The Continuing Saga of the Great Zohydro Freak Out

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I’m saddened and chagrined that I have to revisit this topic so soon, but apparently the state of Massachusetts is making efforts to ban Zohydro in their state, regardless of the fact that the FDA determined it safe enough for the country at large to use. Now typically I’m a big fan of states’ rights, and not particularly a huge fan of the FDA in general, but if I remember my US government classes sufficiently, (and it’s quite possible I don’t, I do have the brain lesions), all state law is pursuant to federal mandate. That’s why states ultimately have to concede to constitutional edict. But, Massachusetts is so afraid of people possibly misusing a pain medication that hasn’t even hit the market yet that they want to try to supersede the Feds. Fortunately, for the time being, their ban has been reversed. (1)
The sticking point that keeps being cited in these articles seems to be that Zohydro has no acetaminophen, which they believe acts as a deterrent to addicts. Their primary concern is that addicts will overdose on Zohydro and die. So…since when has acetaminophen been safe? It’s not as if people don’t die from tylenol overdose far too often, and the reason being that many people don’t realize just how harmful that medication is, and it can be purchased over the counter in 500mg pills in bulk sized containers. You don’t see Massachusetts, or any other state, banning acetaminophen, or even trying to create barriers to its purchase as has been done all across the country with opioids. No one has their hackles raised about the dangers of acetaminophen because there are no addicts seeking it, only people who are trying to relieve pain…so here is the true crux of the problem. Opioids are fun! Right? People take them to get high. They’re not reeally trying to relieve their daily, incessant, mind numbing pain, they’re just looking for a fix. No one has sympathy for an addict, even if that person’s chemical dependency exists only because they have to take daily pain medication to ease their suffering. People are actually UPSET that a dangerous substance is not being added to Zohydro, “to act as a deterrent”, nevermind that it’s slowly killing the livers of pain patients, and could very quickly kill the liver of an addict because it’s not as if they’re keeping track of how much acetaminophen they’ve ingested. And as it turns out, there are more accidental acetaminophen related overdoses due to their inclusion in hydrocodone products than for any other reason, because often the physician prescribes maximum, or even GREATER than maximum daily acetaminophen dosage with hydrocodone, so all it takes is for that patient to take another combo drug with acetaminophen (like Nyquil), and they wind up in the hospital with liver damage. (2)
The makers of Zohydro have proposed adding niacin to their medication to act as a deterrent. This would be safe to anyone who uses it correctly or incorrectly, but to those who choose to abuse the drug to get high, they will have one nasty experience. Anyone who has experienced niacin flush can attest to that, and it would certainly make them think twice about abusing their medication again. Still, people are not mollified. (3)
I can’t stress this enough and I’ll say it over and over again, the best thing that can be done for pain patients everywhere that isn’t being done is to provide education. People don’t understand how opioid medications work, they don’t understand chemical dependence or withdrawal, they don’t understand the ratchet effect with regards to tolerance. I’ve known many people who were placed on high doses of pain meds following a surgery or medical procedure and didn’t have any idea what to expect, how best to take their medications, how or when to discontinue them, and they weren’t properly titrated off of them even though they were on them long enough to develop a dependence, because their doctor decided that they weren’t in pain anymore so they didn’t NEED them, and they just had to sweat out the withdrawal. How does any of this make any sense? Some people who are on pain management are told that they absolutely must take their full dose of prescribed pain meds every day, because the doctor fears that they will overdose and their solution is to keep them on a very high maintenance dose, the dose they’d need for their worst pain days, and take that dosage even on days when they have little to no pain, pushing their tolerance so high that when their worst pain days hit the medication is no longer effective and they have to ratchet it up yet again. How does this make any sense at all? People’s hypervigilance is causing them to enact bizarre treatment decisions. The state of pain management in this country is a sorry affair. No one should have to suffer. Educate them. Tell them what they need to know about their treatment. Every person should be an expert regarding their own disorders and treatment options, and any doctor who becomes angry because a person spends time and energy researching their own health issues is not a good doctor. Forced random UAs and physical prescriptions are not going to help anybody, but education and understanding will. It’s quite possible that some people might opt to not use opioids after they understand how they work, and that would be their decision, but it’d be an informed decision. It’s better than having someone say, “Take these pills, take them exactly as prescribed. Good luck!”

1. http://mobile.reuters.com/article/idUSBREA3E1T520140415?feedType=RSS&irpc=932
2. http://www.prohealth.com/library/showarticle.cfm?libid=18875
3. http://m.livescience.com/43766-zohydro-new-pain-drug-hydrocodone.html

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