Amid the clamor of criticism calling for the reversal the of the Food and Drug Administration’s approval for Zohydro, the alternative, if not lesser evil for the U.S. just might be heroin. Meanwhile, the system lets pain patients suffer without medication. Becoming more easily available at Walmart prices, heroin offers a desirable option among IV drug users who routinely inject prescription pain medications in crushed form. In the meantime, while the media attention rallies around drug abuse issues, people with chronic pain are finding it more difficult to get the attention they need.
Zohydro, manufactured by Zogenix, sets precedence as the first prescription narcotic that contains an extended release form of Hydrocodone in its pure state, without the addition of acetaminophen. Hydrocodone with acetaminophen (the active ingredient in Tylenol,) also known by the trade names Vicodin and Lortab, comes in five mg, 7.5 mg, and 10 mg tablets. Their potency lasts from four to six hours. The extended release form contains unit doses from 10 mg to 50 mg per capsule and works over a period of 12 hours.
In October, 2013, the FDA went ahead and approved Zohydro for release, despite an 11 to two vote by a panel of paid consulting experts advising against it. The decision provoked outcries from those who consider the new medication unacceptably dangerous. The main objection to the new medication is that it contains no abuse deterrents that prevent it from being crushed, making its full potency available for immediate release. But a repeal of Zohydro may turn out to be a legislative act that further opens the gateway to heroin and leaves pain patients suffer.
In fact, Hydrocodone takes last place for potency in a list that includes Morphine, Oxycodone, and Hydromorphone (Dilaudid.) And all of these medications come in the extended release form. Hydrocodone has a potency of little more than half that of Morphine. The potencies of Oxycodone and Hydromorphine both exceed that of Morphine, Oxycodone by up to two times, and Dilaudid by five times. While Purdue Pharma, LP reformulated Oxycontin, making it difficult to crush, the highest available dose of the narcotic is an outstanding 160 mg. This trumps the highest dose of Zohydro by three to four times.
Like all prescription narcotics, Zohydro was formulated for patients that require strong pain medication. In the case of this new drug, Zogenix directed the manufacture for people intolerant to other types of narcotics such as Morphine and Oxycodone, both of which have side effects, such as severe itching, that Hydrocodone does not.
Meanwhile, a parallel black market for heroin has infiltrated America’s suburbs. In in nation where narcotic addiction runs rampant and doctors become more cautious about prescribing painkillers, cheap heroin readily steps in to fill the void. After all, heroin, Hydrocodone, Morphine, and Oxcodone are all narcotics. But heroin, the illegal one, poses perhaps a greater threat as it potency is often unpredictable. Experienced users have died when they receive a bag of heroin that turns out to have a much greater potency than expected.
It is not difficult to empathize with those concerned about the release of yet a new prescription narcotic when abuse already runs high. Indeed, the problem of addiction and abuse need to be competently addressed. But even if there is a choice between Zohydro or heroin, there should be none that let pain patients suffer.
By Robert Wisnewski