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DEA Reschedules Combination Hydrocodone Painkillers
After more than 10 years of hemming and hawing, the Drug Enforcement Administration (DEA) has finally lowered the boom on prescription painkillers containing hydrocodone. It’s about time, since hydrocodone is among the top killer drugs in America.
The new ruling, which comes into effect the first week of October, 2014, moves a long list of painkillers such as Vicodin and Lortab from schedule III to schedule II, placing them in the same category as codeine and oxycodone. DEA says the long-awaited move is a response to the epidemic of prescription opioid overdose deaths across the country.
“Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents,” said DEA Administrator Michele Leonhart. “Today’s action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available.”
What this means is that patients can only get prescriptions for 3 months tops, after which they must see the doctor for a renewal. In many states, only a physician will be able to write such a prescription, excluding the various categories of medical assistants, technicians, nurse practitioners and so on.
Drug schedules run from I down to V. Schedules II down to V must all have accepted medical uses. Schedule II is the highest potential for harm and abuse, with Schedules III, IV and V having progressively less potential for harm and abuse. Schedule I are controlled substances with no accepted medical use and no accepted procedures for safe use.
Hydrocodone Containing Products (HCPs) usually are hydrocodone in combination with such drugs as acetaminophen, ibuprophen or aspirin. When Congress passed the Controlled Substances Act in 1970, HCPs were listed as Schedule III, but hydrocodone by itself was placed in Schedule II, the class reserved for drugs with a higher potential for abuse than SIII.
Over the past decade, prescription drug abuse overtook abuse of illicit street drugs. There’s been no shortage of evidence that the rampant increase in abuse of HCPs has led to thousands of dependencies, abuses, addictions and fatal overdoses.
To its credit, the DEA has been calling for a shift to Schedule II for HCPs for all that time. Surveys from multiple federal and nonfederal agencies, says the DEA, have clearly shown that HCPs indeed have “a high potential for abuse and abuse may lead to severe psychological or physical dependence.” The DEA pointed to federal Monitoring the Future surveys of 8th, 10th, and 12th graders, which showed twice as many high school seniors used the Schedule III HCP Vicodin non-medically as used the more tightly controlled Schedule II drug oxycodone and its popular delayed-release version, OxyContin.
Obviously, for those 10 years, other forces have been at work blocking the DEA’s attempts to tighten controls. Although they cite medical and financial concerns – tighter controls would make it more difficult for patients to get the pain relief they need and it would be more expensive – no credible study supports the argument.
Here in Florida, the damage done by prescription painkillers containing hydrocodone is no secret and no surprise. According to the state’s 2013 Medical Examiners Commission Interim Drug Report, hydrocodone is one of the top half-dozen killer drugs in the state. Deaths from hydrocodone increased 30 percent in the first 6 months of last year over the last 6 months of the year before.
But hydrocodone isn’t the state’s top killer – that’s a distinction reserved for the whole class of drugs called benzodiazapines, with alprazolam (Xanax) and diazepam (Valium) taking the top honors. Almost always, benzodiazapines are found in combination with other drugs, more often than not alcohol.
But any way you look at it, the picture in Florida is a grim reminder of the deadly grip prescription drugs have on the nation. In Florida, prescription drugs represent 78 percent of all overdoses in the state, outpacing illicit drugs like heroin and cocaine. After the benzodiazapines, the drugs that caused the most deaths were alcohol, cocaine, oxycodone, morphine, methadone and hydrocodone.
Hydrocodone is a ‘semi-synthetic’ opioid, meaning it is part natural and part man-made with chemicals from other sources. The natural part originally came from codeine, but most is made today from thebaine, another, much more toxic derivative of codeine. Codeine is a natural derivative of morphine, which in turn comes from opium, which is made from the sap extracted from the green seed pods of a flowering plant called the opium poppy.
The synthetic part simply means that some chemists started with a natural opioid and then tinkered with it in a lab to create the chemical properties of what is now called hydrocodone. And like almost all the opioid/opiates in our prescription painkillers, it originated in pre-WWII Germany in the 1920s and ‘30s.
Another interesting thing about hydrocodone is that it is not just used as a painkiller, but also as an antitussive – that is, a cough medicine, often in combination with acetaminophen or ibuprofen.
Maybe the most interesting thing about hydrocodone is that it’s prescribed predominantly in the United States and is rare everywhere else. The International Narcotics Control Board says 99 percent of the world supply is consumed here in the States.
And yet another interesting aspect of hydrocodone was the recent approval by the FDA of a new hydrocodone formulation, called Zohydro ER (for Extended Release). The FDA approved it over the objections of its own review panel, which said that if it was approved, it would likely “be abused, possibly at a rate greater than that of currently available hydrocodone combination products” such as Vicodin and all the others. At least 30 states asked the FDA not to approve it, some saying they would ban its sale in their jurisdictions. But after a federal judge overturned Massachusetts’ attempt to do so, citing that federal approval trumped state law, the states were forced to accept it.
The bottom line, of course is that the shift to Schedule II for hydrocodone containing products may mean very little in terms of dependencies, addictions and deaths. All one has to look at is the number of fatalities from oxycodone – triple or quadruple that of hydrocodone – and oxycodone containing products are and always have been in Schedule II.
Really, the only good news in all this is the fact that Novus Medical Detox Center has the answer for anyone in trouble with hydrocodone or any prescription or non-prescription opioid. Our medical opioid detox protocols offer the safest and most comfortable detox possible anywhere. Don’t hesitate to call Novus any time and get all your questions answered about opioid detox, or detox from any substance.
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