Tag Archives: vicodin
Posted on June 14, 2012Heroin has become more popular recently, because the most sought-after prescription drugs are ... much more expensive, and inexpensive heroin, especially from Mexico is filling the gap. We look at the "War on Drugs" started by Nixon, inreaction to the grwoing use of heroin in the 60s, and the current changes in demographics, with the realization that heroin is not just the drug of the inner city, the poor and disenfranchised, but rather crosses all levels of society.
Posted on April 30, 2012New statistics from the DEA show a six-fold (600%) increase in the use of opioids, primarily oxycontin and vicodin, over the last ten years. We discuss this trend which we have reported, and the relationship to pain management.
Posted on February 16, 2012A smartphone app to monitor cravings-- a new tool for relapse prevention? Also the newest legal drug - inhalable caffeine ... and more on prescription drug use debate (updated.)
Posted on February 8, 2012Are we overreacting to the issue of increased use/abuse of pain medication, and we are perhaps still under-treating pain?. We try to look at the bigger issues of what is pain, why does it persist, and even if abuse numbers are low, what are the implications for the addiction-sensitive population.
Posted on July 14, 2011After decades of uppers use, we are heading in a "downer cycle" with significant abuse and ODs being reported especially for prescription drugs like Vicodin and OxyContin, but also heroin, methadone and and even the opioid treatment drug suboxone. We look at the trend and some of the implications.
Posted on April 29, 2011
The Obama administration recently proposed legislation which will require doctors to undergo training before being permitted to prescribe powerful painkillers like Vicodin and OxyContin. “The White House is absolutely committed to legislation that will make prescriber education mandatory,” according to Gil Kerlikowske, the White Hojuse's top drug policy adviser. The move would require Congress to make changes to the Control Substances Act of 1970.
This week, the FDA has release a long-anticipated plan that changes the regulation of long-acting and extended-release opioids, which reverses its policy of last summer, and does include additional training requirements for physicians and prescribers of these drugs. There are more than a million prescribers currently registered with the DEA to distribute opioids, and approximately 700,000 of these prescribe long-acting and extended-release products. The plan has sparked controversy, with opposition from patients-rights groups, drug companies and doctors. Dr Inaba comments.
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. A recent story in the New York Times reports tighter rules on pain killers have been proposed by the Obama administration and there is apparently controversy about the move and I am having trouble understanding why. In particular, we’re talking about opioids, Oxycontin probably the most prominent and perhaps the most abused. The article mentions that it is Congress’ responsibility to mandate training, which is what we’re talking about...mandating training for physicians to prescribe opioids. And right now, this is not controlled by the FDA, but by the DEA. So, we have multiple agencies at work here and we have the drug companies, the doctors and the patient’s rights groups….so a lot of different folks involved. How do you see it Darryl?
DARRYL: Well, first of all, opioids have a long history of being diverted or being misused by patients who actually needed them and become addicted to them. And currently, I think Vicodin is probably more misused than Oxycontin and maybe even codeine might be more abused - but the news really focuses on Vicodin and Oxycontin. Oxycontin deserves some real interest, because Oxycontin came out as diversion resistance - the manufacturer indicated that they made a safe pill that contained a lot of oxycodone, which should be a schedule 2 drug, but coded especially so that it can’t be a huge jolt of drug … meaning there’s a slow release of the drug in your system to kill pain, but it doesn't produce the big rush high amounts would….there are 80 to 120 mg of oxycodone, whereas Percodan, the schedule 2 drug, which is harder to get, only has about 5 or 10 mg. The manufacturers of Oxycontin said it was a good pain killer that would be non-divertible but they knew from the beginning that would not be possible. People figured out a way to crush the tablets, to chew on them, to melt them down and once the coating is broken, a huge amount of the drug is introduced to their system. I see both sides of this issue - doctors are in a hard place because Oregon, other states and the government went on this huge campaign about 10, 20 years ago because the thought was that we’re not compassionately treating people with pain, we need to give people as much medication as possible to control their pain and doctors - some here in Oregon were sanctioned and got their hands slapped by the medical boards for not prescribing enough pain medication. So, they’re prosecuted for under-treating pain and now they’re being scrutinized for over-treating pain. They probably feel like a pendulum, wacked in the head, going both ways across their brow. So, I see that as an issue. The current administration - it’s actually the federal drug administration, the Drug Enforcement Administration and the Office of National Drug Control are saying this is really out of hand. Abuse of oxycontin and Vicodin went from very little abuse a few years ago or 10 or 12 years ago to a 500 to 600% increase in abuse - overdoses, toxicity and kids dying. It’s gotten a lot of attention and because of that, doctors are mandated to receive education about diversion of prescription drugs and specifically opiates, how to recognize a person who is doctor shopping for drugs, recognize inappropriate use of medication and prevent the occasions these medications can get out to the general public. It’s interesting because the data indicates that it’s really not doctors who are causing these medications to reach people who are abusing them, it's your mother and your father and your grandmother and grandfather and your friends who are given legitimate prescriptions, who might not use all of it and pass it along to others - or they get robbed at dinner parties in their own homes. Kids go to dinner with their parents, they go through the host's medicine cabinet and steal whatever is there. That’s diversion - that’s how most people who abuse these drugs are getting them - not by ripping off or scamming doctors or getting them off the internet.
HOWARD: That speaks to controlling the number…the size of the prescription, doesn’t it?
DARRYL: Yes it does and that’s always been a bugaboo too because under certain healthcare plans, pharmacy plans and under Medicaid and Medicare, it’s more economical to give a patient 30 or 50 pain pills instead of only the 5 or 6 they need to control - say dental pain. And if the patient has prolonged pain or complications, they have the medications - this rather than having to renew the prescription. But the other side of this is that we don’t have adequate training of our healthcare professionals about addiction. We have more than we’ve ever had before, but it’s still sort of like an elective or one or two hours or maybe at the most, 4 hours in the whole curriculum of medical school and pre-medical school…
HOWARD: Which is a little bit absurd.
DARRYL: And pharmacy schools don’t offer this education - they don’t have anything on this and it really speaks to the need that this has to be inclusive in the curriculum. It has to become a regular part of the curriculum so that doctors and nurses, pharmacists, all healthcare professionals really learn about abusive drugs, addiction, diversion, what to look for, how to deal with it, how to treat it, how to interact, and what referral sources are available. We really have to get on top of this because - I think addiction and drug problems are our nation’s number one public health problem and we spend minimal time educating healthcare professionals about it. That’s a horrible situation. So, I don’t know if the FDA and DEA and Office of National Drug Control Policies are appropriate in saying to doctors….if you’re going to prescribe these medications, Dilaudid, codeine, Oxycontin, Vicodin, and all the various forms of opioids that are out there, you must have special mandatory training. I think we should have mandatory training as a part of medical school before you get your degree and then, I like what we’re doing here in Southern Oregon - working with health clinics to establish a treatment contract, a high risk medication treatment contract. So if a patient comes into a healthcare clinic and needs a high risk (for abuse) medication, either a benzodiazepine, sedative, some sort of sleeping pill or opiates, or maybe even amphetamine for ADHD, the patient enters into a contract with the medical clinic saying they’re not going to divert it, they’re not going to abuse it, they will allow us to do pill counts to make sure they aren’t running out too quickly or selling or doing something that would be inappropriate. They agree to comply with urine testing - we test them from time to time to see that they’re taking their medication and taking it appropriately. We do all that with high risk medication protocol to cut down on abuse and diversion of these medications. I think that’s a much more sane approach and maybe that’s the approach the administrative health organization should be taking, educating healthcare systems rather than individual physicians.
HOWARD: Well, as I said earlier, I find it difficult to believe that there is a debate over whether or not we should have more training to prescribe deadly drugs. I just find that astounding. But as you kind of implied - it’s follow the money. The drug industry is perhaps most concerned because it will likely reduce, to some extent, the number of prescriptions, but we’re talking about over a half a million doctors and dentists who are prescribing these things with just a few hours of training. Given that this is considered one of our biggest, if not the biggest public health crisis or public health issue, …that’s absurd and I don’t understand why there is controversy over the training.
DARRYL: Well, it’s controversy, I think, primarily from those concerned with costs - how much extra is this going to cost our medical care, how much is it going to add to medical care. I think doctors resent having yet another enforced requirement from the federal government or other agencies telling them they must do something extra to get a DEA number to prescribe controlled substances. That they will have to have specialized training. Of course, they must have training in order to prescribe saboxone or buprenorphine for addiction, but they don’t have to do that if they’re going to give buprenorphine for pain. And maybe, if we think it’s important to give the training for doctors who are going to treat addiction with buprenorphine, maybe it should be important training for any doctor who is going to use buprenorphine because it’s abusable and potentially a problem. Oxycontin and Vicodin and all the codines - even though they’re generic - are big business. If you look at the budgets of the pharmaceutical companies, Medicare, medical and public funding, these types of opiate pain medications consume a huge amount of the economic resources we put into those medical systems. And it represents a huge profit, I think, to companies who are manufacturing these, so they are arguing that only if 10 at the most 12% of patients using these drugs are abusing them - why punish the 90% who benefit from them by restricting the ability of doctors to prescribe them. So they’re always going to argue that point - saying we’re sacrificing 90% of the patients who need this drug for pain for the 10%who abuse that privilege.
HOWARD: And your point about drugs reaching the streets through the back-door - not so much because of inappropriate prescriptions…but because of friends and family inadvertently diverting them. Some people just throw them away in the trash.
DARRYL: I saw a pilot for one of the new sit-coms ….it was a really funny show, and it highlighted this very issue. It was about a young man who really resented having to go visit his grandmother in a nursing home - but he goes to visit, goes into her bathroom and looks in her open medicine cabinet and he says, ‘My God, grandma’s got Oxycontin” and next thing you know he is calling up all of his friends and they’re coming over and she is having a grand old time with all these young kids joking around, getting loaded on Oxycontin. Nursing homes are a prime source - there are people who dumpster-dive for medications at certain nursing homes because they know the extra medications are just thrown away. So maybe doctors do contribute to this by over-prescribing…
HOWARD: Well, yes,
DARRYL: But again, the problem is the way health insurance and reimbursements and costs are structured. A small quantity of a prescription it’s going to cost almost the same amount as if they gave you 100. So they might as well give you 100.
HOWARD: Well, we will see what happens ultimately, but not today. But we will keep an eye on this. Thanks for listening and we are always interested in your comments, questions, and suggestions - our email is info@cnsproductions.
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