@SeniorPonzologist_GitEmSteveDave: Looks like Wilson took him to that treatment center just in time.

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WorldHarmony

July 2, 2009 4:18 AM

@karmaghost: Yeah, the first thing I thought of was how this will make an excellent story arc for House.

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CheritaChen

July 1, 2009 3:09 PM

@karmaghost: And I can see ways for this action to be written into the storyline. Can't wait!

Of course, I'd probably be less optimistic if I depended on one of these meds. How long will it take the pharma companies to come out with the standalone versions of the drugs? And why the hell was there no demand for them before, anyway?

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gStein_*|bringing starpipe back|*

July 1, 2009 3:45 PM

@CheritaChen: my understanding was that, in the past, they were bundled together to attempt to cull abuse, since the acetaminophen can damage the liver.
also, my understanding is that the 2 drugs paired together work better than either one separately, so in this case the whole is greater than the sum of the parts.

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vim876

July 2, 2009 2:00 PM

@gStein: Wow, they really bundled them to curb abuse? It's not like drug addicts are going to be like, \"Well, this hurts my liver, maybe I shouldn't abuse it.\" Otherwise we'd have no alcoholics.

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KyleOrton

July 2, 2009 3:42 PM

@vim876: It's similar in effect to denatured alcohol (rubbing or industrial alcohol you buy for anything but drinking).

They basically added crap to it so it would be poisonous and not a cheap easy way to get wasted.

Interestingly, one of my customers called a few weeks ago and asked if they could use non-denatured alcohol during application. I figured it wasn't a problem but there must be better uses for it.

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WorldHarmony

July 2, 2009 4:22 AM

@gStein: Unfortunately, the addition of acetaminophen doesn't stop people from becoming addicted to Percocet or Vicodin- it just made scrupulous doctors more wary about how much to prescribe. The combo, in the end, just makes abuse of the drug that much more dangerous, hence the call for bans and limits.

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SJActress

July 1, 2009 4:43 PM

@gStein:

Yep. I'm kind of glad. Vicodin always made me really itchy. I'm supposed to get my wisdom teeth taken out pretty soon here; I wonder what they'll prescribe for pain?

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jenjen

July 2, 2009 1:18 AM

@SJActress: I had a molar pulled recently and the dental surgeon said that a combination of OTC ibuprofen and acetaminophen has been shown to be just as effective as Vicodin and doesn't make you loopy. The key is to take them together, with slightly more ibuprofen than acetaminophen. He recommended four regular Advil plus two extra-strength Tylenol and it was plenty good enough.

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Phexerian

July 2, 2009 9:48 AM

@jenjen: He is a dental surgeon. He doesn't know anything about drugs.

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madog

July 1, 2009 6:46 PM

@SJActress: If it was a continued itch, it could be an allergy to it. However, most likely it's just an opiate effect of making you itch. If you still take them for pain, take a smaller dose at your normal times.

.....so I've heard.....

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WorldHarmony

July 2, 2009 4:23 AM

@madog: Opiates make me itch as well- it appears to be a common side effect. Narcotics in general tend to make me altogether ill, though - a terrible situation when recovering from surgery, as non-narcotics don't take away pain nearly as well.

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JayDeEm

July 1, 2009 6:43 PM

@SJActress: I got a sampler platter of pain meds when I had mine done a few years back. Percocet, Vicodin and high dose Ibuprofen. The Vicodin also made me sick. I wound up getting by with regular otc Ibuprofen.

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Powerlurker

July 1, 2009 5:01 PM

@SJActress:

Probably something like Vicoprofen (hydrocodone and ibuprofen).

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chersolly

July 1, 2009 12:12 PM

This is bad news for a lot of senior citizens who sell Vicodins and Percocets in order to afford necessary prescriptions.

7 replies

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Trai_Dep

July 1, 2009 5:48 PM

@chersolly: I guess they'll have to go back to earning their money the old fashioned way: dangling their bared naughty bits thru a window and beckoning \"come hither\" with a crooked index finger.
Or, y'know, selling the surplus of over-curious school children lured into their gingerbread homes too pudgy to fit into their roaring ovens.

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Porcelina

July 1, 2009 4:19 PM

@chersolly: My husband suffers from chronic pain, and sometimes sells his pain medication (Lortab), which makes him ill, in order to afford all his other medications, and marijuana, which actually helps the pain and lets him eat without feeling groggy.

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zekebullseye

July 5, 2009 11:05 AM

@Porcelina: That's called drug diversion and it's illegal.

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the_wiggle

July 4, 2009 10:07 PM

@Porcelina: sad to say this is is exactly what happens when the medical system byNlarge refuses to take chronic pain seriously enough to allow people what they need when they need it.

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hairyseaword

July 2, 2009 6:05 AM

@Porcelina: I hope you two don't have kids.

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Porcelina

July 2, 2009 3:04 PM

@hairyseaword: No I don't, but even if I did, what business is it of yours?

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vim876

July 2, 2009 2:06 PM

@hairyseaword: Why not? They are acting as honorably as is possible for them in the context of a broken system. If the healthcare system weren't horsecrap, they wouldn't have to do what they do. Getting kids above the age of 7 to understand that isn't too hard.

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DoktorGoku

July 3, 2009 12:21 AM

@vim876: \"If the healthcare system weren't horsecrap, they wouldn't have to do what they do.\"

\"If the mortgage system weren't horsecrap, I wouldn't have to rob convenience stores.\"

Hyperbole, but you get my point. You choose to to what you do. You can admit to it like an adult, or you can make excuses. Don't make excuses.

@Porcelina: You make it public business by posting on the internet. Don't post something and then expect people not to respond, infer, or do anything else with your statements. People aren't all going to agree with you and applaud your views on everything because Web 2.0 style dictates comments for every story.

Since I deal with this every day with my patients, I also hope that you and your husband are honest with your doctor about what he uses for pain. I doubt you are (an ethical doctor wouldn't prescribe a medication he knows his patient is just going to sell, and you know that), but it really is important, to help guard against side effects of future medications, drug interactions, etc. If you doctor doesn't know, then you are admitting to taking advantage of your doctor- at the price of both your dignity and your husband's potential future health.

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July 1, 2009 12:29 PM

@chersolly: I'm sure they also eat dog food, which is more expensive than normal people food, but sounds so awesome and poisons the well.

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chersolly

July 1, 2009 12:36 PM

@SeniorPonzologist_GitEmSteveDave: There is an entire underground economy of senior prescription drug resellers that needs to be recognized and addressed.

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rpm773

July 1, 2009 1:49 PM

@chersolly: Duly noted. Would the chairman please recognize and address the underground economy of senior prescription drug resellers present today?

The good news about this is that the members of this underground economy will no longer have the weight of self-guilt associated with the reselling of drugs for misuse and abuse, drugs deemed dangerous by the FDA.

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July 1, 2009 1:13 PM

@chersolly: You're right. I was just talking to my dealer, Ethel, as she was rolling down the block on her walker w/spinners, blasting the new Lil' Jon record, and I realized exactly how hard she works. Her biggest problem is she keeps her drugs wrapped in cellophane in one sleeve, and old kleenexs in the other, and sometimes gets them confused.

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WorldHarmony

July 2, 2009 4:25 AM

@600Followers_GitEmSteveDave: I'm sure that was Lawrence Welk she was listening to.

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HiPwr

July 1, 2009 1:22 PM

@SeniorPonzologist_GitEmSteveDave: \"old kleenexs\" as in used? We should have some kind of agency inspecting the packaging for such things.

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ExtraCelestial

July 1, 2009 12:49 PM

@chersolly: It's far too early in the morning to detect facetiousness.

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ekzachtly

July 1, 2009 12:15 PM

Okay, they're not only manufactured together because of \"convenience.\" I made this comment on a previous post: it's also to prevent people from abusing drugs like oxycodone and hydrocodone. When you market them together, people are less likely to become addicted or abuse the drugs, because taking too much of it also means taking too much acetaminophen, which has some nasty effects, obviously. Sell them without acetaminophen (as they do with oxycodone), and abuse/overuse/fraudulent prescriptions all shoot upward. I understand the thought behind this, but I'm not sure it's such a good idea.

5 replies

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JohnQPublic

July 1, 2009 2:03 PM

@ekzachtly: Do you really think drug abusers give a crap about their liver? Or are there other nasty side effects I'm not aware of?

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spanky

July 1, 2009 4:03 PM

@JohnQPublic: Pretty sure the effects can be felt immediately. If you take too much acetaminophen, you'll often start vomiting right then and there. In cases in which those symptoms are delayed, it prevents future drug abuse by killing the potential abuser. Try copping a buzz from the grave, reprobate!

Acetaminophen is added to some narcotic pain relievers in part because it makes it difficult to overdose on the narcotics because of the effects of overdosing on the acetaminophen are more serious. Over half of acetaminophen overdoses are accidental, when someone takes OTC acetaminophen along with one of the prescription drugs. (In fact, I was recently in the ICU with a family member, and there was a young man in the next room, early 20s, who was in the long, slow process of dying from exactly that. He'd had a root canal or something, and had taken a Tylenol, then realized it wasn't strong enough, and took some Vicodin the dentist had prescribed.)

So combining narcotics with acetaminophen prevents some people from intentionally misusing narcotics, but that same effect causes serious, often fatal accidental overdoses. Kind of a scorched earth policy, if you ask me.

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vim876

July 2, 2009 2:13 PM

@spanky: Maybe we should tell the FDA what drugs are supposed to be for: preventing pain and death, not causing it.
P.S. I know it isn't really 'preventing death.' You know what I mean.

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MauriceCallidice

July 1, 2009 4:37 PM

@spanky: \"had taken a Tylenol, then realized it wasn't strong enough, and took some Vicodin the dentist had prescribed\"

I doubt he was dying from taking only \"a Tylenol\" and a prescribed dose of Vicodin. It's not a good idea, of course, but I doubt that a single extra OTC tablet pushed him all the way from properly medicated to dying.

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Phexerian

July 2, 2009 9:51 AM

@MauriceCallidice: Agreed.

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spanky

July 1, 2009 4:46 PM

@MauriceCallidice: Yes, I probably misspoke when I said \"a Tylenol.\" It was the recommended maximum dosage, which I guess is two pills. I do remember specifically that he did not take more than the recommended dosage of either the Tylenol or the Vicodin.

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Powerlurker

July 1, 2009 5:15 PM

@spanky:

I wonder why his dentist/oral surgeon wouldn't have mentioned not to take Tylenol. When I got my wisdom teeth out, he specifically recommended using ibuprofen as a supplement to the Vicodin, not acetaminophen.

Also, I was under the impression that a number of these deaths involved people who drank heavily since alcohol induces the cytochrome P450 pathway that metabolizes acetaminophen into the toxic byproduct NAPQI, which in a hard partying 20-something may play a role. I find it hard to believe that a single recommended dose of both vicodin and Tylenol would kill a typical person since the toxic dose is somewhere around 6g.

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Ann O'Dyne

July 4, 2009 1:20 PM

@Powerlurker:No, you're correct. The toxic effects of acetaminophen are more long-term. The max dose per day of acetaminophen from all sources currently is 4000mg/day, although I understand the FDA is considering lowering that. The problem comes when someone uses that musch day after day. When I was in school we were told the acumulated toxic dose was somewhere around 2kg, but this was *ahem* some time ago, so take that with a grain of salt. The problem comes in when, as previous posters have mentioned, when a person is an alcoholic, or has hepatitis, so may have a compromised liver to begin with. And, no one dose of tylenol, even 1000mg, on top ove one dose of vicodin would not be enough to produce toxicity by itself. And if the problem were acute acetaminophen toxitiy, there is a drug that can be given to protect the liver. My guess, if the story Spanky got was correct, is that he took a lot more than single doses of those drugs, and also had other medical issues.

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spanky

July 1, 2009 5:40 PM

@Powerlurker: I have no idea whether his dentist said anything to him about that or not, but I know I've been prescribed Vicodin by dentists many times, and I don't remember any of them mentioning that out to me. So it's pretty likely that he was never told.

And there was an FDA study not long ago that showed that about 20% of patients who came in with acetaminophen related liver damage did not take more than the recommended dose. For those people, the damage from even a fairly minor overdose could prove pretty severe.

It's tempting to want to defend some kind of Just World fallacy, where people who are hurt and killed are always somehow responsible, and that you can avoid a similar fate just by being conscientious and doing the right thing. Unfortunately, that's not always the case. People are injured and killed all the time for very minor errors, and often, through no real fault of their own at all.

In this case, a LOT of people have been injured, and it's something that could be pretty effectively mitigated with reasonable measures from the FDA.

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Powerlurker

July 1, 2009 11:50 PM

@spanky:

I'm totally unconcerned with whether the world is just or not. I'm just really surprised that taking a single 2g dose of acetaminophen (two vicodin and two regular strength tylenol) would be fatal. Now, if he had been taking the painkillers and Tylenol for a whole day or two, then it makes a lot more sense.

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twophrasebark

July 2, 2009 7:59 AM

@Powerlurker:

Yeah, I'm confused about this story, too.

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floraposte

July 1, 2009 6:27 PM

@spanky: Exactly. It's hard to untangle abuse issues and narcotics, but this really does seem to be a situation wherein people who were using things as instructed have been unnecessarily damaged, and that it's possible to prevent that damage with little detrimental effect.

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johnva

July 1, 2009 4:21 PM

@spanky: Agreed. I don't think that a moral or reasonable way to prevent addiction is to add poisonous substances to the addictive drug.

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Phexerian

July 2, 2009 9:51 AM

@johnva: Thats a biased comment. Tylenol is only poisonous if taken in excessive quantities.

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johnva

July 2, 2009 4:43 PM

@Phexerian: @Phexerian:

Why is it \"reasonable\" for me to have to take a drug that is unnecessary and potentially harmful? It's increasing my risk for no real reason.

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vim876

July 2, 2009 2:19 PM

@Phexerian: Are you telling me that you can tell what an excessive quantity is for every single person? Because that's ridiculous. People's responses to medication vary pretty widely. For example: this week, my shrink got some blood test results back, and checked my blood levels of the antidepressant I'm on now. The levels are 20% lower than they should be. Apparently some people are 'supermetabolizers' of certain drugs. I'm glad I don't supermetabolize tylenol. Then I'd be screwed AND people like you would think it was my fault.

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temporaryerror

July 1, 2009 2:42 PM

@JohnQPublic:
Also, the addition of acet. to several painkillers, such as codeine and hydrocodone takes it down to a schedule 3 from schedule 2. This makes refills and RX'ing much easier for the prescriber.

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vim876

July 2, 2009 2:07 PM

@temporaryerror:
Government sets those schedules, and can change them if there's such a problem.

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johnva

July 1, 2009 1:38 PM

@ekzachtly: Frankly, I don't care. I'd rather not be forced to take acetaminophen just because I need effective pain relief from a narcotic pain reliever (hypothetically - I'm not currently taking this stuff). I don't believe that adding a drug PURELY because of the abuse potential of the other drug is reasonable.

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Phexerian

July 2, 2009 9:49 AM

@johnva: I find it to be quite reasonable. They do this with Lomotil as well.

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Verucalise (Est.February2008)

July 1, 2009 12:15 PM

You ain't takin' my Lortab.... Oh no you din'nt!
(loading my shotgun just in case)

I hate how us responsible pill poppers get grouped together with the Hollywood fuck-ups and abusers.

5 replies

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the_wiggle

July 4, 2009 10:08 PM

@verucalise-T minus 19 days- Happy 4th!: word!

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bohemian

July 1, 2009 3:10 PM

@verucalise-T minus 22 days!: Honest people with real problems already have way too much crap to deal with. Doctors are either suspicious or afraid to prescribe pain meds. Patients with pain problems get treated as potential criminals all through the process and it sucks.
People with real pain problems have to put up with way too much crap and harassment in the name of preventing other people from abusing drugs. After years of dealing with this I am pretty fed up. If some moron wants to abuse drugs let them. It just means they will be shuffling off to a dirt nap all the sooner. I am just so sick of being treated like a criminal and an addict just because I take a low level pain medication.

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floraposte

July 1, 2009 2:38 PM

@verucalise-T minus 22 days!: It's not that simple, though. You can be taking Vicodin and Percocet (and Darvocet, I imagine, though it's not mentioned above) responsibly and suffer liver damage.

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vim876

July 2, 2009 2:21 PM

@floraposte: Untreated or undertreated severe pain can kill people too. It's a condition called suicide. Maybe you've heard of it?

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July 1, 2009 1:13 PM

@verucalise-T minus 22 days!: Load it w/rock salt!

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baquwards

July 1, 2009 12:16 PM

My dentist and oral surgeon handed out vicodin perscriptions like nothing. I had many dental problems and every time I would go in with pain they would hand me a prescription for that. There was a point where I had 5-6 bottles. I only took it sparingly because I knew that it was addictive and the affect that it could have on the liver. I am glad to have my dental drama taken care of, finally.

7 replies

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vim876

July 2, 2009 2:22 PM

@baquwards: The fact that your dentists are incompetent shouldn't have any bearing on whether people in pain have access to the medicine they need. Period.

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baquwards

July 3, 2009 1:52 AM

@vim876: I'm not really sure how you got that out of what I wrote, but more power to ya!

My dentist is not incompetent, far from it, if you could see my before and after shots of my teeth, you would see that she is far from incompetent.

I was just saying, it seems like this stuff is prescribed more than it needs to be, or I just have a higher threshold for pain.

On halloween I had 6 surgical extractions, one of them was a wisdom tooth, and I got by with just ibuprofin, but I had the vicodin, just in case

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Outrun1986

July 1, 2009 4:32 PM

@baquwards: Yeah, they give it out like its water here too. I got a bottle of vicodin after being told I would need a root canal, oh here are some pills in case it starts to act up until the appointment. I didn't take any of them. I was given one ibuprofen after the root canal and I was fine, nothing else needed. The only painkiller I ever took was tylenol with codine and that was only once after surgery when I really needed it.

Unless your having huge huge dental surgery you shouldn't need these pills for more than a week or 2 after the procedure and that is being generous. You will most likely only need them for a couple days after if you need them at all.

I honestly could have used it more after having braces then after having root canal, but I did not get any pills after I had the braces put on (adult braces).

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vim876

July 2, 2009 2:24 PM

@Outrun1986: Do you really think you are morally superior to other people because your body experiences pain differently than theirs?

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Powerlurker

July 1, 2009 5:19 PM

@Outrun1986:

I took a grand total of maybe three or four Vicodin tablets after I got my wisdom teeth out. Most oral surgeons and dentists will dispense more tablets than you probably need in case you're one of the unfortunates who happens to have a difficult recovery even though most people only need the big guns for a day or two. Then if you go back for more surgery at another time they'll probably give you a fresh prescription because they may not know that you still have old pills lying around, or if said old pills haven't expired by then.

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Brunette Bookworm

July 1, 2009 3:00 PM

@baquwards: I only took a few of the vicodin I was prescribed after I had my wisdom teeth out because the drugs made me feel worse. However, they did help the pain right after the surgery. If they don't have a substitute for pain relief for post-surgery patients, then it's silly to take them off the market.

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johnva

July 1, 2009 2:31 PM

@baquwards: See, I find that irresponsible on their part. Instead of just giving you more Vicodin, they should have given you less of something more effective.

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speedwell (!)

July 1, 2009 12:16 PM

Oh, lovely. I can't take Percocet for some reason (it causes lasting dizziness that doesn't resolve for days after I stop taking it), and my doctor told me not to take aspirin or any of the -profens (to protect my remaining kidney). When they sent me home after the removal of one kidney, I spent a couple days on Vicodin and the rest on Tylenol, extended-release, only as needed. I noticed that the 12-hour extended release Tylenol is only one extra-strength dose, released over the 12-hour period... that's the way to take it if you've got to, I guess. (sigh) Time to stock up...

3 replies

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whysteriastar

July 1, 2009 7:18 PM

@speedwell, avatar of snark:
I don't have a kidney condition, but I agree, vicodin is the only thing that works for me. Both Oxycontin and Percocet make me highly sick with nausea and codine makes me anxious to the point that I stay up all night.

I guess doctors will just have to start giving me morphine when I need smaller pain medicines...which is sooo much safer as well all know.

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ShadowFalls

July 3, 2009 2:47 PM

@mac-phisto:

The issue with binding them with ibuprofen is the toll it takes on your kidneys if taken for a long period of time.

The problem is as pointed out, that again the responsible people suffer cause of idiots overdosing. Some people it is the doctor's fault, they should have stronger pain meds rather than be having to take the medication at a higher dose or more often. Time and time again, not just with this kind of thing but others, people are made to suffer cause of what other idiots have done. You can't protect everyone from themselves.

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speedwell (!)

July 1, 2009 12:17 PM

@speedwell, avatar of snark: 8-hour. My bad.

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putermcgee

July 1, 2009 12:16 PM

maybe my leftovers will go up in price now! i didn't just say that on a public site...

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shoelace414

July 1, 2009 12:17 PM

This is bad news for a lot of people in chronic pain. And these people are in chronic pain and NOT drug addicts. Dr House has probably done more bad for pain patients than any real person.

11 replies

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vim876

July 2, 2009 2:26 PM

@shoelace414: Undertreatment of chronic pain has been here way longer than House. Re: War On Drugs.

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floraposte

July 1, 2009 2:42 PM

@shoelace414: I'm wondering about this effect myself, but I'm not sure it's that large. The medication is still available, after all; it's just not available in that particular preparation. Is the oxycodone prescription more expensive than the oxy/APAP prescriptions?

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Phexerian

July 2, 2009 9:56 AM

@floraposte: They are both roughly about the same price. Price differences vary depending on the manufacturer and person selling it. Sometimes one brand will go on backorder from the manufacturer and you will only be able to buy the more expensive brand.

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wakeboarderal05

July 1, 2009 4:57 PM

@floraposte: In order to get the oxycodone without the APAP, some doses only come in brand-name forms. There are generics of a few doses on both the extended-release and immediate-release, but many patients report that the generic forms are just not as effective as their brand-named counterparts. This is probably due to the fact that they were outlawed until only recently, maybe a year or two ago (only the brand-named OxyContin could produce it without APAP before).

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vim876

July 2, 2009 2:27 PM

@wakeboarderal05: Gee, I wonder if Big Pharma has something to do with this?

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pecan 3.14159265

July 1, 2009 1:30 PM

@shoelace414: I'm not sure how House influenced the FDA (but he's a doctor!) or how many senior citizens watch House. But he hasn't done damage because he's a fictional character who is clearly unhappy with much of his life - drugs only make it worse for him. I'm not sure anyone sees his vicodin popping as all glamour and fun.

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cash_da_pibble

July 1, 2009 6:02 PM

@pecan 3.14159265:
You haven't met my brother-in-law.
A 20-year-old that uses a cane, keeps House in the DVD player and is complaining of chronic back pain to get Percocet.

poor basterd, that boy.

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MauriceCallidice

July 1, 2009 4:44 PM

@pecan 3.14159265: @SeniorPonzologist_GitEmSteveDave:

Shoelace414 did not suggest that House glamorized drug abuse.

I'm pretty sure what shoelace414 meant to suggest is that the television show House has led to an increased public perception that chronic pain patients are really dealing more with psycho-emotional issues than with actual physical pain problems, and that as such they just need to suck it up and deal, or perhaps get counseling, but that the problem is mostly in their head.

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shoelace414

July 1, 2009 2:40 PM

@pecan 3.14159265: Because those in chronic pain need pain pills to function. Doctors don't want to give pain pills because they think of House, people who are on pain pills get the vibe from other that they are like house.

Chronic pain needs to be treated. Chronic pain is under treated because of House.

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wakeboarderal05

July 1, 2009 4:55 PM

@shoelace414: I agree completely. I have had chronic pain for over three years due to the immense trauma caused by 9 extensive surgeries on the same place on my body, and the pain will likely never go away. Up until recently vicodin was the only drug I had found that worked for me, but I have since switched to a different drug (no, not percocet, either). The drugs are the only thing that allow me to live an even remotely normal life, as my particular pain is worsened by sitting. So without the drugs I would be confined to bed, simple as that.

I agree that House has hurt the chronic pain community, and not necessarily because of his constant walk on the fine line between abuse and legitimate usage. The main reason he has hurt the community is that he has added to the negative stigma that is associated with painkillers. Because House is miserable and taking these drugs, often in illegitimate ways, the general public begins to assume that anyone taking these drugs is abusing them, which is nowhere near the case.

Taken responsibly, painkillers can be a lifesaver, and House has taken the focus away from that point, which is a problem (that is not to say I don't love the show, because I do).

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SJActress

July 1, 2009 4:50 PM

@shoelace414:

You've got a cause and effect fallacy going here.

Long before House was a gleam in USA's eye, chronic pain was under-treated. It has been that way for years. Doctors don't want to give pain pills because pain is almost always a clinical diagnosis, pain pills are addictive, and they worry about malpractice, not because they think of House.

Seriously, don't blame a television show for something like this.

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MissPeacock

July 1, 2009 12:36 PM

@shoelace414: My grandmother takes two Percocets a day. It's the only thing that even slightly helps her chronic pain. Her doctor told her she could take three a day, but she doesn't BECAUSE she doesn't want to get addicted.

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madog

July 1, 2009 6:53 PM

@MissPeacock: Your grandmother could take a half a percocet a day if she wanted, but if she's been taking it for long enough she is addicted.

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Anonymous

July 5, 2009 3:54 AM

@madog: Of course Granny is not addicted with half a percocet. Dependancy does not even develop unless the doses are well over 60 mg. And that is *dependancy*, not addiction, which is a quite distinct psych problem only experienced by a small minority of opiate users. Its just this small minority is the ones breaking into drug stores, so we tend to notice them more.

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July 1, 2009 12:31 PM

@shoelace414: Yeah, cuz the scenes of him detoxing or cathing himself cuz he can't urinate totally glamorize popping pills.

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Skin Art Squared

July 1, 2009 12:41 PM

Well, Vicodin got me through 2 years of dental reconstruction. I guess it doesn't matter as long as they've got a suitable replacement, although if there was, I'm sure they would've been using it by now. I can't take any of the -profins either because they make me violently ill.

Trouble is, the people that really need this kind of stuff for pain WILL find a replacement if the doctors don't. I know of a few things that work wonders, with a less-than-perfectly-legal status.

3 replies

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Eyebrows McGee (now with more baby!)

July 1, 2009 2:29 PM

@BZMedia: Vicodin is a safe and effective method of pain control after birth when breastfeeding. Or, more to the point for me, after a C-section. :) If hydrocodone isn't available on its own (to make a drug regime of hydrocodone, tylenol, and ibuprofin, which adds complication to the dosing and chances for errors; instead of vicoden and ibuprofin), many women who've just gone through major abdominal surgery will have to choose between effective pain control and safe breastfeeding.

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the_wiggle

July 4, 2009 10:10 PM

@Eyebrows McGee (now with more baby!): yep.

not that the medical system gives a rat's behind.

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kaceetheconsumer

July 2, 2009 5:14 PM

@Eyebrows McGee (now with more baby!): I was just on the generic Vicodin after my foot surgery too. I was careful and only took it when I needed it. I don't even want to contemplate being unable to treat pain AND having a new baby to deal with at the same time.

I'm all for FDA clampdowns on harmful meds or screwy marketing or unreported side effects, but I wish there was a way to let responsible users keep using a drug while also preventing abuse. Seems to me that should be in how it's prescribed and dispensed, not by a ban.

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sir_eccles

July 1, 2009 12:43 PM

I'm sure I remember reading somewhere that there was a simple additive they could put in acetaminophen that would prevent overdoses. But I can't remember what it was, anyone know?

6 replies

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Skankingmike

July 1, 2009 1:29 PM

@sir_eccles: Common Sense

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karmaghost

July 1, 2009 1:53 PM

@Skankingmike: I agree, but drug abuse can be a slow process. One week, it's one extra pill per day, the next, it's another etc. etc. and by the time you or those around you notice you're addicted and/or abusing, it's too late.

Still, though, common sense is sometimes the best medicine.

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Skankingmike

July 1, 2009 2:59 PM

@karmaghost: Yes it can be but that's when self control comes in. I have an addictive personality so I stay away from all forms of drugs (even caffeine) to play it safe.

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speedwell (!)

July 1, 2009 1:38 PM

@Skankingmike: Well played, sir.

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speedwell (!)

July 1, 2009 1:26 PM

@sir_eccles: If you're talking about what I think you are, there is no such thing. Aversive additives (i.e. things that they add to make you feel ill if you overdo it) can only work AFTER you take the overdose.

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temporaryerror

July 1, 2009 2:46 PM

@speedwell, avatar of snark:
There IS N-acetylcystine [en.wikipedia.org]

Also, both oxycodone and hydrocodone are available in combo with ibuprofen. So, everyone will still be covered.

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vim876

July 2, 2009 2:29 PM

@temporaryerror: Except people with reactions to ibuprofen.

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cadieface

July 2, 2009 1:10 AM

@temporaryerror: that's only for AFTER you were dumb and took too many.

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MauriceCallidice

July 1, 2009 4:47 PM

@temporaryerror: Ibuprofen wreaks havoc with my stomach, and my doctor said to stop using it. If I need hydrocodone, I don't want to have to take it combined with ibuprofen.

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sir_eccles

July 1, 2009 2:03 PM

@speedwell, avatar of snark: No not an aversive additive. I did a bit more digging and found what I was looking for. It's called \"methionine\" which helps the body produce glutathione which helps the body metabolize acetaminophen safely and prevent liver damage. It was included in one brand of paracetamol (the UK name for acetaminophen). See this article in the BMJ where it points out the cost and side effect issues the additive raises:

[www.bmj.com]

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kraftmayo

July 1, 2009 12:43 PM

This sounds like the government I know and love. /s

Anyone else think it makes more sense to punish the INDIVIDUALS responsible rather than everyone?

3 replies

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floraposte

July 1, 2009 3:24 PM

@kraftmayo: No, because it's not about wrongdoing, it's about physical harm that happens to people even if they're not wrongdoing. Unless you're suggesting they should lock people up for suffering liver damage as a result of taking prescription meds at the prescribed dosage.

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madog

July 1, 2009 6:56 PM

@floraposte: People do no wrong by going out and having a few drinks (within the \"limit\") every night...... what's the difference between that and taking some acet'?

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mac-phisto

July 1, 2009 2:39 PM

@kraftmayo: yes, please, let's roll the paddywagons to pick up anyone taking a double dose of painkillers. throw those scumbags away! what's that? you took 8 tylenol in a 24-hour period? OFF WITH YOUR HEAD!

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Megalomania

July 1, 2009 12:43 PM

acetaminophen, of course, is also the active ingredient in Tylenol... and has been known for some time to cause liver damage in high dosages or in conjunction with alcohol. Until there's a better alternative, advise of the risks and let people choose for themselves.

3 replies

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bibliophibian

July 1, 2009 2:53 PM

@Megalomania: \"Until there's a better alternative, advise of the risks and let people choose for themselves.\"

Precisely. Prepare some kind of \"Here are the risks\" sheet, in plain language, make people sign for it when they get their prescription, and let people manage their own lives, FFS.

I have chronic pain, and I was BEAUTIFULLY controlled on one Vioxx a day, for more than a year - I had perhaps one or two \"bad days\" a month. Then they took Vioxx off the market. My doctor and I have tried damn near everything else trying to get that level of pain coverage. At one point, I was taking Cymbalta, Lyrica, Mobic, Neurontin, Ultram, and Ultram ER, and I STILL had about 15 \"bad days\" a month, and even my \"good days\" were less functional than they had been. My quality of life plummeted.

I finally gave in and agreed that it's probably better for me to take two Vicodin a day than all that other crap - not to mention cheaper - and I've been functioning moderately well on that. But now...

If Vicodin goes the way of Vioxx, and considering how many hoops of fire you have to jump through to get oxycodone (especially for someone like me, who has a strong family history of abuse, on both sides), I wonder what options I'll have - and how long it'll be before THEY are also removed from the market instead of just black-boxed.

Not to mention: If there's all this concern about people using acetaminophen irresponsibly, why are they targeting the PRESCRIPTION drugs? Why not take Tylenol and generic acetaminophen off the shelves, make it prescription only so they can better regulate it? It just doesn't make sense that they'd remove *only* the prescription drugs, which are by definition controlled (ideally), if the PROBLEM is still available over the counter, in bulk, with no purchasing limits, no controls, no nothing.

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floraposte

July 1, 2009 2:44 PM

@Megalomania: One could argue that we're pretty well-supplied with alternatives, and that that approach would have been pretty nasty with, say, Thalidomide.

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catastrophegirl chooses not to fly

July 1, 2009 8:27 PM

@floraposte: thalidomide is the only drug so far as i know that has been pulled by the FDA and then reapproved, years later. it's strictly controlled and you have to be on a couple of kinds of birth control, but it's available for people in severe situations

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floraposte

July 2, 2009 12:46 AM

@catastrophegirl - just add kittens: I didn't know about that recent approval--interesting. I don't think the FDA ever did approve it the first time though, did they? It was Europe and Canada that had the birth defects. I think they may have approved, pulled, and reissued with different instructions on Lotronex, though.

To be honest I was mainly using it rhetorically anyway, on the grounds that I think there's more to the obligation to keep people safe than merely adding \"be careful\" to a package.

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vim876

July 2, 2009 2:37 PM

@floraposte:
The obligation to keep people 'safe' is based on the implication of a long-term quality of life that patients think is worth living. Undertreated chronic pain often causes people's QoL to fall short of that threshold. Therefore, drugs that treat it, while they need to have warning labels, should also be legal. If they had a drug that would guarantee I'd be able to have a normal life and never have depression again, but would also kill me by age 50, I'd do whatever I had to to get it.

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catastrophegirl chooses not to fly

July 2, 2009 2:52 AM

@floraposte: yeah, i work for a company that is only allowed to have one of our meds available with the strictest prescribing program in the world. rumor has it the FDA may pattern other potentially dangerous drug releases after what we do. there's a lot that goes into it and making sure people are thoroughly educated and carefully monitored.

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sjones411

July 1, 2009 12:46 PM

I took Percocet for three months last year after getting total reconstructive foot surgery. Even constant high doses of Percocet were only able to just barely take the edge off. I'd hate for someone with a similar surgery to not have access to the same drugs I had. I understand that people are stupid, and prone to addiction, and apathetic to their livers, but that shouldn't stop people who actually need the drugs from getting them. To take these drugs away, the FDA panel should have to go to a hospital, and explain to the face of some kid with his foot in three pieces, held together by a screw and 55 staples, that he has to be in more pain because some people don't use the drug responsibly.

6 replies

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johnva

July 1, 2009 1:47 PM

@sjones411: I completely agree. Addiction is definitely a problem associated with these drugs, but I think it's a problem that is almost totally outweighed by the good that they do for pain patients.

I'm fine, though, with them taking them off the market as long as they continue to market alternatives such as pure oxycodone (vs. Percocet). I'd rather not be forced to take acetaminophen anyway, as it can be toxic and I have no desire to take a poison that isn't very effective for pain relief just because some other people get addicted and we think it's better to poison everyone as a deterrent to them taking too much of the narcotic.

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bohemian

July 1, 2009 3:20 PM

@johnva: Someone else's stupid behavior is not my problem. Your right that using tylenol as a deterrent to drug abuse is an illogical way to deal with the issue. I was not amused to find out I was taking tylenol (that did nothing) along with a pain med because of other people's addiction issues. I was able to get a different version of the medication without the tylenol in it. Why should I be abusing my liver due to other people's problems.

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mac-phisto

July 1, 2009 2:51 PM

@johnva: do you know anyone with an addiction to oxycontin? the few i know make heroin addicts look like teddy bears.

this measure by the fda actually concerns me b/c it's bound to push more patients into heavier painkillers that don't necessarily need them. there are alternatives that bind with ibuprofen instead of acetaminophen - perhaps that's a better alternative - but i'd hate to see dentists & physicians prescribing oxycontin for medium-level pain.

perhaps a more widespread acceptance & usage of codeine could fill the gap or other hydrocodone alternatives?

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johnva

July 1, 2009 3:32 PM

@mac-phisto: I'd rather people that genuinely need pain relief have access to effective pain control. Addicts are a secondary concern for me, personally.

I do agree there needs to be other alternatives. I just don't think that I should be forced to take acetaminophen just to get effective pain relief.

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mac-phisto

July 1, 2009 4:08 PM

@johnva: i'm sure they can find another inhibitor to bind the oxycodone. in fact, i would be surprised if a brand new oxycodone drug wasn't waiting in the wings to take over. that seems to be how the fda works: clear the marketplace of cheap generics before a new, better, hardly-tested, super-expensive alternative hits the market.

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JohnQPublic

July 1, 2009 2:08 PM

@johnva: I don't think this is decision is about addition but rather doctors giving liver-damaging doses of acetaminophen to patients.

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johnva

July 1, 2009 2:27 PM

@JohnQPublic: Addiction is a major reason the acetaminophen was ever in the narcotic drugs in the first place. Acetaminophen isn't a very effective pain reliever in the first place, and they even openly say that they use the combo drugs instead of the pure narcotic because it \"discourages abuse\" (a questionable thing).

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speedwell (!)

July 1, 2009 1:22 PM

@sjones411: People are less prone to addiction than you think. I was reading an article yesterday about a scientific study on withdrawal symptoms that proved that a significant portion (one third to one half, IIRC) of the people they studied never actually became dependent on the illegal drugs that they had been taking (that is, they had none of the expected withdrawal symptoms when they went off the drugs experimentally).

Patients simply ought not to lose access to effective pain unless they and their doctor together determine the patient is susceptible to becoming hooked. Individualized medical practice of this sort is well underway and will become even more feasible as time goes by. We should be funding efforts to make medicine apply to the biochemistry and circumstances of the individual patient, not efforts to take drugs off the market because a tiny fraction of the population misuses them.

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vim876

July 2, 2009 2:40 PM

@speedwell, avatar of snark: Yeah. I remember reading somewhere about most physical addiction being largely based on a genetic issue that only some people have. That doesn't make psychological addiction less real, of course, but it's still important.

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ddmeightball

July 1, 2009 12:54 PM

So.....with vicodin being banned soon, what would the street value of an unused, unopened bottle be?

Oral Surgeon gave me Ibuprofen and Vicodin for the pain when I had all 4 wisdom teeth pulled and never had any pain so I have both bottles just sitting at home. I asked him what to do with it (flush it, etc) he said heck no, keep that stuff just in case you have pain later.

2 replies

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July 1, 2009 5:10 PM

@ddmeightball: Not a whole lot, since the Ibuprofin formulation isn't what is being banned here. Hold on to what you have.

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MauriceCallidice

July 1, 2009 4:52 PM

@ddmeightball: As an aside, if you do want to dispose of it safely, many pharmacies will take expired drugs for proper disposal.

If that's not an option, mixing ground-up tablets or opened capsules with used coffee grounds and throwing them away with household trash is less likely to contaminate water supplies than flushing, and the coffee grounds discourage humans or other animals from attempting to retrieve the disposed-of product.

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FangDoc

July 1, 2009 12:58 PM

Vicoprofen = hydrocodone + ibuprofen

Percodan = oxycodone + aspirin

Although there are plenty of people who can't take NSAIDs, at least there are some effective alternatives if the FDA does this deeply stupid thing and bans Vicodin and Percocet. I'm actually a big fan of Vicoprofen because so much dental pain is inflammation - mediated, so the ibuprofen plays an important role that acetaminophen can't. But for anyone who is supposed to avoid NSAIDs due to bleeding disorders, other medications that interact, kidney problems, stomach problems, etc., this is dumb dumb dumb and is only going to lead to responsible people suffering unnecessarily.

4 replies

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johnva

July 1, 2009 1:59 PM

@FangDoc: They should just sell the narcotic drugs not in combination. I agree that the NSAIDs could be a problem. For example, I would not be able to take the ibuprofen combination as for some reason ibuprofen always causes violent stomach pain for me (even though aspirin and naproxen don't).

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floraposte

July 1, 2009 2:50 PM

@johnva: They do. I'm therefore not clear why people are feeling abandoned by this (unless there's an industry/expense reason why taking the APAP free version is going to be a burden).

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johnva

July 1, 2009 3:29 PM

@floraposte: They do for oxycodone. Not hydrocodone, as far as I know. So actually this might well take away a narcotic option.

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floraposte

July 1, 2009 5:00 PM

@johnva: There is at least the Vicoprofen, but now that I'm looking, I can't find a plain hydrocodone either. That does mean a problem there, I think.

I also think the schedule II/schedule III issue raised above is going to be a PITA, and that some doctors are going to be more reluctant to do the same prescriptions with schedule III drugs.

But I still think that some people are confusing the brand name with the significant active ingredient in this discussion, when it comes to what might be removed from the shelves.

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ElizabethD

July 1, 2009 1:18 PM

@FangDoc:
Hey FangDoc,
I just read an article last week about an actual dentist named Dr. Fang. Wonderful!

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speedwell (!)

July 1, 2009 1:13 PM

@FangDoc: indeed, and thank you for speaking up for us!

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npage148

July 1, 2009 12:58 PM

There will still be pain medicine just not more APAP combination. You can still get your oxycodone (the narcotic in percocet), so all you chronic pain/fibro/migraine people will be ok. The APAP never did anything to prevent abuse of them either, if someone wanted to get high they are not listening to the max dose anyways

3 replies

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npage148

July 1, 2009 1:05 PM

@npage148: oh yeah, you can also get codeine and other narcotics. The FDA isn't taking away your pain med, they are making them safer. This will do nothing but cut down on excessive APAP consumption.

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vim876

July 2, 2009 2:51 PM

@npage148: Because clearly, Doctors never think in terms of CYA. They always want what's best for the patient.

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speedwell (!)

July 1, 2009 1:15 PM

@npage148: Too damn bad for me; I can not only manage my pain but work acceptably well on a minimal dosage of Vicodin after dental work or surgery. I'm not so reliable on narcotics, unfortunately, and the upshot is I would have to try to work while in pain, because I can't afford the time off to lie around stoned. Dude.

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npage148

July 1, 2009 1:25 PM

@speedwell, avatar of snark:

What do you think Vicodin is? It's a narcotic. It's hydrocodone! You know what will work? Oxycodone! which would still be around. If you take 1 vicodin (5 mg of hydrocodone) you will just take 2.5mg of oxycodone instead.

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Phexerian

July 2, 2009 10:02 AM

@npage148: Problem is they are different schedules of a controlled substance. You are also replacing one drug with a much stronger different drug. Common sense would be to just give out hydrocodone by itself.

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speedwell (!)

July 1, 2009 1:27 PM

@npage148: Interesting, then, that it does not have the same effect on me that other narcotics do.

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johnva

July 1, 2009 1:50 PM

@speedwell, avatar of snark: In my case, hydrocodone barely worked at all (it had little to no effect on pain relief and no side effects). Maybe you're similar.

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cadieface

July 2, 2009 1:15 AM

@johnva: the thing about chronic pain is everyone is different. for some, oxycodone is perfect. for others, hydrocodone is all that works. the options need to be out there for chronic pain people to get relief- the key that the FDA is overlooking is PROPER EDUCATION. how long does it take to tell a patient \"oh yeah, btw, that vicodin has tylenol. don't take tylenol with it, kthx\"?

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Adrienne Willis

July 1, 2009 1:06 PM

It's a shame that people ruin it for others that really need these pain pills. Even with the chronic pain before my knee surgery and right after I never abused my vicodine (and I had plenty of it). I hope they give a reasonable alternative to these pain meds because ibuprofen just ain't going to cut it after a major surgery.

3 replies

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the_wiggle

July 5, 2009 1:07 AM

@Adrienne Willis: or after serious dental work.

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vim876

July 2, 2009 2:57 PM

@Adrienne Willis: I'm not normally one to stand up for addicts, but it's not their fault people can't get their pain pills. The problem is a national mindset of: \"We're in a War on Drugs (TM). We must stop mind-altering substances from being abused, NO MATTER THE COST! People don't really have chronic pain, they're all secretly addicts. STOP THEM!\" Addicts just reinforce this mindset.

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the_wiggle

July 5, 2009 1:07 AM

@vim876: exactly.

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TCama

July 1, 2009 1:20 PM

Why can't they just majorly amp up the warnings for acetaminophen? It seems as if a lot of these FDA problems come down to people taking too much acetaminophen, but the advisory panel instead recommends such actions as restricting the sale of NyQuil and taking vicodin off the market.

As Frank Zappa said in testifying about the possibility of government-mandated music censorship, \"[the] demands are the equivalent of treating dandruff by decapitation.\"

3 replies

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zekebullseye

July 5, 2009 11:14 AM

There's @TCama:
Thank you. I came to say that. How about putting a huge label on Tylenol bottles: May Be Fatal In Overdose, and for that matter, get rid of the brand name altogether and make everyone use the name \"acetaminophen\" so they don't get confused. And for goodness sake, stop using the abbreviation APAP for acetaminophen. Only medical professionals know what it means and it prevents people from understanding the label. And how about putting in large letters \"contains acetaminophen\" on each bottle of NyQuil?

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johnva

July 1, 2009 1:55 PM

@TCama: I think they're just recognizing the fact that a lot of people will never pay attention to how much they're taking of acetaminophen in these combo products. It's more a recognition of behavioral factors. The packages DO contain this kind of warning, but the combo products make it easier for people to overlook the fact that they are taking more than they think if they also combine it with Tylenol, etc. The FDA is just saying that it's probably best to not rely on the patients to do the math and regulate their intake, given the evidence that there are so many cases of liver damage caused by acetaminophen yearly.

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Eyebrows McGee (now with more baby!)

July 1, 2009 2:36 PM

@johnva: But for prescription drugs, that choice -- and decision about patient behavior -- should lie with doctors. If they have to take NyQuil off the market, fine (plus NyQuil sucks since they cranked down the alcohol); but restricting OTC drugs and restricting what doctors are allowed to prescribe and have access to are two ENTIRELY different beasts.

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johnva

July 1, 2009 2:41 PM

@Eyebrows McGee (now with more baby!): I agree, but there is no reason for acetaminophen to even be in narcotics other than the government NOT trusting doctors and patients to make a choice about dosage of the narcotics. Acetaminophen is not something I want to take if I can help it.

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Ann O'Dyne

July 4, 2009 2:24 PM

@johnva: I really have to say something here. Acetaminophen, aspirin and ibuprofen ae not added to opiate painkillers to prevent addiction. They are added because they work to prevent pain via a different mechanism than the opiates, so that the combination can be more effective than either drug alone. Aspirin and other NSAIDs such as ibuprofen have their own toxicities as well - GI ulceration, kidney damage, and long-term, increased risk of cardiovascular events. So they are not necessarily a \"safer\" or \"better\" alternative.

The problem comes when chronic pain sufferers require long-term administration. Each person reacts differently to each of the various opioid derivatives, so that oxycodone being available alone is not the answer for everyone. And it is true that most of the opioids that are available alone are Schedule II, which does complicate access. My guess is that if hydrocodone, the opiate in vicodin, were available alone it would be a Schedule II drug as well, just as codeine alone is. Still for chronic pain, having the possibility to take each drug separately, and thus titrate each to an effective dose would be a welcome possibilty, no matter how many different strength combinations of percocet are available. And combination products such as vicodin remain a perfectly sound selection for more short-term use, such as post-surgical pain.

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HiPwr

July 1, 2009 1:25 PM

Another case for legalizing pot for medicinal purposes?

2 replies

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spanky

July 1, 2009 4:36 PM

@HiPwr: Reported side effects include increased appetite, changes in mood, and rarely, a ticket or more serious criminal charges, depending on your jurisdiction.

Not great, but if I were suffering from chronic pain, I'd take that over heart attacks and organ failure.

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Porcelina

July 1, 2009 4:24 PM

@HiPwr: I hope so. It works wonderful for pain of all severity levels, and with WAY less side effects and health problems of pills.

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Dansc29625

July 1, 2009 1:27 PM

Dr. House is a non-fictional chronic pain patient? He should start a club, the N-FCPP.

2 replies

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D'Ola Phair

July 3, 2009 7:25 PM

@Dansc29625: A single punctuation mark makes a world of difference. The comma between \"other\" and \"non-fictional\" emphasizes that the others are non-fictional.

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MooseOfReason

July 2, 2009 4:34 AM

@Dansc29625: \"Non-fictional\" would mean real, so maybe it should be called th CPP.

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Anonymous

July 1, 2009 1:31 PM

This new recommendation to remove Vicodin solves nothing. If APAP is the issue, get rid of it in combination pills. The reality is that there are people in chronic pain, like cancer patients. This has only recently become accepted by the medical profession. The choice of treatment will shift to straight narcotics with all the side effect problems of pure narcotics. If Vicodin is banned, we will simply switch to dilaudid or codeine to treat pain. As a physician, it is unthinkable to tell patients they just have to suffer. The FDA experts are great with statistics, not patient care. Real practicing physicians need to be on these \"expert\" panels. I worry about what is next, all medications have toxic side effects at very high doses. Aspirin, for example. Is it next? My final word, \"it is a less than perfect world\". Pain is a real disease, it needs to be effectively treated and the risks put in perspective and managed. Banning drugs is not the answer.

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Skankingmike

July 1, 2009 1:32 PM

I think the lesson here is pain medication is over prescribed to the point that they have to make something so bad for you and addictive rather than actually finding neurological/surgical ways of helping those with \"chronic\" pain.

My uncle has been basically addicted to pain killers for almost ten years now. Because they can't make the pain in his arm (from a machine crushing it) go away.

2 replies

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johnva

July 1, 2009 1:42 PM

@Skankingmike: They don't \"make\" it addictive; it just so happens that effective pain relievers *are* addictive.

In actuality, I think that pain medication is BOTH under- and over-prescribed. Some doctors are giving it out too much, but in reality now due to all the government/DEA scrutiny doctors are under the opposite problem is becoming more common (doctors are afraid to give out adequate pain relief to people with real pain problems). I'm not sure if you were trying to mock the idea of chronic pain with the quotes, but it's most definitely a real thing. Some arthritis can be very painful and chronic, as can neuropathic pain. It's not that the doctors aren't trying other things...it's that nothing else works.

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Skankingmike

July 1, 2009 3:07 PM

@johnva: When I went to my dentists 2 years ago because I waited too long (rather I was poor and had no dental) to get my 4 wisdom teeth removed I had some abscessed teeth and an infection from it.

My dentist prescribed vicodin for me.

On the package it said to take 2 pills twice a day. I knew that it was excessive so i took 1. It was way too strong for my body (due to me not taking pain pills of any kind unless it's really bad). From then on I just took 1 Advil and felt much better. even after surgery I just took one Advil.

That btw is the other problem with pain medicine, doctors often just look at the patients size and determine dosage when medical science says other wise.

I think the other problem here is peoples tolerance to pain meds. They need to either limit or remove over the counter pain medicine as too many people take it when they shouldn't. It looses it's effects and increases the tolerance towards other pain meds.

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johnva

July 1, 2009 3:37 PM

@Skankingmike: There is lots of individual variation in how pain relievers affect people. In my case, Vicodin does essentially nothing for my pain, and does not make me feel \"high\" at all.

Part of the reason doctors use these \"one size fits all\" guidelines is because of the DEA paranoia re: these drugs. They don't want to be accused of giving too much to a patient who didn't need it if that patient turns out to be an addict or trafficker.

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floraposte

July 1, 2009 3:27 PM

@Skankingmike: I'm not sure what you're saying at the end there, but if you're saying what I think you're saying, it's not true--tolerances develop with some medications, but they don't develop across medications, so taking ibuprofen, say, doesn't mean that Vicodin will work less well on you later.

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dancekat1

July 1, 2009 1:45 PM

As a person who is myself hypersensitive to pain, and insensitive to vicodin, I have needed percocet at various times in order to get through post-surgery recovery, etc. The solution here is to require better monitoring without losing choices for consumers. There are also risks with market removal. Pain -> depression -> all kinds of other problems. Better education for doctors and consumers as well as oversight is required. I will be horrified if they remove these from the market.

1 replies

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johnva

July 1, 2009 1:56 PM

@dancekat1: Again, it's fine as long as there are alternatives. (Such as the same drugs without the acetaminophen or the same drugs with an NSAID).

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Ilovegnomes

July 1, 2009 2:08 PM

It sounds like they need to run an education campaign rather than banning it. Doctors need to be better about prescribing it for a short term condition (since long term causes damage) and limiting the amount of pills based on the circumstances. That is what my doctor does. It is called prescribing it and using it responsibly.

Just like every other medication that someone is prescribed, the doctor should discuss usage and effects (as well as the pharmacy if the patient wants a consult) with the patient.

If/when I am suffering from pain, I don't want options to deal with it being taken away because the FDA thinks that doctors and patients can't be trusted with medication.

1 replies

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johnva

July 1, 2009 2:38 PM

@Ilovegnomes: While I don't totally disagree, I think that these combo drugs may have been ill-advised in the first place. As we're finding out, acetaminophen is a potentially very toxic drug. And it's not a very good pain reliever. It was put in these combos partly to discourage their abuse/overuse (something that isn't working very well given the widespread liver damage caused by acetaminophen).

Along the lines you're speaking of, I'd prefer that the government just trust doctors and patients to take the drugs separately rather than in combination. They don't have to take away the narcotics just because acetaminophen has proven dangerous.

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VikingP77

July 1, 2009 2:50 PM

Why is this happening? Why do we further punish people in pain?

1 replies

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floraposte

July 1, 2009 2:54 PM

@VikingP77: Why do you think that's what this is? The problem is that a large number of these people are damaging their livers by taking a medication that isn't particularly helpful along with the one that's working for their pain. The pain-relief medications will still be available. I think perhaps some people aren't realizing that.

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Geroge Lamothe

July 1, 2009 2:53 PM

this is bad news for me.. Percocet is the only thing that keeps me functional when i get a migraine... there goes the career..

2 replies

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July 1, 2009 5:17 PM

@Geroge Lamothe: There are alternatives: Percodan and Percoprofin... the first has asprin and the second has ibuprofin instead of tylenol.

If none of those will work for you, Oxycodone (as Oxycontin) *IS* sold in 5mg capsules, then you can take a regular (not \"extra strength\") tylenol with it. That would be about the equivalent. It's just a matter of getting your doctor to prescribe Oxycontin. :-/

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Spectre1125

July 2, 2009 11:10 AM

@I am Mrs. Nerdtastic.: Although if the doctor gave out Percocet for migraines, getting bumped up to straight oxycodone probably won't be hard.

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u1itn0w2day

July 1, 2009 2:56 PM

I forget which but I think it's Vicodin that gives me a headache and stuffs my sinuses swells my mouth .

So for things like dental work or bad sinus headaches I find my self taking 2 Motrin and 2 Tylenol(acetomitophen) and a Benadryl which works great . All generic or store brand at that .

You can damage you body/liver by ABUSING your body in many ways so why take something off the market that works for the non abusers or affected . I even heard if you take OTC Tylenol/extra strength doses off the market that could lead to people going right to their doctors for prescription meds rather than going to the drug store .

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H3ion

July 1, 2009 2:57 PM

Ibuprofen (Advil) also causes liver damage if taken in excess quantity. Almost any drug, prescription or OTC, will cause damage if used to excess so the \"excess\" argument applied only to Tylenol is specious. As far as combination drugs go, there is no reason the individual drugs can't be offered separately, but I'm willing to bet that the combination is a brand name and the components are generic so the pharmaceutical industry will not want the ban, even though the patient is only inconvenienced in some very minor manner (taking two pills instead of one). Also, just for information, there are plenty of OTC combination drugs as well. Excedrin is a combination of aspirin, acetaminophen and caffeine. Most cold remedies are combination products. I think the FDA is just trying to look like it's doing something because this is one issue that doesn't need to be raised.

2 replies

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floraposte

July 1, 2009 3:30 PM

@H3ion: Tylenol causes damage even if not used to excess, the damage is less easily reversible than the gastric problems with NSAIDS such as ibuprofen, and the liver problems take a considerably higher dosage.

They're not treating it as a safe/dangerous binary--it's that it's become increasingly clear that what looked to be a safe dose with acetaminophen isn't, and that it's in stuff it doesn't need to be.

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H3ion

July 1, 2009 4:29 PM

@floraposte: According to one report (I think it was in the Washington Post) 4 grams of acetaminophen in a 24 hours period is considered safe but only a slight increase, say 5 grams, is suspect. Isn't this more an issue of patients self-dosing above the recommended dosage? Frankly, I'd rather have the drugs available with sufficient information also available to allow me to make the choice.

FWIW, my doctor believes that ibuprofen causes kidney problems and that's true (in his opinion) in almost any dose, including as recommended.

I don't disagree with you that combination drugs may contain ingredients that aren't necessary, but I'd like the option of having that drug available considering the FDA has already approved some of these drugs for non-prescription use. You can't stop some person from swallowing an entire bottle of aspirin but that doesn't mean that aspirin doesn't belong on the market.

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cadieface

July 2, 2009 1:23 AM

@H3ion: well, if we ban tylenol, ibuprofen is gonna be the next drug of choice for people to take too much of. kidney failure is just as fun as liver failure! so are bleeding ulcers! and metabolic acidosis! hurray!

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theblackdog

July 1, 2009 3:06 PM

Well that's just great, now what the hell is the hospital going to give me the next time I land in the ER?

Vicodin and Morphine both make me puke my guts out for hours on end after they're given to me and Toradol (sp?) is only appropriate for when I have had a kidney stone. Percocet has worked well for me, but now they're likely to take it away.

3 replies

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July 1, 2009 5:19 PM

@theblackdog: There are *plenty* of alternatives. Maybe next time you'll get a shot of Dilaudid or Nubain... then you won't be on these forums bitching. :)

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floraposte

July 1, 2009 5:06 PM

@theblackdog: They'll give you OxyContin, which is Percocet without the acetaminophen.

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theblackdog

July 1, 2009 9:32 PM

@floraposte: So I can turn into a 300 lb republican who thinks all addicts should be locked up, except for myself because I simply made a mistake and just \"need help\"? ;-)

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Gustastic

July 1, 2009 3:19 PM

This pisses me off, seriously. Why punish the general population for the people who are too stupid to understand the contents of what they're putting in their bodies? I heard Nyquil might be yanked, too.

So, winter will be full of pnuemonia and fun. Great.

I don't care if this comment gets disemvoweled, this is really ridiculous.

1 replies

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HogwartsAlum

July 1, 2009 7:19 PM

@Gustastic:

NOOOOOO!!!! Don't touch my Nyquil!!!! That's the only thing that gets me through a cold!

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temporaryerror

July 1, 2009 3:26 PM

Don't forget... If Vicodin and codeine are made into single entity products, they will be much harder to get RX'd, and every time you need a refill, you'll have to get a new paper RX from the Dr. This is because they would be CII instead of CIII.

Also, there is a difference between dependence and addiction. Please remember that.

1 replies

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johnva

July 1, 2009 3:39 PM

@temporaryerror: If it causes prescribing problems due to the drug scheduling, we need to just reschedule the narcotics downwards and tell the DEA to back off. Getting adequate pain relief to people who need it is more important than fighting the \"War on Drugs\".

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m4ximusprim3

July 1, 2009 3:29 PM

Somewhere in texas, Ryan Leaf heaves a dry sob.

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bobpence

July 1, 2009 3:35 PM

I used Percocet (as Endocet) as prescribed for a week or two following surgery, gradually cutting down the number of pills per day, then moving to just acetaminophen, then finally no regular pain medication as the pain from the surgery subsided. So have millions of others. Restrict the term of use, sure, but don't eliminate a useful tool and make millions suffer needless pain.

2 replies

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ScarletsWalk

July 1, 2009 4:25 PM

@bobpence: That's what I was thinking. I've used vicodin and percoset for limited times with great success. I am not judging their use for chronic pain, but for post-op, occasional use, I don't get it.

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johnva

July 1, 2009 4:30 PM

@ScarletsWalk: It's really quite simple: acetaminophen is proving to be more dangerous than people thought it was (especially given the risk of people mixing OTC products with the prescription pain pills). So they're reevaluating whether or not it should be mixed into these narcotic pain relievers. That doesn't mean they'll necessarily take away the narcotics entirely; it just means that they might take away approval of the acetaminophen mixture with them.

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ScarletsWalk

July 1, 2009 5:06 PM

@johnva: I totally get that part, but for someone who may take that one pill on very limited occasions, it seems excessive. To me, it seems like the concern was more for people who use them frequently or long-term, but being applied to all uses.

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johnva

July 1, 2009 8:27 PM

@ScarletsWalk: Not necessarily. You can cause permanent liver damage to yourself in only 1 or a few days of taking too much acetaminophen. So it's not just long-term or frequent users who are at risk.

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PrestonBerryworth

July 1, 2009 5:08 PM

What is the purpose of banning narcotic painkillers if the non-narcotic over the counter medicine is still avaliable? If APAP is the reason for banning Vicodin then we would also ban APAP right?

Worse yet, if the new Vicodin is just hydrocodone it is going to be entierly abused by drug just like OxyContin is. APAP keeps drug users from really going over board with these pills, and I'm sure they will have a field day with out this.

Even worse yet, if this happens and drug companies make narcotic only pills, then doctors will be afraid to hand them out to the average pain suffer. I got Vicodin for my root canal. No chance in hell that I'd get OxyContin for a root canal. So basically if you are in mild to moderate NON-chronic pain you will get 800mg ibuprofon and that's it. Chronic pain patients may get some pure hyrdocodone, and OxyContin, but more often then not drug users will trick doctors into giving it them. Thanks America.

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July 1, 2009 5:22 PM

What about those (like me) who are in chronic pain? It's going to be like pulling hairs to get my doctor to prescribe something like Oxycontin. It's just too strong for me and he knows it. I will probably end up on Vicoprofen, as long as that's still an option.

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Anonymous

July 1, 2009 5:31 PM

I see that a lot of people are commenting on the fact that APAP is used to deter abuse of Percocet and/or Vicodin, and that removing it would cause an upsurge in abuse. In fact anyone actually looking to abuse the pills would have little trouble defeating the APAP to prevent abuse mechanism. A simple cold water bath process quickly and easily removes the APAP thus defeating the utterly pointless mechanism. Anyone looking to abuse the pills isn't going to be stopped by the APAP in the first place, as they would either ignore it, or remove it. Seeing how quick and simple it is to remove, it would only really stop someone of quite limited intelligence from abusing the product, as a trained monkey could do the APAP removal process. So in this particular case there was really no need for the APAP in the first place. However, as was mentioned by another user, removing the added ingredients change the schedule of the narcotic causing many more hassles for the end user in the RX process. The debate on scheduling and the like is far to big a topic to get into .Sadly the number of people that seem to think having APAP in the product is actually any sort of deterrent appears to be larger than the number of people who recognize that having APAP in said products was virtually pointless in the first place. That being said, ideally if they were forced to remake the product, the companies in question could add a few milligrams of a chemical that has no real effects so as to keep the product in it's current schedule. Alas this post grows long, and I digress.

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bubbledumpster

July 1, 2009 5:34 PM

Wow. Hydrocodone isn't sold by itself in America?

I wonder how my mom got that giant bottle of liquid hydrocodone that says in giant letters on a bright yellow sticker at the bottom \"NOT FOR PERSONAL USE.\"

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dreamsneverend

July 1, 2009 6:26 PM

Brett Favre is crying quietly in a corner somewhere.

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macdude22

July 1, 2009 6:35 PM

I was under the impression it's the acetaminophen in these drugs that's the danger to your liver. And that the acetaminophen is placed in to prevent some users from becoming addicted (makes you sick or something from too much acetaminophen). I had a couple throat surgeries and was given Vicoden which worked great when needed. Didn't need it very much, still have a bottle and a half left of the stuff. Uhh if you don't abuse the stuff, it's not a problem, and if they are going to ban Vicoden they might as well ban tylenol since I can buy that and pop a whole bottle.

4 replies

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cadieface

July 2, 2009 1:19 AM

@macdude22: and the \"generics\" aren't very descriptive or helpful. they list the acetaminophne as \"APAP\". who the crap knows that's the same as acetaminophen?

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macdude22

July 2, 2009 1:59 PM

@cadieface:
Your pharmacy should provide ample instructions about the usage of the \"generics\". My bottles of hydrocodone are generics and they came with 6 pages of information about drug interactions, additionally any reputable pharmacist should give you a quick talk about the drugs before they send you (or your representative) on their way. I'm sorry but acetaminophen (or the standard APAP abbreviation) is an OTC medication but you want me to believe it's dangerous in a prescription form, because people can't read and/or follow directions. Sorry folks, people have to take some form of responsibility.

And I don't wish death on anyone, but again if someone doesn't follow the instructions on PRESCRIPTION medicine, how is that mine, yours, or the government's fault?

I could drink draino and die too, you want to take that off the market? Marbles? What other dangers should we \"protect\" you from?

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Spectre1125

July 2, 2009 10:59 AM

@cadieface: APAP is the common abbreviation.

It is also incredibly difficult to kill yourself with it. Downing a bottle of Tylenol would likely result in a trip to the emergency room and liver/kidney damage.

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johnva

July 1, 2009 8:29 PM

@macdude22: It's not just addicts who are the problem. It's people taking more than one product containing acetaminophen at the same time. And it doesn't just \"make you sick\"...it can kill you. Even narcotics addicts don't deserve to die for abusing drugs.

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RobertBaron

July 1, 2009 6:36 PM

Seriously, what's the worst that can happen to a narcotic addict healthwise and why should the government care?

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HogwartsAlum

July 1, 2009 7:23 PM

I was given Darvocet when I had a blood clot in my leg, but it was too strong for that. I took one and was like, Whoa, no wonder people like this stuff! Really, regular ibuprofen worked fine. I didn't use the rest of the Darvocet.

Then Vicodin when I had a tooth taken out (too poor to get cavity filled, tooth broke, oral surgeon had to remove it because the root was curled in my jaw). That was also too strong. Again, ibuprofen to the rescue.

Now I've built up a tolerance to ibuprofen from taking tons of it for my messed-up shoulder (which is better now after physical therapy). What do I do if I need it now? :(

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Anonymous

July 1, 2009 8:10 PM

As someone with SLE who is dependent (there is a difference between dependence and addiction btw) on daily vicodin doses to be able to do little things like go to the restroom, feed myself, and get dressed, this scares the crap out of me. Vicoprofen is not an option, as I'm already taking rx level doses of ibuprofen daily. The type compounded with asprin is not an option due to the aforementioned NSAID therapy. This whole thing is stupid. Hydrocodone has not been available in the US as a stand alone medication for years. It was originally compounded with gen. tylenol to limit the possibility of abuse. Does this mean that restriction will be lifted? Or will doctors now have to prescribe excessive pain medication (morphine, demerol, dillaudid) for moderate pain that used to be treated with Vicodin?

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vladthepaler

July 1, 2009 9:13 PM

If they're dangerous over extended periods, they should only be prescribed for short-term use. Taking them off the market completely doesn't make sense.

Sleeping pills are also dangerous over long-term use.

1 replies

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johnva

July 2, 2009 12:21 AM

@vladthepaler: No, they're also dangerous for short-term use.

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simplekismet

July 1, 2009 9:36 PM

CALM DOWN PEOPLE.

Hospitals have been removing Vicodin from their formularies very steadily over the past 10 years. It's being replaced with Norco, which is the exact same damn thing except it has less acetaminophen in it.

IT'S OKAY.

1 replies

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cadieface

July 2, 2009 1:17 AM

@simplekismet: BUT ACETAMINOPHEN IS EVIL. THAT MUST BE REMOVED AS WELL. IT WILL DESTROY US ALL.

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bananaboat

July 2, 2009 2:13 AM

Bad for the liver? So when the FDA gets control over alcohol, the proof will be lowered or booze banned all together too?

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mikells43

July 2, 2009 2:32 AM

this is a badddd thing if they do it. reallly bad really really bad.

just make it easier to snort and shoot oxycodone. its scaring me just thinking about it. its making it easier for the addicts. me being an addict myself i know this. im recovering nwo for 3 years and its scaring the heck out of me reading this.

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MooseOfReason

July 2, 2009 4:33 AM

If it's illegal, they'll create a black market. This won't solve the alleged problem.

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pika2000

July 2, 2009 7:39 AM

Yeah, Acetaminophen is so dangerous that it should be banned. Cigarettes? Oh, they're okay. Heck, it's easier to buy booze than to buy Sudafed nowadays.
Next, 2nd prohibition.

1 replies

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the_wiggle

July 5, 2009 1:10 AM

@pika2000: lord yes. trying to keep enough Sudafed in the house for all of us, all year (gotta love those allergies!), has become an Orwellian p.i.t.a.

that joke of a replacement does f-all to decongest.

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Spectre1125

July 2, 2009 11:46 AM

I'm reminded of an episode of Scrubs where Dr. Cox informs an intern to simply throw a handful of ibuprofen into the patient's mouth, and whatever lands in there is the right dosage. Aspirin, APAP, and ibuprofen might as well be the same crap (they're all considered NSAIDs..Sort of) as far as pain relief is concerned. Basically, they inhibit the body's chemical reaction to pain. Opiods work directly on the central nervous system and \"block\" pain all together.

Tylenol lowers the speed limit, Vicodin blows up the road. I don't know off hand, but I imagine they were originally combined to be synergistic as opposed to help prevent addiction. The opiods acted as a temporary solution to the pain while the APAP served more to aid the body in attacking the source of the pain itself while dealing with fever/inflammation. For a chronic pain sufferer, this additonal action would be useless I'd imagine.

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PsiCop

July 2, 2009 3:38 PM

They're just trying to make it harder for people to get their hands on painkillers. It's already nearly impossible to get Oxycontin ... many pharmacies won't even stock it, and many doctors won't prescribe it. Now they've got Vicodin in their sights.

The liver-toxicity that can result from large doses of acetaminophen, has been known for decades. Suddenly the FDA has decided it's something they need to worry about? Sorry but I'm not buying that ... not for a moment. There is no conceivable way that these guys only just now realized there's a problem with it. It's just not a credible claim. Rather, they're using this as a pretense for taking Vicodin off the market. Nothing more and nothing less.

Despite the fact that drugs like Vicodin and Oxycontin are abused, two incontrovertible facts remain: 1. There are some folks who genuinely suffer from real, and debilitating, chronic pain; and 2. For a lot of them, there simply are no alternatives that are as good at killing their pain, as these powerful narcotics.

What the FDA is doing, in the name of playing pharmaceutical-morality police, is to condemn these people to unnecessary suffering. I don't know how or why doctors, who've presumably taken the Hippocratic Oath, can in good conscience do this. But they are anyway.

2 replies

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u1itn0w2day

July 3, 2009 5:59 AM

@PsiCop: That puzzles me as well about the Tylenol and liver toxicity . Prolonged use or abuse of any drug can cause problems .

Even with all the celebs and non celebs that have ABUSED prescription meds I don't think it's the FDAs job to limit legal stuff now . The problem is not the substance but the doctors prescribing it and looking the other way .

It does ruin it for real pain sufferers .Here they are ignoring the chronic pain sufferers to cut the supply to the junkies & dealers who don't have the guts to go to the street corners for their supplies .

What will really hurt me is the lower dose Tylenol which I find myself taking along with Motrin to avoid stuff like Vicadin and stuff with Codene to which I get an allergic reaction .

The FDA shouldn't be the ones trying to stop the abusers including the doctors that over prescibe it should be law enforcement like the DEA and the local medical boards going after the doctors .

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PsiCop

July 3, 2009 5:02 PM

@u1itn0w2day: Pssst ... not to mention, if the FDA's true goal here is to save livers, they should first ban the one substance that damages more of them in just one year than acetaminophen has in all the time it's been on the market ... which is (of course!) alcohol.

Not that they ever will; that's been tried already (in Prohibition) and failed utterly and pathetically.

You're also right that it's not the FDA's job to stop abuse of drugs. That should be up to doctors, pharmacists, the nurses and other personnel that administer or store drugs, and — to police them all — the DEA.

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Anonymous

July 3, 2009 2:03 PM

i am kind of surprised that the FDA is finally doing something about the negative effects of acetaminophen. but i am even more surprised that people on this website, which claims to want to protect consumers, are complaining about it. there are zillions of painkillers out there. they should be prescribed without the acetaminophen, which, by the way, does not prevent anyone from getting addicted. this new move toward legislation and regulation is meant to protect consumers. isn't that a good thing?

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u1itn0w2day

July 3, 2009 8:59 PM

Part of the problem of the abuse let's face it IS THE ABUSERS themselves , some patients are like predators when they deal with the doctors - they know how to spot a softie like a lion picking out the weakest link in heard .

To stand up for many doctors I empathize with the position they are put in do what's best for their patient . You can't be calling a patient liar or wimp everytime they want meds but you can't tell me there are not signs of pain killer abuse .

I know people who play sports in their spare time who want to play so bad that they have called 3-4 doctors in one day because their regular doctor was supposedly understands athletes was not available . They were intent on getting a quick fix or pain meds - to play a game . They were so desperate that they have gone to docs for procedures that their insurance didn't cover .

Not only is that person addicted to the high of sports or meds they are jacking the insurance as well .

They say with Jackson alot of these doctors are star struck . Some might even feel empathy if they know his real physical condition and what he wants/has to do . But that still comes back the doctors AND the patient who is using the docs for their own ends .

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OsiUmenyiora

July 4, 2009 3:10 AM

I don't recall the anyone saying that they were going to stop production of hydrocodone or oxycodone, just that they would stop combining them in pills with acetominophen.

Which is a major score for someone like myself who likes to pop the occasional 25 mgs of hydrocodone for a buzz. No more acetominophen to worry about! Woohoo!

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Anonymous

July 4, 2009 4:01 AM

Bad news: OxyContin has been implicated in some pretty nasty cases of involuntary addiction. My impression of day-release narcotics is that it was a sound idea on paper which turned into a real nightmare for many people told to use it.

Which would probably leave us with Percocet, assuming you can handle the ASA. Personally when considering OTC pain reliever Aspirin remains my favorite, so I don't mind.

It may have side-effects, but these are well known and documented. And combined with a narcotic painkiller, the synergetic effect is generally far more pronounced than with acetaminophen.

But the problem is that ASA has fallen in such public disfavor that finding something as basic as AC&C let alone Percocet has become a challenge: Pharmacists just don't stock them anymore, and some will even substitute acetaminophen-based compound without telling patients.

Which is dangerously non-professional, but hey - they don't want to lose the sale. Business is tough, you know...

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nsv

July 4, 2009 7:10 PM

Two years ago I was in a bad accident. My doctor prescribed huge amounts of Vicodin and, with my head injury clouding my thoughts, I took it as prescribed. It took the edge off the pain.

A year ago my liver tanked. Imagine that. The doctor who discovered the liver failure tried to switch my prescription to hydrocodone, and was as surprised as I was when I got the prescription filled and got hydrocodone/APAP, because hydrocodone is not available alone.

I've since been switched to Vicoprofen. The dose is less, but fortunately the pain is less, so it still takes the edge off. It does NOT relieve the pain.

A few months ago I found out that aspirin may protect the liver from damage from APAP ([news.bbc.co.uk]), so I started taking low-dose aspirin. But after last year's liver biopsy I'm just too afraid to get another blood test and find out what the damage is. Ain't denial grand?

Acetaminophen is evil.

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Anonymous

July 4, 2009 11:31 PM

I also take pain meds for a failed back fusion; I see a pain specialist and take Vicoprofen (hydrocodone/ibuprofen). This has always been a better choice because I already knew about Tylenol (and its generic versions) causing liver damage, even in people who didn't take a lot of it. The combo of ibuprofen/hydrocodone actually works better because of the anti-inflammatory effect of ibuprofen. I'd like to recommend that to those of you who aren't abusing. There is also low-dose oxycodone which isn't time-released like Oxycontin. The lowest dose of oxycodone (non-timed release) is about the same pain-relieving strength as two Vicoprofens.

The sad thing is that many people who are in chronic pain are going to have to find this out for themselves. Do your research; talk to your doc.

This is a thinly veiled attempt by the FDA to ban all painkillers thanks to abusers who use and sell them. God help you if you get cancer and the pain becomes intolerable: we're going to have a LOT of suicides because of that.

BTW, my doc is no pill-pusher; I get urine tested at random times and if I don't show up for the test, no meds for me. Believe me, I follow my docs instructions to the letter!

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Amanda Boles

July 5, 2009 2:23 AM

But hydrocodone is available in the US without acetaminophen. I am a vet tech, and we prescribe Tussigon to patients with kennel cough all the time. I'm pretty sure it just has hydrocodone in it, as acetaminophen is a big no-no for dogs.

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Amanda Boles

July 5, 2009 2:37 AM

@Amanda Boles:

ah, never mind. Tussigon is not straight hydrocodone. It has an anticholinergic medicine, Homatropine, to dry up secretions as well.

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Alessandro DeCredico

July 5, 2009 2:23 AM

Good god, when did the consumerist start running a whinery?

You can still take the drugs, you just have to pop an extra pill. Unless I've missed something, or the 4'th of July has rendered me completely addled, if you don't have a physical limitation on the number of things you can swallow in a day there's nothing particularly bad about this.

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wkiernan

July 5, 2009 2:45 AM

Good, then their doctors can switch all their patients to hydrocodone without acetaminophen. If the chronic pain patient wants to accentuate the effect of the hydrocodone (this is the official rationale of mixing APA with hydrocodone) he or she can simply take limited doses of over-the-counter acetaminophen, with extra accent on the word limited. Same pain killing efficacy, less danger of acetaminophen toxicity.

No, wait, their doctors can't just switch the prescriptions, because Vicodin, which includes hepatoxic acetaminophen, is Schedule III while unadulterated hydrocodone, free of the hepatoxin, is Schedule II. That's a regulation that needs to be changed.

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Anonymous

July 5, 2009 5:35 AM

I have been dealing with kidney stones for the last couple of years and I've had several removal surgeries. So far these medications are the only thing I've found that can take some of the edge off the agony. Don't screw over those who need to manage chronic pain. Let our doctors have a choice in pain management drugs.

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zekebullseye

July 5, 2009 11:16 AM

It's funny how everyone is freaking out about Vicodin being taken off the market. If it is, some company will see a business opportunity and release plain hydrocodone as a product. I'm perplexed that it isn't out there already, considering codeine and oxycodone are.

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Anonymous

July 5, 2009 6:00 PM

So I guess that I will have to be shunted to Dilauded for breakthru pain if the gubment does this. I will then become an unproductive slug due to the side effects of the stuff when vico took care of the pain but didn't make me a drugged out dummy. Thanks you fuckin gubment assholes.

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zentec

July 5, 2009 8:11 PM

Are they kidding???

When I had my tonsils removed at the tender age of 38, Vicodin was the drug that made life possible. Granted, I took the drug for exactly 5 days, but it made those three days a dull throb as opposed to a sleepless living hell.

Ruin the fun for everyone because people get hooked on it. I'm sure they're going to ban hammers next because a few idiots keep hitting their thumbs with them.

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zentec

July 5, 2009 8:12 PM

@zentec:

Please insert...

the three days immediately following the surgery...

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Anonymous

July 5, 2009 8:48 PM

From your article: \"While oxycodone is available without the acetaminophen (as OxyContin) hydrocodone is not available alone in the United States.\"

What do you mean Hydrocodone on it's own (without Acetominophen) is not available in the United States? This is all my dentist prescribes for pain -- he doesn't prescribe Vicodin (Hydrocodone + Acetominophen). I have a bottle of Hydrocodone less than a foot from me.

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Russell Petrick

July 5, 2009 10:13 PM

Why do we let these government agencies run our lives like this?

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Tankueray

July 6, 2009 1:34 AM

I'm not understanding all of this. Tylenol has been on the market all my life and was the \"go to\" painkiller before opiates became popular again and other things like ibuprofen and naproxen became available. I took plenty of Tylenol as a child.
After almost every surgery I had I got hydrocodone/apap. I take it now a few times a year for insane migranes.

In thirty plus years of millions of people taking it, we're just now realizing acetaminophen is bad? I do recall the new Tylenol commercials that basically tell you not to be an idiot.

A few weeks ago my veterinarian tipped me off to acetaminophen being pulled, but there are a lot of things with it in it. I can't take codeine or ibuprofen, and naproxen never did anything for me. I've always been creeped out by Oxycontin. (Just watched a show today on MSNBC called \"Generation Rx\".)

It seems to me that \"they\" want to remove Vicodin because it's cheap and out of patent, re-schedule it so it's more expensive and harder to get, and reformulate the OTCs so that they work less and we buy more.

Is this really about liver health? Is it about big-pharma lining their pockets? Lawmakers doing the same? I have a background in biology and chemistry, and I don't deny the health effects or addiction capabilities, but I feel like \"they\" aren't being completely honest.

I also have known people truly addicted - to Vicodin, NyQuil, and even cocaine. Watching that was seriously disturbing. But as scary as that was/is, they all made their own choices.

I'm more disturbed about not having a choice in this matter.

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Tankueray

July 6, 2009 1:56 AM

@Tankueray: Maybe change the maximum dosage of 5/500 Vicodin to 2 every 6 hours? Removing 7.5/750 altogether?
If the apap is removed, won't there be more demand from the black market as it will be more \"pure\"? I've seen people crush it up and snort it, would this replace apap overdoses with narcotics overdoses? Then it would be easier to ban the narcotics...

I'm just full of conspiracies today, but if the food companies manipulate sugar and fat to make you eat more, could the pharm companies be trying to get us to take more drugs? (narcotics/NSAIDS/anti-depressants/tranquilizers/whatever?)

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Anonymous

July 6, 2009 12:09 PM

I have had 9 surgeries on my spine due to degenerative disc disease. I have several fused vertebrae including titanium plates and screws in my low back. The chronic pain has disabled me and I now live day to day just trying to cope with the reality that my life as i knew it is over. If not for Percoset (AND Fentanyl patches) I would have no reason whatsoever to go on living. I would not be able to sleep at all, and I would be unable to get out of bed. If they do this I may as well take all the pain meds I have left and get it overwith.

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Anonymous

July 6, 2009 7:15 PM

Being a pain patient for over a decade, I can say this... The longer you take them, the less effective they are. For you guys who can take a darvocet and get relief, I am happy. It doesnt work that way for me. I have 2 bad discs in my back and surgery is the ONLY option. But they wont do surgery until it gets worse. I take 4 Norco 10/325s per day, nothing else. If I didnt have them, I couldnt make a living for my family, my pain is that debilitating. I see people on the abuse side and do agree, but at the same time, have something in place for us \"Real\" pain sufferers to switch too. I have no doubt that my body is somewhat addicted to them, But which is worse?, pain that is so bad that you cant do anything, even play with your child or pain meds that allow me to care for my family and stay off medicare, food stamps as well as disability? My daughter would rather have her father play with her than not. I agree, its a chance I am willing to take to fulfill both my daughter and my own life. Hope you can find some compassion for those who really do have problems. Like others have said, they treat you like a criminal and an addict. I would like to hear your thoughts about what I said. Please, no flaming or name calling.

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philipcfromnyc

October 8, 2009 9:42 AM

Does anybody know whether the proposed ban extends to other formulation of hydrocodone and acetaminophen? If the proposed ban is limited to Vicodin and Percocet specifically, the impact will not be as severe as would be the case were the ban to extend to all compound formulations of hydrocodone and oxycodone.

This recommendation is further proof (if further proof were needed, which it is not) that the \"war on drugs\" has encroached on the field of pain management, and that the FDA is making recommendations based not on the proper usage of these dugs (Vicodin and Percocet) , but based instead on their abuse.

Patients suffering from chronic pain will be the losers as a result of this decision. At present, hydrocodone is available as a prescription drug when combined with acetaminophen; the resultant combinations (of which Vicodin is only one) are Schedule III controlled drugs, which means that they may be prescribed on regular prescription blanks, and that each prescription may be issued with up to five refills. This enables doctors to prescribe this drug to patients suffering from chronic pain without as much risk of the D.E.A. (or state licensing authorities) auditing the prescription habits of the physicians. Oxycodone is also available as a compound drug (mixed with acetaminophen); however, all prescriptions for oxycodone are Schedule II prescriptions, regardless of whether oxycodone is mixed with acetaminophen or is issued alone.

Hydrocodone is currently NOT licensed for prescription as a stand-alone drug; this means that patients suffering from chronic pain who are currently able to manage this pain with Vicodin will find themselves unable to obtain a substitute formulation containing only hydrocodone; in order to obtain relief similar to that obtained from Vicodin, these patients will now have to take oxycodone preparations instead. This is undesirable for several reasons; doctors will be less willing to prescribe adequate pain medication due to fear of being audited; oxycodone is considerably stronger than hydrocodone (patients will have to take a stronger opioid than hydrocodone in order to obtain similar relief); and prescriptions may not be issued with refills, making it much harder for patients to obtain this drug on a timely basis without interruption.

I sincerely hope that other formulations of hydrocodone and acetaminophen will still remain available and that the proposed ban is limited only to the above two named drugs; it is currently possible to obtain a compound analgesic named Norco, which contains 5 mg or 10 mg hydrocodone mixed with 325 mg acetaminophen (other formulations are also available). If the ban is limited just to Vicodin and Percocet, patients currently taking Vicodin will be able to switch to Norco (thereby still obtaining the pain relief associated with hydrocodone).

Comments, and answers to the above questions, would be greatly appreciated.

PHILIP CHANDLER