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The power of the pen

BY DR. CHARLES SHAW Modified: February 5, 2013 at 11:41 am •  Published: February 5, 2013

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.