FDA panel votes to eliminate Vicodin, Percocet.

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I got one for #420 oxycontin 40mg today
4 tabs 5x/day Ok to fill early pt is going on vacation

I remember getting one for almost 1000 Oxycontin various strengths for one of our regulars, who said she was going on a Florida vacation. She brought with her to the pharmacy her "driver," a burly guy who may as well have had "Hells Angels" written across his chest.

In all fairness, that particular doctor lost his narcotic-prescribing license, an event that gained lots of business for the methadone clinic nearby as all the Oxycontin addicts created by this dr were left stranded.

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Interesting stuff. But addictions will be as rampant as ever.

Where I live, Oxycontin has replaced heroin as the #1 opioid of abuse. Thirty years ago, addicts were injecting heroin. Now they're injecting (or chewing) oxys. Six of one, half a dozen of...like that.

I can't tell if that's a good or bad thing. Perhaps C2 abuse is better than c1 abuse. I hate the fact that we're the ones filling it, but I wonder if it's better.
 
I remember getting one for almost 1000 Oxycontin various strengths for one of our regulars, who said she was going on a Florida vacation. She brought with her to the pharmacy her "driver," a burly guy who may as well have had "Hells Angels" written across his chest.

In all fairness, that particular doctor lost his narcotic-prescribing license, an event that gained lots of business for the methadone clinic nearby as all the Oxycontin addicts created by this dr were left stranded.
Okay, definitely a bad thing.
 
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This should be done...and should have been done years ago.

But the whole mess over otc is absurd. Most of these people who died of liver failur were abusing combo opiates.

Get rid of any of these drugs with 750mg APAP(with hydrocodone) per dose...those addicts are prolly goin down first...as well as the codeine/propoxyphene combos.

Just imagine an addict getting by on...idk...5 tabs of hydrocodone/APAP 7.5/750...crackhead hits a drought...raids grandma's cabinet...takes 4 DarvocetN100...crackhead assesses situation...takes 4 more...drinks six-pack (you know...gotta have some PBR to get the buzz to kick in)...


The addicts are gonna take as many as they need to feel good...

why even mess with codeine as an Rx? You've got the metabolism issues and the ceiling effect...the only thing you need for mild-mod pain mgt is hydrocodone 1mg-10mg/325mg...

MOST addicts...i would imagine...would never approach the daily limit for 10/325...if they're abusing it more than that...saionara!

Save the codeine as antitussive for the kiddies.
 
This is an interesting subject. Leaving aside the subject of drug addiction for the time being, let's move to prescribing of these types of medication, specifically Vicodin.

Vicodin is usually prescribed for a variety of different pains, as you all know, I'm sure. The question then becomes....SHOULD it be? Many studies have shown that regular Motrin works better in bone pain (such as for a broken bone) than Vicodin or similar drugs. Yet, instead of sending you home with a prescription for 800 mg Ibuprofin, they send you home with a prescription for a narcotic. When I broke a bone they gave me 200 Vicodin! That's outrageous! Maybe we should change the way these drugs are prescibed, and then drug addiction won't be such an issue as there will be much less of it on the street.

Agreed, people usually respond to motrin (anti-inflammatory). But when you have a broken bone, you can not take an anti-inflammatory medication because it will keep you from healing or increase blood loss in the area of the break. You do know this right?

Take me for example. I had a C5-C6 ACDF. I am not allowed to take anything anti-inflammatory because it is not conducive to healing. As you can imagine, my pain levels are out of control. The only medication that gives me any type of relief is vicodin and Avinza (after having my vertebrae shaved and every single nerve in my neck touched).

There is a huge amount of stigma about people who use pain relieving medications like vicodin. Some people use this medication exactly as prescribed to get relief from real pain.

Do all pharmacists think people like me are junkies?
 
Agreed, people usually respond to motrin (anti-inflammatory). But when you have a broken bone, you can not take an anti-inflammatory medication because it will keep you from healing or increase blood loss in the area of the break. You do know this right?

No I don't know that. The latest study actually points to nonunion of the fractured bone resulting in a higher use of NSAID, not use of NSAID resulting in non-union.

I don't know. I haven't read everything nor am I an orthopod/pain specialist..

But "I can't use NSAID because my bone won't heal instead I have to use Narc" is a great excuse for junkies to get more Narcotic analgesic.
 
No I don't know that. The latest study actually points to nonunion of the fractured bone resulting in a higher use of NSAID, not use of NSAID resulting in non-union.

I don't know. I haven't read everything nor am I an orthopod/pain specialist..

But "I can't use NSAID because my bone won't heal instead I have to use Narc" is a great excuse for junkies to get more Narcotic analgesic.

While I understand what you are saying about people abusing these medications I think you need to understand why they are prescribed (instead of an anti-inflammatory med like motrin/ibuprofen).

The truth is, I could probably get by with just the Avinza (which does not give you a high at all - unless of course you break it open and eat it straight) and Aleve. But I am not allowed to take them until I have a successful fusion proven by an MRI.

Even with avoiding anti-inflammatories I still have a non-union eight months later. Top it off, I will be going in for a C5-C7 ACDF revision in about a month.

Just as a side note, if you have never experienced blinding nerve pain from a ruptured disc you couldn't possibly understand the need to for these types of meds. From a patient standpoint it blows to hear that pharmacists are associating "junkie" with anyone who uses these meds regularly.

In my case, I work with a pain management group. I have tried several different meds to find the right combo for my level of pain and the way the meds processes in my body. The only combo that works for me is Vicodin, Soma (yes, I have constant severe muscle spasms), Neurontin, and Avinza. I do still have breakthrough pain and I use Dilaudid as a rescue med. This keeps me from running to the ER with non-stop vomitting and tremors only to get a shot of Dilaudid and Zofran.

Does this make me a junkie? Or an abuser? I am well aware I am dependent on my meds and once this whole situation is taken care of I plan to detox. But I am not a seeker and I sure as heck am not raiding peoples medicine cabinets. I guess I can thank my doctors for that since they give me exactly what I need, no more no less.
 
I did not make any judgemental statement regarding your situation. But you sure are very defensive. And don't tell me what I need to understand or not.




While I understand what you are saying about people abusing these medications I think you need to understand why they are prescribed (instead of an anti-inflammatory med like motrin/ibuprofen).

The truth is, I could probably get by with just the Avinza (which does not give you a high at all - unless of course you break it open and eat it straight) and Aleve. But I am not allowed to take them until I have a successful fusion proven by an MRI.

Even with avoiding anti-inflammatories I still have a non-union eight months later. Top it off, I will be going in for a C5-C7 ACDF revision in about a month.

Just as a side note, if you have never experienced blinding nerve pain from a ruptured disc you couldn't possibly understand the need to for these types of meds. From a patient standpoint it blows to hear that pharmacists are associating "junkie" with anyone who uses these meds regularly.

In my case, I work with a pain management group. I have tried several different meds to find the right combo for my level of pain and the way the meds processes in my body. The only combo that works for me is Vicodin, Soma (yes, I have constant severe muscle spasms), Neurontin, and Avinza. I do still have breakthrough pain and I use Dilaudid as a rescue med. This keeps me from running to the ER with non-stop vomitting and tremors only to get a shot of Dilaudid and Zofran.

Does this make me a junkie? Or an abuser? I am well aware I am dependent on my meds and once this whole situation is taken care of I plan to detox. But I am not a seeker and I sure as heck am not raiding peoples medicine cabinets. I guess I can thank my doctors for that since they give me exactly what I need, no more no less.
 
I did not make any judgemental statement regarding your situation. But you sure are very defensive. And don't tell me what I need to understand or not.

Wow, relax a bit.

I read this thread and saw some discrepancies that I thought should be corrected and that have the potential to create some dialogue about why these meds are not so evil. Especially when you look at them from my specific situation, hence my detailed explanation.
 
Wow, relax a bit.

I read this thread and saw some discrepancies that I thought should be corrected and that have the potential to create some dialogue about why these meds are not so evil. Especially when you look at them from my specific situation, hence my detailed explanation.

I'm relaxed. But you don't need to tell me to do that either. You're presenting your limited pharmacology understanding to a bunch of experts as if you're an expert. You're not. Your understanding of molecular effect of analgesics and clinical outcome is only limited to your situation to justify your existence.

You think opiod has no effect on bone healing?

Here's what Avinza (morphine) can do to your bone healing.

Similarly, opioids are most frequently used to treat severe pain caused by metastatic bone cancer (e.g., breast and prostate cancer) but do have a variety of nonskeletal (and potentially skeletal) side effects that could inhibit bone healing. Opioid side effects such as sedation, clouding of mental status, or cognitive impairment can reduce mobility, resulting in loss of bone and muscle mass.

Opioids also may have direct, detrimental effect on bone healing. Recently, it was shown that analgesic therapy provided by morphine accelerated sarcoma-induced bone destruction and doubled the incidence of spontaneous fracture in mice.
 
I'm relaxed. But you don't need to tell me to do that either. You're presenting your limited pharmacology understanding to a bunch of experts as if you're an expert. You're not. Your understanding of molecular effect of analgesics and clinical outcome is only limited to your situation to justify your existence.

You think opiod has no effect on bone healing?

Here's what Avinza (morphine) can do to your bone healing.

You are correct. I am limited in my understanding.

And thank you for the linked info. I was not aware of that possible effect from Avinza. I am quite surprised my pain management doc decided that was an appropriate med considering he is fully aware of my full history. And of course I remind him I am not fused whenever he needs to change a med because my surgeon was super clear about the fact that I was NOT ot take anything anti-inflammatory until fusion was proven.

Maybe that is why I didn't fuse properly.

Thanks again.

Dawn
 
ps.

Could you link me to that study? I would like to bring it to my next appointment to discuss this with my PM doc.
 
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Alright dude.....stop coming in a messing up my threads. I thought we had a talk about this remember? You were going to ask my permission before you posted anything in a thread I started. Come on, get with the program. I know it gets lonely in your office. I have Slaver's phone number. I can get him back in here to put the smack down on you....again.


Lonely in my office? You aint kiddin...I got the house to self for 2 weeks..OMG is this what it's like to be a single man? :smuggrin:
 
Lonely in my office? You aint kiddin...I got the house to self for 2 weeks..OMG is this what it's like to be a single man? :smuggrin:

2 weeks? How did you swing that? I am in heaven for the 6 hours I get by myself on the 2 days a week I close. I can't imagine having two weeks.

I do not think my wife would leave me alone for two weeks. Check that, I know she would not leave me alone for 2 weeks.
 
2 weeks? How did you swing that? I am in heaven for the 6 hours I get by myself on the 2 days a week I close. I can't imagine having two weeks.

I do not think my wife would leave me alone for two weeks. Check that, I know she would not leave me alone for 2 weeks.


You're a loser!
 
There is a huge amount of stigma about people who use pain relieving medications like vicodin. Some people use this medication exactly as prescribed to get relief from real pain.

Do all pharmacists think people like me are junkies?
You have focused on one of the reasons the over-prescribing of opioids is my pet peeve: the stigmatizing of legitimate patients. Unfortunately, there are too many physicians who hand out opioids like candy.

As I have mentioned before, the US is 5% of the world's population but uses 90-95% of the world's opioids, and 99% of the world's hydrocodone supply. IMO, the largest volume of opioid prescribing is not done on the basis of evidence-based medicine. For instance, fibromyalgia is one of the most frequent diagnoses cited for opioid prescribing in Medicare databases (a study I read last year), but doesn't do those people any good, really.

I have had arguments with doctors who hand out Oxycontin willy nilly to guys with long criminal records and no clear pathology. So it puts pharmacists in the position of being narcs, and it puts legitimate pain patients in the position of having to be on the defensive.
 
Rather than posting a new thread, I decided to revive this ancient thread instead.

http://news.yahoo.com/s/ap/20110113/ap_on_he_me/us_painkiller_safety_fda

I think this is a good idea. But as mentioned in some of the other ancient posts, removing the acetaminophen entirely would make more sense, I think.

btw, apparently Old Timer is some type of prophet!

I will bet you all a jelly doughnut that the end result will be:

Any combo with more than 325 mg of Acetaminophen will be withdrawn from the market. Vicodin, Vicodin ES, Vicodin HP all Lortab products Percocet 7.5/500 and Percocet 10/650. This gives them the cover to boot Darvocet-N 100 and generics off the market as well.

The Norcos of the world will remain and the Vicodin & Lortabs will suddenly be re-formulated.....

As for OTC's Tylenol Extra Strength is a goner as will any products containing more than 325mg per dose. They may allow the 650 as a single dose.....

I think someone is owed a substantial number of jelly doughnuts.
 
Rather than posting a new thread, I decided to revive this ancient thread instead.

http://news.yahoo.com/s/ap/20110113/ap_on_he_me/us_painkiller_safety_fda

I think this is a good idea. But as mentioned in some of the other ancient posts, removing the acetaminophen entirely would make more sense, I think.

btw, apparently Old Timer is some type of prophet!



I think someone is owed a substantial number of jelly doughnuts.

Awesome news. Now everything will be uniform. Vicodin/Lortab/Norco...all 5/325, 7.5/325, 10/325. Only that one weird ass drug that's like 10/300 will remain and be different.
 
I thought the only reason the APAP was there was an attempt to discourage abuse, which is why the junkies always have forged scripts for the 10/325... most narcotic, least APAP.


Maybe we're going to start harvesting their livers, and want them in relatively good shape. Medicaid won't pay for itself you know. :eek:
 
Rather than posting a new thread, I decided to revive this ancient thread instead.

http://news.yahoo.com/s/ap/20110113/ap_on_he_me/us_painkiller_safety_fda

I think this is a good idea. But as mentioned in some of the other ancient posts, removing the acetaminophen entirely would make more sense, I think.

btw, apparently Old Timer is some type of prophet!



I think someone is owed a substantial number of jelly doughnuts.

If you remove apap entirely that would be nice in an ideal world but then you'd have tons of abuse. And hydrocodone would become a c2 so no refills. Patients will be happy the FDA didn't pull their blue watsons!:laugh:
 
I always put a an MDD on the label to max at 4g APAP/day and adjust the day supply accordingly. Never had a dr complain, though patients complain about it a lot
 
Acetaminophen really isn't that great of a drug and I think lowering the amount of it in each tablet of combination products is a good thing that will benefit patients.
 
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