FDA May Take Vicodin And Percocet Off The Market
Bad news for Dr. Greg House and other, non-fictional chronic pain patients. The FDA advisory panel that met yesterday about the effects of excessive doses of acetaminophen made another recommendation to the FDA—to take popular painkillers Vicodin and Percocet (and their generic versions) off the market because of the effect both drugs can have on the liver when taken for extended periods. The FDA will most likely follow this recommendation.
Vicodin is a combination of hydrocodone and acetaminophen; Percocet is oxycodone and acetaminophen. While oxycodone is available without the acetaminophen (as OxyContin) hydrocodone is not available alone in the United States. A ban would be problematic for patients and doctors alike.
"It ties the doctor's hands when you put the two drugs together," said Dr. Scott M. Fishman, a professor of anesthesiology at the University of California, Davis, and a former president of the American Academy of Pain Medicine. "There's no reason you can't get the same effect by using them separately."
Dr. Fisher said the combinations were prescribed so often for the sake of convenience, but added, "When you're using controlled substances, you want to err on the side of safety rather than convenience."
Still, some doctors predicted that the recommendation would put extra burdens on physicians and patients.
"More people will be suffering from pain," said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. "More people will be seeing their doctors more frequently and running up health care costs."
Most discussion after this panel has been about the restrictions on over-the-counter medications contaning acetaminophen, but removing commonly prescribed drugs from the market entirely is something else entirely.
Panel Recommends Ban on 2 Popular Painkillers [New York Times] (Thanks, Kelly!)
(Photo: veeliam)
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This is bad news for a lot of senior citizens who sell Vicodins and Percocets in order to afford necessary prescriptions.
Okay, they're not only manufactured together because of "convenience." I made this comment on a previous post: it's also to prevent people from abusing drugs like oxycodone and hydrocodone. When you market them together, people are less likely to become addicted or abuse the drugs, because taking too much of it also means taking too much acetaminophen, which has some nasty effects, obviously. Sell them without acetaminophen (as they do with oxycodone), and abuse/overuse/fraudulent prescriptions all shoot upward. I understand the thought behind this, but I'm not sure it's such a good idea.
You ain't takin' my Lortab.... Oh no you din'nt!
(loading my shotgun just in case)
I hate how us responsible pill poppers get grouped together with the Hollywood fuck-ups and abusers.
My dentist and oral surgeon handed out vicodin perscriptions like nothing. I had many dental problems and every time I would go in with pain they would hand me a prescription for that. There was a point where I had 5-6 bottles. I only took it sparingly because I knew that it was addictive and the affect that it could have on the liver. I am glad to have my dental drama taken care of, finally.
Oh, lovely. I can't take Percocet for some reason (it causes lasting dizziness that doesn't resolve for days after I stop taking it), and my doctor told me not to take aspirin or any of the -profens (to protect my remaining kidney). When they sent me home after the removal of one kidney, I spent a couple days on Vicodin and the rest on Tylenol, extended-release, only as needed. I noticed that the 12-hour extended release Tylenol is only one extra-strength dose, released over the 12-hour period... that's the way to take it if you've got to, I guess. (sigh) Time to stock up...
maybe my leftovers will go up in price now! i didn't just say that on a public site...
This is bad news for a lot of people in chronic pain. And these people are in chronic pain and NOT drug addicts. Dr House has probably done more bad for pain patients than any real person.
@chersolly: I'm sure they also eat dog food, which is more expensive than normal people food, but sounds so awesome and poisons the well.
@shoelace414: Yeah, cuz the scenes of him detoxing or cathing himself cuz he can't urinate totally glamorize popping pills.
@SeniorPonzologist_GitEmSteveDave: There is an entire underground economy of senior prescription drug resellers that needs to be recognized and addressed.
@shoelace414: My grandmother takes two Percocets a day. It's the only thing that even slightly helps her chronic pain. Her doctor told her she could take three a day, but she doesn't BECAUSE she doesn't want to get addicted.
Well, Vicodin got me through 2 years of dental reconstruction. I guess it doesn't matter as long as they've got a suitable replacement, although if there was, I'm sure they would've been using it by now. I can't take any of the -profins either because they make me violently ill.
Trouble is, the people that really need this kind of stuff for pain WILL find a replacement if the doctors don't. I know of a few things that work wonders, with a less-than-perfectly-legal status.
I'm sure I remember reading somewhere that there was a simple additive they could put in acetaminophen that would prevent overdoses. But I can't remember what it was, anyone know?
This sounds like the government I know and love. /s
Anyone else think it makes more sense to punish the INDIVIDUALS responsible rather than everyone?
acetaminophen, of course, is also the active ingredient in Tylenol... and has been known for some time to cause liver damage in high dosages or in conjunction with alcohol. Until there's a better alternative, advise of the risks and let people choose for themselves.
I took Percocet for three months last year after getting total reconstructive foot surgery. Even constant high doses of Percocet were only able to just barely take the edge off. I'd hate for someone with a similar surgery to not have access to the same drugs I had. I understand that people are stupid, and prone to addiction, and apathetic to their livers, but that shouldn't stop people who actually need the drugs from getting them. To take these drugs away, the FDA panel should have to go to a hospital, and explain to the face of some kid with his foot in three pieces, held together by a screw and 55 staples, that he has to be in more pain because some people don't use the drug responsibly.
So.....with vicodin being banned soon, what would the street value of an unused, unopened bottle be?
Oral Surgeon gave me Ibuprofen and Vicodin for the pain when I had all 4 wisdom teeth pulled and never had any pain so I have both bottles just sitting at home. I asked him what to do with it (flush it, etc) he said heck no, keep that stuff just in case you have pain later.
Vicoprofen = hydrocodone + ibuprofen
Percodan = oxycodone + aspirin
Although there are plenty of people who can't take NSAIDs, at least there are some effective alternatives if the FDA does this deeply stupid thing and bans Vicodin and Percocet. I'm actually a big fan of Vicoprofen because so much dental pain is inflammation - mediated, so the ibuprofen plays an important role that acetaminophen can't. But for anyone who is supposed to avoid NSAIDs due to bleeding disorders, other medications that interact, kidney problems, stomach problems, etc., this is dumb dumb dumb and is only going to lead to responsible people suffering unnecessarily.
There will still be pain medicine just not more APAP combination. You can still get your oxycodone (the narcotic in percocet), so all you chronic pain/fibro/migraine people will be ok. The APAP never did anything to prevent abuse of them either, if someone wanted to get high they are not listening to the max dose anyways
@npage148: oh yeah, you can also get codeine and other narcotics. The FDA isn't taking away your pain med, they are making them safer. This will do nothing but cut down on excessive APAP consumption.
It's a shame that people ruin it for others that really need these pain pills. Even with the chronic pain before my knee surgery and right after I never abused my vicodine (and I had plenty of it). I hope they give a reasonable alternative to these pain meds because ibuprofen just ain't going to cut it after a major surgery.
@chersolly: You're right. I was just talking to my dealer, Ethel, as she was rolling down the block on her walker w/spinners, blasting the new Lil' Jon record, and I realized exactly how hard she works. Her biggest problem is she keeps her drugs wrapped in cellophane in one sleeve, and old kleenexs in the other, and sometimes gets them confused.
@npage148: Too damn bad for me; I can not only manage my pain but work acceptably well on a minimal dosage of Vicodin after dental work or surgery. I'm not so reliable on narcotics, unfortunately, and the upshot is I would have to try to work while in pain, because I can't afford the time off to lie around stoned. Dude.
@FangDoc:
Hey FangDoc,
I just read an article last week about an actual dentist named Dr. Fang. Wonderful!
Why can't they just majorly amp up the warnings for acetaminophen? It seems as if a lot of these FDA problems come down to people taking too much acetaminophen, but the advisory panel instead recommends such actions as restricting the sale of NyQuil and taking vicodin off the market.
As Frank Zappa said in testifying about the possibility of government-mandated music censorship, "[the] demands are the equivalent of treating dandruff by decapitation."
@SeniorPonzologist_GitEmSteveDave: "old kleenexs" as in used? We should have some kind of agency inspecting the packaging for such things.
@sjones411: People are less prone to addiction than you think. I was reading an article yesterday about a scientific study on withdrawal symptoms that proved that a significant portion (one third to one half, IIRC) of the people they studied never actually became dependent on the illegal drugs that they had been taking (that is, they had none of the expected withdrawal symptoms when they went off the drugs experimentally).
Patients simply ought not to lose access to effective pain unless they and their doctor together determine the patient is susceptible to becoming hooked. Individualized medical practice of this sort is well underway and will become even more feasible as time goes by. We should be funding efforts to make medicine apply to the biochemistry and circumstances of the individual patient, not efforts to take drugs off the market because a tiny fraction of the population misuses them.
Another case for legalizing pot for medicinal purposes?
What do you think Vicodin is? It's a narcotic. It's hydrocodone! You know what will work? Oxycodone! which would still be around. If you take 1 vicodin (5 mg of hydrocodone) you will just take 2.5mg of oxycodone instead.
@sir_eccles: If you're talking about what I think you are, there is no such thing. Aversive additives (i.e. things that they add to make you feel ill if you overdo it) can only work AFTER you take the overdose.
Dr. House is a non-fictional chronic pain patient? He should start a club, the N-FCPP.
@shoelace414: I'm not sure how House influenced the FDA (but he's a doctor!) or how many senior citizens watch House. But he hasn't done damage because he's a fictional character who is clearly unhappy with much of his life - drugs only make it worse for him. I'm not sure anyone sees his vicodin popping as all glamour and fun.
This new recommendation to remove Vicodin solves nothing. If APAP is the issue, get rid of it in combination pills. The reality is that there are people in chronic pain, like cancer patients. This has only recently become accepted by the medical profession. The choice of treatment will shift to straight narcotics with all the side effect problems of pure narcotics. If Vicodin is banned, we will simply switch to dilaudid or codeine to treat pain. As a physician, it is unthinkable to tell patients they just have to suffer. The FDA experts are great with statistics, not patient care. Real practicing physicians need to be on these "expert" panels. I worry about what is next, all medications have toxic side effects at very high doses. Aspirin, for example. Is it next? My final word, "it is a less than perfect world". Pain is a real disease, it needs to be effectively treated and the risks put in perspective and managed. Banning drugs is not the answer.
I think the lesson here is pain medication is over prescribed to the point that they have to make something so bad for you and addictive rather than actually finding neurological/surgical ways of helping those with "chronic" pain.
My uncle has been basically addicted to pain killers for almost ten years now. Because they can't make the pain in his arm (from a machine crushing it) go away.
@ekzachtly: Frankly, I don't care. I'd rather not be forced to take acetaminophen just because I need effective pain relief from a narcotic pain reliever (hypothetically - I'm not currently taking this stuff). I don't believe that adding a drug PURELY because of the abuse potential of the other drug is reasonable.
@Skankingmike: They don't "make" it addictive; it just so happens that effective pain relievers *are* addictive.
In actuality, I think that pain medication is BOTH under- and over-prescribed. Some doctors are giving it out too much, but in reality now due to all the government/DEA scrutiny doctors are under the opposite problem is becoming more common (doctors are afraid to give out adequate pain relief to people with real pain problems). I'm not sure if you were trying to mock the idea of chronic pain with the quotes, but it's most definitely a real thing. Some arthritis can be very painful and chronic, as can neuropathic pain. It's not that the doctors aren't trying other things...it's that nothing else works.
As a person who is myself hypersensitive to pain, and insensitive to vicodin, I have needed percocet at various times in order to get through post-surgery recovery, etc. The solution here is to require better monitoring without losing choices for consumers. There are also risks with market removal. Pain -> depression -> all kinds of other problems. Better education for doctors and consumers as well as oversight is required. I will be horrified if they remove these from the market.
@sjones411: I completely agree. Addiction is definitely a problem associated with these drugs, but I think it's a problem that is almost totally outweighed by the good that they do for pain patients.
I'm fine, though, with them taking them off the market as long as they continue to market alternatives such as pure oxycodone (vs. Percocet). I'd rather not be forced to take acetaminophen anyway, as it can be toxic and I have no desire to take a poison that isn't very effective for pain relief just because some other people get addicted and we think it's better to poison everyone as a deterrent to them taking too much of the narcotic.
@chersolly: Duly noted. Would the chairman please recognize and address the underground economy of senior prescription drug resellers present today?
The good news about this is that the members of this underground economy will no longer have the weight of self-guilt associated with the reselling of drugs for misuse and abuse, drugs deemed dangerous by the FDA.
@SeniorPonzologist_GitEmSteveDave: Looks like Wilson took him to that treatment center just in time.
@speedwell, avatar of snark: In my case, hydrocodone barely worked at all (it had little to no effect on pain relief and no side effects). Maybe you're similar.
@Skankingmike: I agree, but drug abuse can be a slow process. One week, it's one extra pill per day, the next, it's another etc. etc. and by the time you or those around you notice you're addicted and/or abusing, it's too late.
Still, though, common sense is sometimes the best medicine.
Meanwhile, from somewhere in the vicinity of Princeton, NJ, a scream was heard to emanate that could be heard for many miles.