According to The Oklahoman of Jan. 26, the “FDA pursues stronger limits on Hydrocodone.” It is about time!
The FDA acknowledged that Hydrocodone (Lortab, Vicodin) has grown into the most widely prescribed drug in the entire U.S. -- 131,000,000 Hydrocodone prescriptions in 2011.
This is not new to Oklahoma. We had the dubious honor of prescribing more Lortabs -- 120 million tablets in 2010 which was the most of any state in the country, even California, which is 10 times bigger than we are (37,000,000 compared our 3,700,000 population).
Hydrocodone is just the tip of the iceberg! All prescription opiates are generously over prescribed by our physicians, including Oxycontin, Tramadol, Percocet (Oxycodone), Morphine IR (Instant Release) and ER (Extended Release).
All of these names -- this codone and that Oxycodone, Tramadol are all confusing to most patients. All they know is they want something for their pain!
This idea of “pain relief was blown completely out of proportion by our federal government in the early 1990s. They claimed “doctors are not giving patients enough pain medication to treat their pain adequately because “they are too afraid they will get their patients addicted!”
They even said all doctors must keep a pain level chart in every patient’s records and rate the patient’s pain on a 1 to 10 scale which is still done and is useful.
Well, guess who took that in the early 1990s and ran with it? The drug companies of course. New pain pills started popping up everywhere. Percocet, Vicodin, and Lortab flooded the market. Pharmaceutical salesmen (detail men we called them) brought in drug samples by the hundreds for doctors to hand out with their prescription for the “new pain pill.”
One company detail man even approached me in my office at St. Luke’s Hospital in Phoenix where I was Director of Chemical Dependency and tried to tell me he had a “new non-addicting pain pill” called Ultram. Before he left my office, I asked him if he would leave me a few samples so that I might try them on some patients.
I immediately looked up the drug and guess what the chemical name was -- Tramadol, which today is used sparingly because of its strong addictive nature plus numerous side effects, one of which is causing seizures!
My point is the “drug reps” were getting away with saying anything the company told them to say to sell drugs. The crowning glory of this government induced fiasco consummated with the release of Oxycontin in 1995. What is it? Oxycodone is an extended release tablet (like a long acting Percocet). No more, no less.
However, the company made a big mistake by claiming Oxycontin was “less addictive” than other opiates because “it is longer acting and more slowly released.” Oxycontin rapidly became the drug of choice of the younger (18-30) opiate addicts.
It was not only swallowed, but ground up and snorted or dissolved in water and used IV (intravenously). The claim Oxycontin “was less addictive” cost the company $624,000,000 in a suit brought by 24 states in 2006.
When I returned to Oklahoma City to practice addiction medicine in 2008, I could not believe what I was seeing. Patient after patient hopelessly addicted to Oxycontin and/or Lortab. Most paid around $80 for a 40mg Oxycontin on “the Street” after they had become addicted and used up their “supply.” It was very depressing to me to say the least.
In 2009, the pharmaceutical company that made Oxycontin ER was for forced to change the covering of the pill so that it could not be so easily crushed and snorted or used IV. This did limit somewhat the demand, but the lower doses of Oxycontin IR, instant release, remained heavily abused.
Then, in late 2009, a new opiate hit the market -- Opana ER, but it really was not a new drug. Opana is Oxymorphone, which was first sold in 1950 as Nubain, or “blues” as they were called. This narcotic was so easily ground up and then used IV or snorted and smoked that even the heroin addicts began to covet it.
The drug company then “voluntarily” removed it from the market in 1962, but then returned with the same drug Oxymorphone in 2009 when the Oxycontin ER got in trouble, and just called it Opana ER (Oxymorphone extended release).
There is something fishy here. How can a drug company who voluntarily remove a drug in 1962 because it was so widely abused be allowed to bring it back again even though it was the extended release version? I simply do not understand that.
With regard to Hydrocodone being moved from Class III to Class II narcotic, this means:
-- It cannot be refilled 5 times as it is now, but can only receive a single 90-day prescription maximum before the patient must be seen again and a new prescription.
-- The drug cannot be prescribed by nurses or physician assistants.
I cannot believe 10 panelists on the FDA voted against changing Hydrocodone classification (vote was 29 for and 10 against). They claimed it would have unintended consequences, driving addicts to get drugs “illegally.” THEY ALREADY ARE!
There are so many Lortabs and Vicodin out there as well as Roxicets and Percocets. Also, some pharmacists groups and some physicians claimed the new restrictions would “burden medical professionals and disrupt patient care.” That is hogwash!
Maybe doctors will start taking a look at their prescribing practices or even consider using another old standard for “mild to moderate pain” -- Tylenol #3 (Tylenol with ½ grain of codeine). Why? I used it in a very active family practice for 90 percent of my “pain patients” and they did fine.
Codeine does not give the “buzz” that Lortabs do, but is effective for short term pain. Also, in trial studies with Ultram, which I mentioned earlier, Tylenol #3 was as effective as Ultram (Tramadol)!
Some of the negative panelists also said “rescheduling Lortab would create hardships for all -- leading to delayed access for vulnerable patients with legitimate chronic pain,” according to the National Community Pharmacists Association.
Who are they kidding? You are trying to tell me Hydrocodone is the only medication for chronic pain? It sure is the easiest to get and has spread from our elders medicine cabinets to our young people as well as from “the power of the pen and prescription pad.”
It is time for each and every physician to read the Hippocratic oath, which in part states, “I will never give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. I will apply dietetic measures for the benefits of the sick according my ability and judgment. I will keep from harm and injustice.”
Today’s physician must be aware of the “Power of the Pen” and the prescription pan. Chronic pain patients deserve relief from pain, but please take a look at your options.