Skip to comments.New powerful painkiller has abuse experts worried
Posted on 12/26/2011 3:02:28 PM PST by E. Pluribus Unum
Drug companies are working to develop a pure, more powerful version of the nation's second most-abused medicine, which has addiction experts worried that it could spur a new wave of abuse.
The new pills contain the highly addictive painkiller hydrocodone, packing up to 10 times the amount of the drug as existing medications such as Vicodin. Four companies have begun patient testing, and one of them Zogenix of San Diego plans to apply early next year to begin marketing its product, Zohydro.
If approved, it would mark the first time patients could legally buy pure hydrocodone. Existing products combine the drug with nonaddictive painkillers such as acetaminophen.
Critics say they are especially worried about Zohydro, a timed-release drug meant for managing moderate to severe pain, because abusers could crush it to release an intense, immediate high.
"I have a big concern that this could be the next OxyContin," said April Rovero, president of the National Coalition Against Prescription Drug Abuse. "We just don't need this on the market."
OxyContin, introduced in 1995 by Purdue Pharma of Stamford, Conn., was designed to manage pain with a formula that dribbled one dose of oxycodone over many hours.
Abusers quickly discovered they could defeat the timed-release feature by crushing the pills. Purdue Pharma changed the formula to make OxyContin more tamper-resistant, but addicts have moved onto generic oxycodone and other drugs that do not have a timed-release feature.
Oxycodone is now the most-abused medicine in the United States, with hydrocodone second, according to the Drug Enforcement Administration's annual count of drug seizures sent to police drug labs for analysis.
The latest drug tests come as more pharmaceutical companies are getting into the $10 billion-a-year legal market for powerful and addictive opiate narcotics.
"It's like the wild west," said Peter Jackson, co-founder of Advocates for the Reform of Prescription Opioids. "The whole supply-side system is set up to perpetuate this massive unloading of opioid narcotics on the American public."
The pharmaceutical firms say the new hydrocodone drugs give doctors another tool to try on patients in legitimate pain, part of a constant search for better painkillers to treat the aging U.S. population.
"Sometimes you circulate a patient between various opioids, and some may have a better effect than others," said Karsten Lindhardt, chief executive of Denmark-based Egalet, which is testing its own pure hydrocodone product.
The companies say a pure hydrocodone pill would avoid liver problems linked to high doses of acetaminophen, an ingredient in products like Vicodin. They also say patients will be more closely supervised because, by law, they will have to return to their doctors each time they need more pills. Prescriptions for the weaker, hydrocodone-acetaminophen products now on the market can be refilled up to five times.
Zogenix has completed three rounds of patient testing, and last week it announced it had held a final meeting with Food and Drug Administration officials to talk about its upcoming drug application. It plans to file the application in early 2012 and have Zohydro on the market by early 2013.
Purdue Pharma and Cephalon, a Frazer, Pa.-based unit of Israel-based Teva Pharmaceuticals, are conducting late-stage trials of their own hydrocodone drugs, according to documents filed with federal regulators. In May, Purdue Pharma received a patent applying extended-release technology to hydrocodone. Neither company would comment on its plans.
Meanwhile, Egalet has finished the most preliminary stages of testing aimed at determining the basic safety of a drug. The firm could have a product on the market as early as 2015 but wants to see how the other companies fare with the FDA before deciding whether to move forward, Lindhardt said.
Critics say they are troubled because of the dark side that has accompanied the boom in sales of narcotic painkillers: Murders, pharmacy robberies and millions of dollars lost by hospitals that must treat overdose victims.
Thousands of legitimate pain patients are becoming addicted to powerful prescription painkillers, they say, in addition to the thousands more who abuse the drugs.
Prescription painkillers led to the deaths of almost 15,000 people in 2008, more than triple the 4,000 deaths in 1999, the Centers for Disease Control and Prevention reported last month.
Emergency room visits related to hydrocodone abuse have shot from 19,221 in 2000 to 86,258 in 2009, according to data compiled by the Drug Enforcement Administration. In Florida alone, hydrocodone caused 910 deaths and contributed to 1,803 others between 2003 and 2007.
Hydrocodone belongs to family of drugs known as opiates or opioids because they are chemically similar to opium. They include morphine, heroin, oxycodone, codeine, methadone and hydromorphone.
Opiates block pain but also unleash intense feelings of well-being and can create physical dependence. The withdrawal symptoms are also intense, with users complaining of cramps, diarrhea, muddled thinking, nausea and vomiting.
After a while, opiates stop working, forcing users to take stronger doses or to try slightly different chemicals.
"You've got a person on your product for life, and a doctor's got a patient who's never going to miss an appointment, because if they did and they didn't get their prescription, they would feel very sick," said Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing. "It's a terrific business model, and that's what these companies want to get in on."
Under pressure from the government, Purdue Pharma last year debuted a new OxyContin pill formula that "squishes" instead of crumbling when someone tries to crush it.
But Zogenix, whose drug is time-released but crushable, says there is not enough evidence to show that such tamper-resistant reformulations thwart abuse.
"Provided sufficient effort, all formulations currently available can be overcome," Zogenix said in a written response to questions by The Associated Press.
At a conference for investors New York on Nov. 29, Zogenix chief executive Roger Hawley said the FDA was not pressuring Zogenix to put an abuse deterrent in Zohydro.
"We would certainly consider later launching an abuse-deterrent form, but right now we believe the priority of safer hydrocodone that is, without acetaminophen is a key priority for the FDA," Hawley said.
FDA spokeswoman Erica Jefferson said the agency would not comment on its discussions with drug companies, citing the need to protect trade secrets.
Drug control advocates say they're worried the U.S. government is too lax about controlling addictive pain medications. The United States consumes 99 percent of the world's hydrocodone and 83 percent of its oxycodone, according to a 2008 study by the International Narcotics Control Board.
One 41-year-old loophole in particular has fed the current problem with hydrocodone abuse, critics say. The federal Controlled Substances Act, passed in 1970, puts fewer controls on combination pills containing hydrocodone and another painkiller than it does on the equivalent oxycodone products.
A Vicodin prescription can be refilled five times, for example, while a Percocet prescription can only be filled once.
The Drug Enforcement Administration and Food and Drug Administration have been studying whether to close this loophole since 1999 but have made no decision. Congress is now considering a bill that would force the agencies to tighten the controls.
"This is a problem that is fundamentally an oversupply problem," said Jackson, the drug-control advocate. "The FDA has kind of opened the floodgates, and they refuse to recognize the mistakes made in the past."
Pure hydrocodone falls into the stricter drug-control category than hydrocodone-acetaminophen medications, meaning patients would have to go to their doctors for a new prescription each time they needed more pills. But Jackson said that's no guarantee against abuse, noting that dozens of unscrupulous doctors have been caught churning out prescriptions in so-called "pill mills."
The Drug Enforcement Administration, which enforces controls on medicines along with the FDA, said it could not comment on drugs that have not yet been approved for sale.
However, Zogenix has acknowledged the abuse issue could become a liability.
"Illicit use and abuse of hydrocodone is well documented," it said in a filing with the Securities and Exchange Commission in September. "Thus, the regulatory approval process and the marketing of Zohydro may generate public controversy that may adversely affect regulatory approval and market acceptance of Zohydro."
I don’t know how people even take Hydrocodone. It tears up my stomach even taken with food.
Big pharma has half the U.S. population on drugs.
Yeah, we can’t have people doing what they want with their bodies. How freedom loving is that? F*** the government and the horse they rode in on. And f*** their regulations that interfere with what I want to do with my life. I do not do drugs but I do other things that the government thinks they have the right to control and restrict. BS, they do not have this right and we need to take back our country.
They tried it with alcohol
Your post is interesting. A friend just passed away from cancer. He had the same complaint. Maybe it was his medication and not the cancer that made him so uncomfortable.
I don’t know what oral pain medicine he was using at home.
It's the only thing that actually kills pain for me. Everything else just makes me delirious.
And even that doesn't work very long. Most of the time I just take nothing.
There are people who need them legitimately. What about those who are in severe pain? The junkie will always get their drugs. Let's be reasonable.
Are you guys sure it was the hydrocodone and not the acetaminophen that caused the problems?
So how did it turn out in the end?
They'll try it again.
The whole idea is to make criminals of as many of the peasants as possible.
There goes any chance of me enjoying the golden years.
I was reacting to the title. A new drug comes out, and the first thing we have to do is wring our hands in anxiety that something might go wrong. State-controlled media is so predictable.
“I think all drugs should be outlawed on the grounds that somebody somewhere might find a way to abuse them.”
No, lets just outlaw them for use by Congress and the DEA.
Having two broken arms is a pain in the a$$.
Oh, and their families.
And let's create a special "health care" system just for them, administered by us.
Turnabout is fair play.
And your arms don't feel that good, either.
I'm with you. Tried after rotator cuff surgery earlier this year and it made me dog sick. Worse than any pain.
And they are pushing hard to take away our inexpensive supplements.
I’m sure. I can take acetaminophen, no problem.
Dilaudid makes me nutty(er).
A new type of “hillbilly heroin”.
During prohibition they did this same sort of thing to ethyl alcohol, they spiked it with methyl alcohol so it would sicken or kill anyone that abused it.
Only a sick f##k would do such a thing :-(
Our drug laws have created a twisted society. And the truly sad part is it is unconstitutional for the fed gov to even ban medicines. This all started in earnest after prohibition failed. They started requiring tax stamps to possess marijuana, then they refused to sell the stamps. Then Nixon came along and made it all a lot worse. The rest of the world then followed our poor example.
Some people just want to take dope... a drug war is not the answer.
And to answer the next question.
I work on a CATIA scope all day.
I called to the next cubicle to assist a co-worker, and I went to help.
MY FREAKING SHOELACES HAD GOTTEN TANGLED IN THE WHEELS OF MY CHAIR!!!
TWO HOURS BEFORE CHRISTMAS SHUTDOWN!!!
I will never criticize another work-related injury again.
I take Avinza 75 mg twice a day for severe back pain.
Time release but truly dangerous. My wife is a pharmacy tech and sets up all my medications on morning and evening doses so I don’t make any mistakes.
I'm with both of you. I don't know how people can stand Hydrocodone. They make me feel like crap and there is no enjoyment whatsoever. People talk about a pleasurable sensation but I never felt it. I'd rather take an ibuprofen and drink a couple of beers for pain.
I don’t know if it is true but I heard they add stuff that makes you sick in order to discourage over use?
It's only "hillbilly heroin" if it is manufactured in the trunk of a Buick.
Ban them for legitimate use because they might also have illegitimate uses. By that same logic we could stop bank robbery if we shut down all the banks.
Anything we can do to make peasants die faster is good.
I prefer dilaudid myself...
Itching X 10! Yep, I’m allergic. That stuff makes me itch like I have chiggers all OVER my body.
Or are you one of those people who needs a laugh track to know what you're supposed to do?
Chronic severe pain is the cause.........
I prefer my Morphine in a drip, that's some potent stuff. seriously, I've had it a couple of times in the hospital and when I'm taking it, I'm vaguely aware of pain somewhere or other but just don't give a big old rat's a$$.
I dont know how people even take Hydrocodone.
I have used Hydrocodone for twelve years now, 10mg. Thankfully I have no problems with the drug. I have always taken as prescribed by my DR. I take no more no less than prescribed (back surgery). I have never had a high nor have I had a low. The drug controls my pain which allows me to have limited mobility that I would other wise not have. I do know people who were prescribed this drug, and they allowed it to control their lives, apparently they received the fore-mentioned high.
“I think all drugs should be outlawed on the grounds that somebody somewhere might find a way to abuse them.”
There are too many people who agree with your statement. I am of the crazy few who think adults ought to be able to put whatever they want into their bodies and get restore the freedoms the government sole from us.
Late next year a virtually abuse-proof form of oxycodone will enter final human clinical trials in the United States and Australia. The oxycodone will be delivered transdermally through the skin via a credit card sized waterproof patch that lasts for about three days.
The oxycodone in the patch cannot be extracted, concentrated or abused in any way, and because the oxycodone dose is steady and doesn’t have the peaks and troughs associated with pills, is less habituating than pills. This patch was developed by an Australian company in partnership with 3M.
My expectation is that this patch will be a godsend for pain sufferers.
Last time I had some surgery they started some drip on me in the prep room. I remember thinking to myself "This is great! I should do this more often."
I broke a couple ribs a week and a half ago. Doc prescribed Hydrocodone cough med for both pain and coughing. Thought I was gonna croak! Turns out that not only do I get the rare side effects of excitability, pulse rate and BP elevation, I got severe itching, a sign of allergic reaction. Was abdo-lutely miserable, and freaked out, after taking only one teaspoonful!
I took it last winter because of an extremely painful case of shingles, my first. I’m glad I had it, but it made me extremely nauseated.
My state, Washington State, has become the toughest state to obtain a narcotic prescription. Essentially, only available after surgery or an accident. Most clinics have stopped prescribing altogether. The legislature and governor went too far. Seattle Times had a long article. I’m not looking forward to the time I’m in pain for whatever reason.
No offense, but I wouldn't bet on that.
Druggies are an entirely different class of being.
If they can find a way to mainline it with a shovel, that's what they'll do.
And I bet there’s still plenty of it around, but just for the non law-abiding citizens.
The first time I took it was for a gall bladder attack. I still had a lot of pain but the difference was dramatic. While I would have complained about the subsequent pain had I only experienced that, the relief was so great that the residual pain was bliss. Thank God for narcotics! Better living through chemistry!
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