausea: 0.87(0.24,3.12), vomiting: 1.54(0.40,5.97), dizziness/vertigo: 0.61(0.21,1.76), headache: 1.42(0.57,3.53), somnolence/drowsiness: 0.47(0.09,2.58), constipation 0.64(0.28,1.49), pruritus 0.41(0.05,3.51)]. CONCLUSIONS: Pain intensity and ORs of AEs between non-TRTs/TRTs and placebo did not vary by treatment duration and opioid formulation (p-values>0.05). TRTs and non-TRTs had comparable safety profiles and both were more efficacious than placebo in reducing pain intensity.  Since TRTs are designed to reduce misuse/abuse due to tampering, they may be a means to reduce public health burden of opioid abuse.