The Hydrocodone Files

The Hydrocodone Files

Prescriptions and abuse, far outstrip all other opioid painkillers combined

If someone you know is abusing prescription opioid painkillers — that is, taking them non-medically — chances are good they’re abusing something containing hydrocodone. Hydrocodone products — generic hydrocodone as well as brands such as Vicodin, Norco, Lortab and many others, are the most commonly prescribed opioid analgesics in the United States. According to the encyclopedic website, which recently ranked the 100 top-selling drugs, hydrocodone was the number 2 most-sold drug in America, including every kind and type of drug prescribed for any reason. Judging by those sales figures, it’s little surprise to also learn that hydrocodone is the most widely abused prescription opioid painkiller in the country, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

That’s why it’s a good chance that someone you know who’s abusing painkillers is probably into hydrocodone in some form or other. The only other opioid painkiller in the top 100 drugs by sales was OxyContin, at number 42, Purdue Pharma’s extended release oxycodone-based pain reliever. A little higher, at number 31, was suboxone, a combination of buprenorphine, an opioid, and naloxone, an anti-opioid. It’s mainly used to treat opioid addiction, not cause it. Sometimes it is abused, however, but the vast proportion of sales are for treatment, not abuse. The number 1 selling drug in America, the only one ahead of hydrocodone, was budesonide, a corticosteroid mainly used to treat asthma and ulcerative colitis. After hydrocodone came dozens and dozens — well, 98 to be exact — more drugs, for diabetes, allergies, asthma, emphysema, high blood pressure, high cholesterol, acid indigestion, sleep and mood disorders, sexual dysfunction — truly a stunning and bewildering array of physical and mental conditions, many of which most people probably have never heard of. Currently there are no hydrocodone formulations available that incorporate abuse-deterrent technologies like that built into the current OxyContin formulations.

Such deterrence factors make it difficult, if not impossible, to crush the pills into a decent powder which then can be snorted or dissolved and injected. A single extended-release pill contains enough narcotic to last up to 24 hours — up to 5 times as much as a single pill. The attraction for abusers is that they can inhale or inject this enormous dose of opioids all at once. And that is an open invitation to sudden overdose death. But the maker of OxyContin, Purdue Pharma, recently announced that trials of a new extended-release hydrocodone pill have been very successful. The drug is ready to be submitted for FDA approval, and it incorporates the same abuse-deterrent technology used in their new OxyContin. The Purdue announcement comes at a bad time for the FDA, fanning the flames of a massive media war that broke out a year ago, after the FDA approved a pure hydrocodone extended-release painkiller with no abuse deterrence, called Zohydro ER. The FDA’s expert panel advised against approving Zohydro ER, or any other such drug, without abuse resistant features like OxyContin now has. But the Administration’s management, apparently more in touch with the opioid needs of America than its own medical, scientific and research advisory committee, approved Zohydro ER as-is.

Go figure. The FDA approval caused a veritable media avalanche of public, political and medical disapproval:

  • Some officials said they’d do everything in their power to cancel any extended release hydrocodone drug with no abuse deterrence if an abuse-deterrent formulation becomes available.
  • Now Purdue’s announcement of an abuse-deterrent hydrocodone sent Zogenix, the maker of Zohydro ER, scampering back to the lab to try to create some sort of abuse deterrent formulation or risk obliteration by the new Purdue product.
  • Cities, counties and entire states tried to ban Zohydro outright, but a Massachusetts test case was tossed out by a federal court and now everyone has to accept it.
  • A little time passed and then cities, counties and entire states realized they were actually fed up with the colossally expensive prescription opioid addiction epidemics in their areas. They decided to sue all pharmaceutical companies that make opioid painkillers that are causing addictions and deaths. The drug companies, they say, caused or at least contributed to, these epidemics.
  • Meanwhile, organized anti-addiction groups across the country are calling for the resignation of the FDA Commissioner, Margaret Hamburg, for unleashing yet another dangerously addictive drug on America. They say Zohydro ER will create another massive wave of addictions and overdose deaths the way OxyContin did, for 10 or more years, until Purdue added abuse resistance a few years ago.

Are Americans suffering more pain?

Does the high sales of hydrocodone mean Americans are suffering more chronic pain than anyone ever imagined? Actually, no it doesn’t. It means that when doctors reach for their prescription pads, most of the time they specify hydrocodone. The drug does have a decent reputation for effectiveness among chronic pain sufferers, and many doctors still listen to their patients. But the enormous sales of hydrocodone could also mean that doctors have been listening to the sales pitches from pharmaceutical companies who make hydrocodone. We’ll probably never know for sure why or how hydrocodone achieved such enormous market share.

But we do know that the SAMHSA studies prove that enormous amounts of hydrocodone are being diverted for non-medical use and abuse. Studies confirm that more Americans are abusing hydrocodone than any other prescription or street narcotic. It’s not the same in every state or region. But nationwide, hydrocodone rules prescription opioid dependence and addiction. Here’s another interesting hydrocodone statistic. According to the International Narcotics Control Board, 99 percent of the worldwide supply of hydrocodone is consumed right here in the United States. The rest of the world is largely disinterested in it, because it’s too easily abused and it doesn’t seem to offer anything better than the painkillers they already have (painkillers, by the way, that are also available here in America). And also, drugs like this cost a lot more in America than they do in most other countries.

Here at Novus, we’re intimately familiar with not just hydrocodone dependence and addiction, but all the prescription and street opioids. Novus has pioneered new medical protocols to help patients get through their opioid detox with surprising little discomfort — far less than they expected. So if you or someone you know is dealing with any opioid dependence, not just hydrocodone, call us today and we’ll answer all your questions. We’re always here to help.

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