Anything but that
Wednesday, July 1 2009
From the “Please God No” file comes this NY Times article:
A federal advisory panel voted narrowly on Tuesday to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver.
Vicodin saved my life, among other uses. I haven’t used it in months, but I would still regard a ban as deeply problematic – and not just because it would rob House, MD of a key plot device.
Vicodin is part hydrocodone – a narcotic pain-reliever – and part acetaminophen – aka Tylenol. This combination has been linked to several deaths from liver failure. The irony is that the deaths aren’t due to the hydrocodone; instead, it’s the acetaminophen – the Tylenol – that causes liver failure in high doses. That’s what’s killing people, and ostensibly why the FDA voted to ban it. Of course, the FDA isn’t voting to ban over-the-counter acetaminophen products.
The problem for anyone with pain is that hydrocodone is the safer half of Vicodin, but it isn’t sold as a stand-alone drug. So banning Vicodin would mean de facto ban on hydrocodone based pain-relievers – leaving a lot of people without a safe and useful drug. As far as I know, there’s nothing comparable in strength to Vicodin, so the only place for these patients to go is for even stronger drugs like hydromorphone (ie. Dilaudid).
I’d be interested to hear from medical professionals if I have any of this wrong. In the meantime, I’m holding on to my left-overs. Maybe someday they will be collectors items, but I might need them before then.
Um, while I completely agree with you that it’s a mistake to ban Percocet and Vicodin, it is possible to get plain old oxycodone with no acetominophen added in. When I was concerned about all the dang acetominophen I was taking, my doctor switched me to 5 mg oxycodone, which as I understand it is the narcotic half of Vicodin, nothing else added. Am I wrong? Is it a completely different drug?
Aviva – oxycodone is the narcotic half of Percocet – also the active ingredient in OxyContin. Hydrocodone is the narcotic half of Vicodin, and as far as I know is not available as a stand-alone med. I hope I’m wrong, and even if I’m not, that will probably change when the FDA bans Vicodin. But I have found that oxycodone is a little too strong for me – it tends to be more disorienting than hydrocodone for comparable doses.
Ah! Thanks for clarifying! I thought it was the same drug in both Vicodin and Percocet, just in different strengths.
I love learning from other patient bloggers. Thanks!
It is possible to Rx the Oxycodone without the acetaminophen (Oxycodone = Roxycodone), but the Hydrocodone (in Vicodin) would have to be done without the APAP. Stupid to put it in there in the 1st place. I don’t think you have anything to worry about.
The FDA Meeting Issue Background Document is at:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCommittee/UCM164897.pdf
Options 1(a) and 1(b) propose limitation of acetaminophen to 325mg per dose for OTC sales (and possible inclusion of all prescription formulations).
Option 5(b) proposes eliminating all prescription medications complexed with acetaminophen.
What is not (directly) stated by the FDA is the single most significant factor at play. Hydrocodone (Vicodin, Lortab) complexed with acetaminophen is a Schedule III medication. Hydrocodone (alone) is under Schedule II. And there currently is NO SUCH PRODUCT manufactured!
Thus, the FDA [if they choose to vote for Option 5(b)] will (effectively) “re-schedule” hydrocodone from Schedule III to the *much* more restrictive Schedule II (written prescriptions only, maximum 30-day supply, etc.).
Addressing the current non-existence of any hydrocodone (only) product, the FDA Background Document (lazily) states:
“For development of hydrocodone single-agent formulations, implementation would include:”
… “Submission of NDAs and ANDAs for single-ingredient hydrocodone products, which may also require clinical studies for demonstration of efficacy.”
A reported 460,000 prescriptions for hydrocodone with acetaminophen are written and filled every business day in the United States. (Despite) the fact that the public comment window has passed, all affected patients, physicians, and institutions would be wise to protest – loudly.