Drug Policy

Massachusetts Tackles an 'Epidemic of Opiate Abuse' by Banning One Version of Hydrocodone


Office of the Governor

Last week Massachusetts Gov. Deval Patrick imposed an emergency ban on Zohydro, an extended-release version of the narcotic painkiller hydrocodone that was approved by the Food and Drug Administration last year. Patrick said Zohydro "poses a significant risk to individuals already addicted to opiates and to the public at large." Zohydro's manufacturer, Zogenix, complains that the "unprecedented" state ban on a specific FDA-approved product "only serves to unfairly restrict patient access to the only hydrocodone pain reliever available for long-term, daily, severe chronic pain patients who are obtaining relief with short-acting hydrocodone combination products, but who are at risk for potentially fatal liver toxicity due to their daily intake of acetaminophen." As Reuters explains, Zohydro's detractors view the absence of that risk as a dangerous drawback:

The company has defended the drug as a necessary option for pain patients who cannot tolerate acetaminophen, a nonsteroidal anti-inflammatory drug linked to liver damage and stomach bleeding.

But critics worry that with no built-in abuse deterrents, Zohydro will be a draw for addicts looking for an easy fix.

You might have thought that hydrocodone products such as Vicodin and Lortab contain acetaminophen with the goal of achieving a synergistic analgesic effect that reduces the amount of hydrocodone required for a given level of pain. But in truth the acetaminophen functions more like the methanol that the government required manufacturers to put in industrial alcohol during Prohibition: as a poison aimed at deterring abuse. In the case of acetominophen, there is no direct mandate, but "combination products" traditionally have been less restricted than straight hydrocodone, placed on Schedule III rather than Schedule II of the Controlled Substances Act because they were deemed to have a lower potential for abuse. Now that the FDA wants to eliminate that distinction, there is not much advantage to mixing hydrocodone with acetaminophen, especially for patients with severe chronic pain who take the pills every day for an extended period of time. But Patrick is basically telling Zogenix that it cannot sell Zohydro to those patients unless it agrees to slowly poison them with acetaminophen or comes up with a tamper-resistant formulation that is harder to crush for snorting or injecting.

Zogenix argues that its product has become a scapegoat for what Patrick calls "an epidemic of opiate abuse":

Contrary to some recent media reports, most other opioid medications on the market today are [either] equal to or more potent than Zohydro ER (e.g., oxycodone, fentanyl, hydromorphone and oxymorphone), and all are available in higher strengths per unit-of-use than Zohydro ER. Claims that Zohydro ER is "more powerful" or "more addictive" than other commonly prescribed opioids are not supported by scientific data.

Over the last 12 months, more than 360,000 prescriptions for extended-release opioids were dispensed in Massachusetts, and a significant majority did not have FDA-approved abuse deterrent claims. We fail to see how banning the sale of a single new product will achieve the governor's policy objectives when all of the products that are currently part of the epidemic remain available for sale in the state….The [Drug Enforcement Administration] quota for Zohydro ER is less than one percent of the total allotted hydrocodone product that will be manufactured in the U.S. this year.

Even if Zohydro were especially attractive to addicts, that consideration should not override the needs of legitimate patients. As usual with attempts to "balance" drug control and pain control, Patrick's ban sacrifices the interests of patients to protect addicts from themselves, a tradeoff that is not morally justified.

NEXT: Flying Out of NYC, Gun Owners? Not So Fast. The Locals Want To Bust You and Steal Your Firearms.

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  1. I thought Massachusetts was socially tolerant?

    1. Hahahahahaha!

    2. +1 socon

    3. Mass. is a good illustration of why it is a mistake to assume that “liberal” “Democrat” “progressive” and “tolerant” have anything to do with each other. Mass. is Democrat dominated is all.

      1. “Social Tolerance” is pretty dubious anyway since they are perfectly willing to ban stuff they don’t like.

        And I’m pretty sure the movement toward Pot Legalization more has to do with the belief that Pot isn’t Bad for You rather than any sort of belief in individual rights.

        1. Like most people, Democrats are largely tolerant of things they think are OK and intolerant of things they don’t.

          My comment was mostly in response to the false assumption that people often make that everyone on one “side” or the other of politics agrees about everything. Just because Mass is run by Democrats doesn’t mean that they are all socially liberal hippies from San Francisco. There are loads of socially moderate to conservative Democrats in Mass.
          Similarly, not everyone who supports unions is also a pro-abortion environmentalist gay marriage supporter. The two party system makes people dumb and seems to convince a lot of people that there actually are just two sides.

  2. But critics worry that with no built-in abuse deterrents, Zohydro will be a draw for addicts looking for an easy fix.

    Right! I’m sure addicts are concerned about their acetaminophen intake.

    Could this just be makers of older drugs pulling crony strings to eliminate potentially new competition?

    1. Ockham’s Razor suggests its a case of drug warriors being retarded thugs.

    2. Uh, they’re extremely fucking concerned about it, because it can kill you. That’s why oxycontin took off; it was oxycodone with no acetaminophen, which meant you could take more and more and not die from liver failure. But even before that, they came up with techniques like cold water extraction to remove the acetaminophen.

      I would go with drug warrior evil over cronyism in a big way here. Because there’s no reason the older drug companies couldn’t just make their own acetaminophen-free pills. In fact, years ago you could get mixes with aspirin or ibuprofen, but those have slowly disappeared. Guess why?

      1. Sure, the USG prohibitionists allowed 10,000 people to die from tainted alcohol in the 1930’s, but I’m sure they learned from that and would never let it happen again.

  3. The acetaminophen in painkillers is one of the simplest and most direct signs of how fucking evil drug warriors are, and what their real motivations are. They don’t give a fuck about people in pain. They just want to make sure people who use narcotics more than they approve suffer and pay for it.

    1. This can’t be said enough.

  4. Wait… The problem is that this drug is too safe?

    1. Yup. It’s too safe, so “drug abusers” might take more. As I said, drug warriors are pure fucking evil.

      1. Also, it’s my firm belief that if alcohol didn’t cause hangovers and damage your liver over time, or if they invented synthahol (fuck you, TNG) that didn’t, it would be outlawed. I mean, look at weed. It’s a fucking plant with no hangover and no particular health issues (other than smoke inhalation), and…it’s illegal most places.

        Drug warriors will only tolerate drugs that cause enjoyment if they are dangerous.

        1. it would be outlawed

          You mean still outlawed?

        2. It seems like at this point safety is irrelevant. Any new drug that is fun gets banned simply for being fun. MDMA is another good example of that.

        3. I mean, look at weed. It’s a fucking plant with no hangover [. . .]

          Though a rare breed, a weed hangover is a very real thing.

          1. If you say so. I’ve never had one, and I have smoked tons of weed, of different types, at different ages, in different amounts.

            1. Depends on what you mean by “hangover”, I guess. Still baked when you wake up is certainly possible.

              1. No. It was a hangover. Headache in the morning. Feeling like shit in general until you can get enough sugar in your blood to counteract it. The whole works. The only thing missing is nausea.

            2. They exist, though like I said, it’s a rare breed.

              After 20 years, I can say that I’ve had exactly 3 weed hangovers. The first was from smoking a shit load of year-old schwag (we couldn’t get anything else at the time). The second was from smoking well beyond the point where one could get any higher over a period of about 16 hours. The third was from repeatedly hitting a bong through the night that I had no business hitting.

              1. Sounds like it might be more the result of excessive smoke inhalation than pot specifically.

              2. smoking a shit load of year-old schwag

                Gag. THC can go rancid, you know.

  5. look at how racist the Drug War is!

    oh wait a sec.

  6. Fuck you, Taxachusetts. And fuck every other state that fucks over people in pain because of drug warrior bullshit. I hope you suffer the most painful fucking disease possible, Mr. Patrick, and that you can’t find any relief from the horror because of the bullshit laws you endorse. Go fuck yourself with a barbed wire covered bat.

    1. I hope you suffer the most painful fucking disease possible, Mr. Patrick, and that you can’t find any relief from the horror because of the bullshit laws you endorse.

      Though I agree with the sentiment, you’re crazy if you think that he wouldn’t be able to get whatever he needed to be comfortable, and at no penalty even if he’s caught.

      1. I know that. I just wanted myself to feel better with that thought for two seconds while I ranted.

  7. The great irony is that many people in chronic pain would rather be dead than live through their ‘unaltered’ state of being. Of course these drugs are ‘addictive’, feeling good is addictive, feeling slightly less than awful with who knows how many side effects is addictive. Pain is one of the worst facets of the human condition. Fuck these fascists.

    I am sorry I have nothing constructive to add to this conversation.

    1. What I’ve always thought funny is that the euphoria and tingly feeling you get from taking opiates is always described as a “side effect” when in fact IT IS PART OF THE FUCKING THERAPY AND WHY THE DRUG FUCKING WORKS.

      Feeling good on Vicodin is the point of Vicodin.

      1. Exactly. The euphoria and removal of anxiety really helps when you’re stuck in a hospital bed in pain.

        1. Yes, but I don’t see it as separate from whatever it is in opiates that takes away the pain (or lessens it). It IS what takes away the pain (or lessens it), or at least part of it.

      2. Being really itchy is usually annoying as hell. Usually.

        1. Every time I’ve been prescribed opiates (which is only a few times, most recently with kidney stones) I ALWAYS get the itchy nose syndrome where I cannot stop scratching it, and I eventually get raw.

          1. Not the itchy all over in a completely sublime way syndrome?

        2. They’ve never made me itchy. I wonder if its a mild allergy.

    2. The instance of people using opiates for relief of pain going on to be addicts after the pain stops is fairly low. The mass underprescription of opiates for pain relief because of fears of addiction is just like most gun laws… they only serve to punish the law-abiding.

      1. I was thinking more along the lines of chronic pain: where the patient has no immediate hope of feeling good outside the medication. To some observers, it would appear this person is ‘addicted’ to the drug(s) they are taking, when the reality is that life for that person is otherwise unbearable.

        My grandmother took opioids for several years because of fractures in her spine (one source of pain among many as her condition worsened). She had no hope of feeling better because surgery was impossible. She received back injections, but even those were not enough. But she would frequently forgo taking the pills because of the side effects.

        My point on this was that pain is highly personal, but that there are a good number of people who think they know what is best for the person experiencing it. Until that mindset changes, things like this are only going to get worse.

  8. The only punishment that is fitting for these assholes is the boats.

  9. Keep it up Deval, you and the SJC (Mass. legislature for those not from the People’s Republic of Taxachusetts) just keep giving me more and more reasons to sell short and take my skills and savings someplace else.

  10. Abort this fuck.

  11. Sometimes man you jsut have to roll with the punches.


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