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Gregory Bunt, M.D.

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The Prescription Opiate Arms Race

Posted: 01/ 9/2012 11:11 am

Plans for the manufacture and sale of hydrocodone pills five to 10 times more potent than is now available and sold under the brand name Vicodin and others is a warning sign of an escalation of what we might call the "prescription opiate arms race" among pharmaceutical companies. They are competing in a race to develop a stronger super-potent narcotic drug.

Reports surfaced last month that four pharmaceutical companies are attempting to develop a drug containing pure hydrocodone in high dosages per tablet. More troubling is that one company, Zogenix, is a year away from applying for approval for its product, Zohydro.

If the Food & Drug Administration (FDA) approves Zohydro, it could hit the market in two years and elevate the prescription opiate arms race to a new, heightened level.

Hydrocodone, currently the second most abused opiate drug, is available for prescription with other components in 5, 7.5 or 10 mg tablets. The rationale for vastly increasing the dosage of hyrodocodone tablets up to 50 mg, argue the manufacturers, is that there are clinical indications for higher doses.

Unstated are the anticipated high profits from sales of this very potent opiate narcotic product, which of course would not be a generic. Brand drugs sell for far more than generics.

History has a well-known habit of repeating itself. In 1995, Purdue Pharma introduced Oxycontin, produced in doses per tablet substantially larger in its oxycodone component than what was then on the market. At the time oxycodone was prescribed in 5, 7.5 or 10 mg tablets and sold under the brand names Percocet and/or Percodan.

Oxycontin was an instant market success. Purdue earned billions of dollars in the first few years of its release.

Today, oxycodone is one of the most commonly abused narcotic medications in this country. It's no coincidence that the drug's branded version, Oxycontin, currently can be prescribed in pills that deliver enormous dosages, up to 40 mg or 80 mg tablets (or even 160 mg manufactured outside the U.S.).

The unfortunate reality was that its introduction led to a rapid escalation in overdoses, emergency room visits and drug addiction as a result of the inevitable misuse of this super-potent prescription narcotic.

Nonetheless, or maybe for the same reasons, the prescription opiate arms race among drug manufacturers shows no signs of abating.

Oxycodone and hydrocodone are two drugs prescribed as opiate narcotic painkillers. They are chemically similar. Both are classified as synthetic opiates and in the same class of drugs as heroin, morphine and opium.

Opiate narcotic analgesics typically sell on the street for a dollar a milligram, making them attractive for drug dealers to obtain from those prescribed the drugs, which they resale on the black market. Consider too how desirable another super-potent opiate tablet would be. And consider the extent to which some people would go to obtain a new, pure, highly-addictive drug on the market.

Abuse of new, super-potent opiate pills on the market will surely lead to severe opiate addiction for many. What follows are all the medical, family, social and economic consequences of addiction. Some opiate addicts will resort to violent crime to obtain the drug. You may recall last June when four people were gunned down in a Long Island pharmacy by a man motivated to steal thousands of hydrocodone pills for profit as well as to feed his wife's addiction to the narcotic drug. We have not seen the end of this type of violent tragedy in our nation.

According to recent and alarming statistics, and correlated with the availability of super-potent prescription opiates, the CDC has estimated that the number of prescription painkiller overdoses more than tripled between 1999 and 2008.

Government studies also show more than 37,000 people died as a result of a drug overdose in 2009. And for the first time in our nation's history, drug overdoses outnumbered motor vehicle accidents as a cause of death.

We cannot ignore the current epidemic of prescription opiate abuse in this country today, largely as a result of over-prescription (unnecessary medical prescribing). And with no reliable national database to monitor the legal sale of prescription drugs, "pill mills," doctor-shopping and unregulated foreign internet pharmacies will continue to thrive.

The adverse consequences of misuse of currently available -- and potentially future new -- super-potent narcotic drugs should not be underestimated. Solutions exist to reducing the current tsunami of prescription opiate abuse and addiction in our country. Pharmaceutical companies and government officials in every state must launch campaigns of prevention, early intervention and treatment of drug addiction. This will be the best antidote to the for-profit competition we witness in the form of the "prescription opiate arms race."

For more by Gregory Bunt, M.D., click here.

For more on health news, click here.

For more on addiction and recovery, click here.

 
 
 
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HUFFPOST SUPER USER
Terry S Singeltary Sr
11:28 AM on 01/23/2012
National Cancer Institute at the National Institutes of Health

Cannabis and Cannabinoids (PDQ®), Cancer Antitumor Effects, Prion prevention, Pain management, muscle relaxer, and Palliative Medicine

Cannabis and Cannabinoids (PDQ®)

Laboratory/Animal/Preclinical Studies

Antitumor Effects Appetite Stimulation Analgesia

snip...

http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4

snip...see full text and more here ;

Friday, January 6, 2012

Cannabis and Cannabinoids, Cancer Antitumor Effects, Prion prevention, Pain management, Muscle relaxer, and Palliative Medicine

http://fdafailedus.blogspot.com/2012/01/cannabis-and-cannabinoids-cancer.html
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C Karen Stopford
12:28 PM on 01/22/2012
Welcome to capitalism.
03:13 AM on 01/18/2012
I have had people tell me medical marijuana reduced their need for pain meds by 50% for cancers they had in treatment. It would be an interesting study to quantify it, especially which strains are more potent pain killers. Its less harmful than the narcotics I think and not addicting and lowers the acetominophen load on the liver. Obviously the medical community isn't going to get involved with that until the Feds reschedule it, if they ever will. But that seems a better solution to me than putting out ever more powerful narcotic pills that would likely be diverted into the wrong kinds of markets.
06:47 AM on 01/17/2012
Opiate containing narcotic Pain Pills are highly effective for short term pain control, but were never intended for long term use. Over time, these drugs cause sever addiction, as well as profound suppression of the endocrine system, with inhibition of testosterone and adrenal hormones. Women addicts may stop menstruating.

Opioid-induced hyperalgesia, or increased sensitivity to pain, is a form of hypersensitivity to pain in which the original painful condition becomes worsened and magnified. Other adverse effects include impaired cognitive function, and suppression of the immune system, rendering the patient more susceptible to common infections.

Narcotic pain pills lose their effectiveness over time. The brain and nervous system develops a "tolerance" to the drug, and higher doses are required to achieve the same result. The initial pain relief from opioid pain pills may not be sustained long term because of drug tolerance, opioid-induced hyperalgesia, and intermittent drug withdrawal effects.

Historically, opiate addiction has been with us for centuries and is invariably associated with increased mortality in the user, as well as destabilization and disruption of the fabric of society. Other forms of non-drug pain control are now available such as low level laser, useful for back and neck pain. Why not use this and forget the addictive narcotics?

For more: http://www.bioidenticalhormones101.com/Low_Testosterone_Opiates.html

jeffrey dach md
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HUFFPOST SUPER USER
C Karen Stopford
12:31 PM on 01/22/2012
If these drugs are not intended for long-term use, then why are doctors and dentists allowed to prescribe 30- and 60 day supplies at a clip? The supplies that are currently on the black market are not, for the most part, spoils of drug store heists. They were prescribed by legitimate medical people. Until the social consequences of medical decision making are brought to light and included in medical schools' curricula alongside a comprehensive medical ethics program, I think doctors like you who advocate alternative therapies will be a rare and precious breed.
11:17 PM on 01/23/2012
Dr Dach, I see you believe in things about opioids that may not be as true as you may think.. Based on your beliefs about opioids you would have a higher likelihood of addiction than people with a different set of beliefs. Having been in pain management for 12 years and group healthcare software and consulting since 1982, I have experience with people on opioids and other troublesome drugs developing taper caculation programs and "addiciton potential" screening questionaires. People with beliefs like yours are more likely to become addicts and not just opioids. I'm a model pain management patient, never abuse, never run out and sucessfully manage pain with a tremendously improved life as a result.. My dose of morphine now is 40% lower than it was my first 4 years. It works great for pain management essentially without side effects. After dealing with the pain we were able to pay attention to the medical issues being ignored because pain overwhemingly controled my life making other conditions invisible to physicians and corrected some conditions causing pain, reducing my pharmacy bill by $1400/month, only $50 of that being from reduced morphine doses. Beliefs like yours caused my life to be unrelenting hell for 20 years from rampant uncontroled pain. If you were open to it you could learn a lot from those without an MD following their name. My testosterone bottomed out a decade before I received opioids. Testosterone was helpful but only a small puzzle piece.
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HUFFPOST BLOGGER
Scott Mendelson, M.D.
06:19 PM on 01/13/2012
No one would argue that abuse of extremely potent, potentially lethal opiates is a good thing. However, the critical question for Dr. Bunt is: "Do opiates have a place in the treatment of severe, intractable pain, and if so how does one manage their use?"
03:22 AM on 01/18/2012
We need more research into non-narcotic adjuvants that synergize well both pain control and the anxiety/depression's associated with it. So far as I know, the antidepressants have been a bust for too many folks, and the newer anticonvulsants are hit or miss. Frankly nothing seems to beat good physical therapy in the orthopedic pain dept. and general exercise and conditioning. I suspect that is more than endorphins on the brains opiate receptors, but in fact, a local muscle neurologic phenommena. The endocannabinoid sysem looks interesting but little is known about it or how it modulates pain perception, but it seems to. The federal government seems to be blockcading attempts at ethical research so its not surprising we find ourselves in the dark ages on this still.
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senorlou
10:56 AM on 01/11/2012
Yeah, liver damage from massive doses of Tylenol mixed in with the drug is much more preferrable.
08:39 PM on 01/10/2012
I think it is about time we get some pure hydrocone mediations. I suspect that a lot of the larger size doses will be time release. In oxycodne there are immediate release ovysodone up to 30mg, 45mg morphine equivalent. Of course a 50mg Hydorcodone will be approximately equivalent to an approximately maybe a 35mg of morphine or that same 30mg oxycodone. Immediate release morphine goes up to 60 mg and time release to 200mg. I take 30mg morphine 6 times a day. I found oxycodone intolerable becasue of side effects that actually increased pain and it didn't wprk worth beans on my pain. Methadone was even worse, no pain relief and unstopping nausea. There are pople like me out here in the world that have very limited choices. No opioids leaves suicide the only reasonable choice for a lot of people in the face of genuinely severe chronic pain. Pure hydrocodone provides another possibility in this fight against pain that some will find more tolerable and more effective than other meds. I've been in pain management almost 12 years and it has given me a life back from a life that I had lost everything in because of decades of opioid refused "treatment" for pain. I took $1500/month of other kinds of meds and all it did was make me sick and destroy my lifes savings without letting me work and enjoy life. I woke up every morinng for decades in terrible pain and tears wishing I were dead.