The Zohydro Super-pill is under attack by health care advocate, who claim that the drug may be too dangerous for public consumption. Said to be 10 times more potent than Vicodin, the new drug may be a panacea to some and a curse to others, pitting people in pain against substance abusers, who are often in a very different kind of pain.
On one side of the Zohydro debate are the oncologists, who deal with people in extreme pain, and their patients. The other side of the debate includes a cross-section of health care advocates who deal with substance abuse issues and their clients, the substance abusers.
The tipping point issue on which the Zohydro issue hinges is the fact that it has not been formulated in an “anti-crushing” compounding that would make it difficult for abusers to crush the pills and “snort” them to get a faster, stronger effect from the drug. The current opiate of choice among many drug abusers, oxycodone, has been reformulated in the anti-crushing configuration, making it less attractive to drug abusers.
Zohydro is actually oxycodone (also known as hydrocodone) reformulated into a long-acting extended release configuration specifically designed to provide a steady amount of painkiller for patients with extreme chronic pain who do not respond well to other pain medications. Reports that the new drug is ten times more potent than oxycodone may be hyperbolic, however. Each of the drugs in the opiate series – opium, morphine, laudanum, heroin, methadone, and oxycodone – is approximately twice as powerful as its predecessor.
The manufacturer of the new drug, Zogenix, deliberately chose to make the drug in a long acting formula for therapeutic reasons and there are apparently therapeutic reasons why you cannot have both a long-acting formula and a crush-proof formulation. The specific mission for which the drug was designed was to allow patients in chronic and often terminal situations to stay out of the hospital and away from nursing home environments as long as possible. No one wants to spend their last days on Earth in a hospital.
And that is the point according to oncologists speaking off the record. No one is saying it out loud, but Zohydro was designed for a very special population of patients who are very sick, in a lot of pain, and not likely to recover.
On one level, this is a simple needs assessment, a choice between increasing the risk of addiction and overdose deaths for a relatively small number of people who might overdose on Zohydro (there were 38,000 overdose deaths in the United States in 2010, the last year for which there is good data) versus the 600,000 people who die from cancer each year, often in such extreme pain that it can devastate everyone around them.
According to DrugWarFacts.com, there were approximately 335,000 opiate users in the United States in 2012, which was twice as many as there were in 2005, indicating that the rate of opiate abuse is going up. But that means that twice as many people die of cancer each year as all of the heroin users in the country.
People in the substance abuse treatment profession see things differently. They see a different kind of suffering, long-term, chronic, sometimes fatal, but curable. No one with a drug abuse condition has to die from it. Help is available everywhere you look. Sometimes, it is very expensive help, but there are also low cost alternatives for people who need help.
People who have lost a loved one to substance abuse have experienced a different kind of pain from those who have watched a loved one die in pain from cancer.
One long-time substance abuse treatment professional, who is also a cancer survivor, sees it from both sides of the bed. “The key to understanding this issue is whether or not you believe that society can provide the will power necessary to beat drug abuse if the patients cannot provide the will power for themselves. That never works. We tried that with Prohibition, and that didn’t work out too well.”
“People who want to control access to drugs as a means of controlling drug abuse don’t understand that the abuser will always find something to abuse. If it is not Zohydro, it will be oxy, and if it not that, then heroin, or methadone, or alcohol, or something….but it is the pattern of abuse that has to be addressed, not access to the drugs themselves.”
Attorneys General in 28 states have asked FDA Commissioner Margaret Hamburg to reconsider the drug’s approval, or impose more stringent label restrictions on the new drug to discourage abuse. Additional label restrictions might include in-hospital use only, or limit the maximum number of doses a patient may receive for any one episode.
Before jumping to conclusions either way, consider this: on average, any given person is 20 times more like to need this drug as a cancer patient, or will know someone who does, as they are to die from an overdose of it or know someone who did.
In the final analysis, however, the health care advocates who have put the Zohydro Super-pill under attack are ignoring one blatant fact: the potency of a drug, any drug, does not matter because, if it is not strong enough, drug abusers will simply take more until they get the effect they want.
By Alan M. Milner