Medicine

US Government (Sorta) Reconsiders Poisoning Drug Addicts for their Own Good

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What kind of pussy doctor gets addicted to Vicodin?

Yesterday the FDA finally settled on new rules for acetaminophen in prescription opioid painkillers, and while they're not as draconian as they could have been (a 2009 panel recommended banning the combination altogether), they will limit the amount of acetaminophen to 325 milligrams per pill. Drugs affected include Vicodin—the most commonly prescribed medication in the United States—and Percocet, along other with a few lesser known drugs.

Regardless of the merits of this new wave of regulation, it's worth examining why Vicodin, which is a compound of the opioid painkiller hydrocodone and acetaminophen (a.k.a. Tylenol), is so popular to begin with. Reading The New York Times gives you the impression that it's simply a popular and effective medicine, but there's another benefit to the combination found in Vicodin over straight hydrocodone: It's less regulated.

Pure hydrocodone is a Schedule II drug under the 1970 Controlled Substances Act, whereas hydrocodone compounded with acetaminophen is a more loosely regulated Schedule III drug, supposedly for its lower abuse potential. Wishing to avoid greater scrutiny, doctors prefer prescribing Schedule III substances like Vicodin over purer Schedule II formulations which don't contain liver-damaging acetaminophen. But why does adding a sometimes-unnecessary ingedient make it difficult (but not impossible) to abuse? For the same reason that the FDA is now regulating it: Because it's poisonous, and can even cause fatal liver damage in the quantities necessary to sustain a heavy addiction. Researchers refer to it as an "abuse deterrent formulation"—the modern-day equivalent of the government spiking industrial alcohol during Prohibition. Except rather than blindness-inducing methanol, we now use deafness-inducing acetaminophen.

To be fair to the FDA, they share custody of the scheduling of controlled substances with an alphabet soup of other federal agencies and have comparatively little control over the process. But given all of the ink spilled and time spent regulating the acetaminophen out of Vicodin, it would have been helpful if they had at least acknowledged why it's there in the first place. Simply reclassifying pure hydrocodone as a slightly less controlled Schedule III substance might have worked just as well as this—a heavy-handed, roundabout approach that will take away even more options from pain sufferers.

More Reason on acetaminophen regulation and painkiller crackdowns. Here's reason.tv last year on banning Vicodin:

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34 responses to “US Government (Sorta) Reconsiders Poisoning Drug Addicts for their Own Good

  1. it would have been helpful if they had at least acknowledged why it’s there in the first place.

    Not helpful for the government.

  2. Except rather than blindness-inducing methanol, we now use deafness-inducing acetaminophen.

    Oh, don’t hold back Stephen, they can both kill you.

  3. STEVE SMITH NOT REMEMBER WRITE THIS

    1. Speaking of which, where the fuck is Episiarch? We had a deal.

  4. We had to destroy the village drug users in order to save the village drug users…

  5. maybe the best approach is for the FDA to ban acetamenophen entirely. According to the Yahoo article I read on this yesterday, acetamenophen causes 57,000 cases of liver damage in the US annually.

    1. Then why not just ban liver damage?

    2. i realize you are probably being sarcastic. at least i hope so.

      liver toxicity is a reality with a lot of drugs (to put it mildly) that are effective.

      used in moderation, for those w/o liver dysfunction, APAP is perfectly safe.

      otoh, used in excess it’s insanely dangerous and the ONLY pill i’ve ever seen anybody successfully commit suicide (more than once). and it’s a nasty death, too btw.

      i have a really good orthopedic surgeon who prescribed mostly straight oxycodone (roxycodone) and oxycontin, to help me limit my APAP ingestion.

      1. APAP is actually a rather unsafe drug, and easy to overdose on due to the variety of OTC products containing it. It also has a very low therapeutic index, with only 10 grams acutely being a possible lethal dose. APAP OD is the most common cause of acute liver failure in the US.

        I agree on the suicide thing. When I was in EMS, I transported a couple of college girls who tried to commit suicide using OTC “sleeping pills,” which turned out to be APAP plus diphenhydramine. I never got to follow up, but both had taken more than enough to completely fry their liver–ie a whole bottle of Tylenol PM in a 100 lb girl.

        1. i am well aware of what you say with the understanding that 10 grams is a metric assload of APAP

          APAP OD is relatively common. APAP is also a very very common drug, and is available OTC.

          people are (a given) morons when it comes to APAP. i don’t think (especially) kids etc. have any idea how moronic it is to consume mass quantities of nyquil, due to how much APAP it has in it.

          i just hesitate ot call APAP “unsafe”. used within proper dosages, and assuming no pre-existing major liver issues, it’s safe.

          to paraphrase some greek dude, all things are poison in sufficient dose (except maybe mj ) 🙂

  6. As any sufficiently motivated opioid user could tell you – it’s a trivial matter to perform an acetaminophen extraction with a handful of pills.

    1. “Just eat AROUND the poison, stupid.”

  7. It’s a sickening practice, all part of our stupid, immoral and harmful WOD.

  8. I like you a lot more than your brother, Stephen A. Smith.

  9. So in the drug warriors mind, it’s better that the thousands of people who are prescribed Vicodin flirt with liver destruction so that the smaller number of addicts don’t get a buzz without consequences. What the hell is wrong with these lunatics?

    1. Sounds more nanny-state than drug-warrior, but sometimes, it’s hard to tell the difference.

  10. I think that all drugs should be available to whoever wants them, so I am not promoting the way things are. But given that things are as they are, I think it is a bit hyperbolic to say that these drugs are unreasonably endangering prescribed users. If you bother to read the shit that comes with your prescription, it clearly says not to use other acetomenophen containing drugs when you take Vicodin. You don’t read the instructions, you get what you get. Still, the rules are dumb and doctors should be able to prescribe pure hydrocodone without extra hassles if they think it is appropriate.

  11. But why does adding a somtimes-unnecessary ingedient make it difficult (but not impossible) to abuse?

    You might want to try that sentence again.

  12. Methylated spirits never went away. It isn’t as overt, but the government still forced the methyl alcohol into those products, and they will still kill you very dead if you drink too much.

  13. Interesting way to extract the acetamenophen from the narcotic.

    http://www.poppies.org/news/96924960077672.shtml

  14. the modern-day equivalent of the government spiking industrial alcohol during Prohibition.

    Oh, as opposed to the modern day equivalent of….spiking industrial alcohol? Something about that historical equivalency strikes me as invalid when we still use the same practice today.

    Instead the sentence could have just referred to the practice without referring to prohibition:

    “… the pharmaceutical equivalent of spiking industrial alcohol.”

    1. Shorter Me: Stay off Sullum’s sugarturf.

  15. If this results in Vicodin’s having a greater ratio of hydrocodone to acetaminophen, while still being schedule 3-N, that’s a win. Patients will be able to get more hydrocodone safely for their pain, and doctors won’t be any more afraid to prescribe it.

    1. this is true. many dr’s (fortunately not mine) are deathly afraid of the dreaded C-II designation. and for somewhat good reason. the DEA scrutinizes scripts for C-II drugs much more rigorously than C-III.

      like others have said, sufficiently motivated opioid users can always do a CWE and regardless of how much APAP is in the drug combo, extract it out.

      the problem is with people with legitimate pain who aren’t going to do a CWE and the pain is bad enough where they take enough vic’s to get enough APAP where it starts getting dodgy for the liver. iirc, for a healthy individual, 4 gms a day is the max of APAP they recommend. i wouldn’t want to take anywhere near that personally.

      also noted the new oxycontins (they are imprinted with “OP” not “OC”) have solved (for now) the problem of people crushing them into a powder to smoke them. if people crush them, they turn into a weird gelatinous mass and are not smokable. some enterprising person will figure out how to defeat it, but for now – this will make o/c less scary for dr’s to prescribe imo since the potential for abuse is lower.

      otoh, the hardcore addicts will just replace o/c’s with heroin imo

      more bang for the buck anyway

  16. Simply reclassifying pure hydrocodone as a slightly less controlled Schedule III substance might have worked just as well as this?a heavy-handed, roundabout approach that will take away even more options from pain sufferers.

    But then your dentist wouldn’t be able to prescribe it, and the need for pain killers in dental work is ubiquitous and easily grasped, even by drug warriors.

    1. also note that APAP, which is an NSAID works well with opioids. different mechanism, of action etc. one is strictly an analgesic, the other is an anti-inflammatory.

      iow, it’s not the only reason they combine the two (to prevent people from taking too much of opioids, or at least to try to) but that taking an opioid with an NSAID *is* more effective than taking the opioid alone. this is especially true with some types of injuries etc and post surgical situations where inflammation is significant.

      post surgery, i used

      NSAID – APAP (acetaminophen)
      opoid – oxycodone
      ice treatment (i had a device that circulated icy water into a bladder over the surgical site. helped SIGNIFICANTLY with pain)
      other dietary anti-inflammatories (fish oil, etc.)

      worked very well

      1. No, actually acetaminophen is only analgesic, not anti-inflammatory. It is, however, a somewhat synergistic mixer with opiates.

        And who says you couldn’t legally fill a dental prescription for a schedule 3-N drug? Are you saying the states would make special rules specifying that only dental prescriptions including a non-narcotic ingredient could be filled?

        1. you are correct. i was wrong.

          WRONG I SAY. WRONG!

          Ibuprofen is anti-inflammatory. APAP not at all.

          My bad.

  17. The usage of prescribed painkillers recreationally is at epidemic levels, according to the Centers for Illness Control and Avoidance. Just what is it about the tablets that makes them so hazardously habit forming and a possible gateway for heroin?

    The unusual solution, at the very least to several non-medical specialists, is that the typical painkillers that physicians and dental professionals recommend to users after injuries and surgical treatments have the exact same active component as the drug that alleyway individuals inject into their arms. And both act in comparable methods on the human mind to produce a sense of delight that can easily overcome its thought operations.

    While lots of who abuse prescribed painkillers think about heroin as a low-class drug that will certainly never ever make its method into their lives, they do not recognize, they’re currently addicted to a sort of it.

    Prescribed painkillers of the kind that 12 million Americans made use of nonmedically in 2010, according to Non 12 Step rehabs, are narcotic opioid medications, more frequently described as opiates. They consist of hydrocodone and oxycodone, even understood by the brand Vicodin and Oxycontin, respectively.

  18. The usage of prescribed painkillers recreationally is at epidemic levels, according to the Centers for Illness Control and Avoidance. Just what is it about the tablets that makes them so hazardously habit forming and a possible gateway for heroin?

    The unusual solution, at the very least to several non-medical specialists, is that the typical painkillers that physicians and dental professionals recommend to users after injuries and surgical treatments have the exact same active component as the drug that alleyway individuals inject into their arms. And both act in comparable methods on the human mind to produce a sense of delight that can easily overcome its thought operations.

    While lots of who abuse prescribed painkillers think about heroin as a low-class drug that will certainly never ever make its method into their lives, they do not recognize, they’re currently addicted to a sort of it.

    Prescribed painkillers of the kind that 12 million Americans made use of nonmedically in 2010, according to Illinois rehabs, are narcotic opioid medications, more frequently described as opiates.

  19. The usage of prescribed painkillers recreationally is at epidemic levels, according to the Centers for Illness Control and Avoidance. Just what is it about the tablets that makes them so hazardously habit forming and a possible gateway for heroin?

    The unusual solution, at the very least to several non-medical specialists, is that the typical painkillers that physicians and dental professionals recommend to users after injuries and surgical treatments have the exact same active component as the drug that alleyway individuals inject into their arms. And both act in comparable methods on the human mind to produce a sense of delight that can easily overcome its thought operations.

    While lots of who abuse prescribed painkillers think about heroin as a low-class drug that will certainly never ever make its method into their lives, they do not recognize, they’re currently addicted to a sort of it.

    Prescribed painkillers of the kind that 12 million Americans made use of nonmedically in 2010, according to the CDC, are narcotic opioid medications, more frequently described as opiates. They consist of hydrocodone and oxycodone, even understood by the brand Vicodin and Oxycontin, respectively.

    http://www.non12step-drugrehab…..rehab.html

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