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Really, the war on drugs is bad for most everything, save prison contractors and gangsters- but today's news about the FDA considering pulling the popular pain meds Vicodin and Percocet from pharmacies has my focus on the harm that drug laws do to vital organs.
Vicodin and Percocet are compounded opiates. This means they are a two drugs in one pill- a strong opiate pain killer mixed with another drug- in this case acetaminophen- aka Tylenol. Compounded opiates are widely prescribed for pain management and have been famously abused by celebrities and hobos alike.
With all of the fear mongering about illicit drugs, it is interesting that the story here is about acetaminophen- widely considered among the safest drugs in the world. It is safe- most of the time, for most people, when used properly. When too much is used however it can be toxic to the liver. Acute acetaminophen poisoning is a major cause of emergency room visits, and leads to hundreds of deaths per year.
The FDA's advisory panel voted 20-17 to remove these drugs from pharmacy shelves, citing the high potential for overdose- particularly when people combine these prescription meds with over the counter products that also contain acetaminophen.
The media coverage is missing a crucial element of the story. The popularity of compounded opiates is due largely to the war on drugs. While Vicodin and Percocet are controlled substances, they are less controlled than oxycontin, morphine or other non-compounded opiates.
The extra paperwork involved in 'triplicate' scrips is not just a matter of convenience- although that plays a role. One of the copies of a triplicate goes to the DEA- the Drug Enforcement Administration. The DEA has no expertise in pain management, or any other kind of medicine. Their expertise lies in restricting access to drugs.
Many doctors don't love the idea of a group of cops looking in to their prescribing practices- and an easy way around that is compounded opiates. For people with chronic pain, this leads to an increase risk of liver problems from the acetaminophen and quite importantly the risk of addiction.
The DEA should have no role in medicine. Period. Pain management and other medical decisions should be made by patients and their doctors, not cops (or insurance adjusters, but that is a different story).
The war on drugs is costly, counterproductive and an injustice of monumental proportions. Getting the DEA out of medicine will not end the war on drugs, but it would immediately save lives.
Explained my thoughts exactly- this isn't about science...
Could not have said it any better. If we continue to allow the DEA to run rampant and control even our healthcare--the very essence of privacy and dignity!-- there will be no turning back. And for WHAT, I ask? We continue to live in an imaginary world where citizens truly believe giving DEA cowboys control and making laws will prevent drug use? Is ending drug use THAT important? And if it IS, I gotta ask WHY is it? Why have Americans suddenly become obsessed with out lawing anything and everything that could POSSIBLY hurt us--and where has personal risk assessment and responsibility gone>?
Why not focus on making the use of drugs as safe as possible, like we do with all other forms of ADULT entertaiment?
We have already given the DEA too much power over our lives and our bodies-now they want our healthcare too? And we are just sitting back and letting it happen!
Well as I prescriber of opioiods every day of my clinical practice I must say bravo to your well articulated points. However, let me clarify a a vital element here that is lost to most people - especially those patients who ARE INDEED drug seekers and DO NOT care what the consequences are for the person writing the script. There are hundreds of stories of very caring doctors and nurses who end up in jail and then the "poorhouse" because of patients that lie, steal, and cheat their drugs from us. I believe I practice very good HIV and PAIN control medicine. It is nothing for me to write an appropiate script for 300 TABLETS of methadone for one patient. (The reasons would fill another yet much needed POZ article.)I long ago let go of the fear of jail and loss of license (and trust me it has come close at times) because I simply cannot let people suffer. Do I get suckered by con artists even through we have a very comprehensive monitoring program for compliance and diversion that most practice would marvel at? Damn right I do and I get it a lot.
This is not a black and white problem with good guys and bad guys. It is very complex and those of us brave enough to risk everything (including our very lives at times - did I mention the countless times guns have pointed at me by "patients" or my loved ones threatened?)are left holding the bag. And just to make sure everyone is clear...the bag we are left holding typically contains the tatters of our lives mixed in with some shit. But we do it anyway because it is the right and, dare I say - Godly - thing to do.
Also be assured that the DEA and virtually every drug manufacture knows EXACTLY what every signal licensed clinician prescribes on a near daily basis. Every one is tracked if they prescribe penicillin to morphine. Down to the last pill. If anyone even THINKS that there is some minute level of medical (especially when it comes to medications) privacy they are simply diluting themselves. Medical privacy went out the window a good ten years ago. I can find out anything about anyone I care to - it isn't hard. And what medications people take and who prescribes them might as well be posted on the Internet...oh, wait, I forgot, it is actually.
Over the years I'd come to hope that the FDA would do something like this, as I've found that almost no one appreciates the dangers of acetaminophen...people take it to cure hangovers, people take compounded meds like Percocet n Vicodin with alcohol, take overdoses via several different cold remedies, etc.
I applaud this article for expressing my own concern about our failed and ever-failing "Drug War"..this war is what couple opioids and acetaminophen together in the first place. the DEA has no reason to be involved in medical decisions, and they have hounded and prosecuted patients and their healthcare providers needlessly and often ruthlessly.
since we supposedly have a new kind of Executive in office, it would be wise to lobby the new administration publicly and relentlessly...because the DEA will certainly keep rolling over the sick and their caregivers otherwise.
my impression is that Obama is very much like Clinton in that he'll seek the path of least political resistance. patients in pain and their doctors must NOT lay down so Obama can appear "tough on drugs". a good place to start would be to demand that hydrocodone NOT be rescheduled into category 2.
As we consider revamping our healthcare system, the time to quarantine the DEA's influence and power over Medicine is now.
Good article. Opioids are incredibly important medications. Perhaps a newly patented pain medication is coming along at an outrageous price and they need to clear the deck of cheap competition? (Gosh, perhaps I'm cynical.)
But a note--acetaminophen (or paracretamol) causes its liver toxicity by wiping out glutathione. The antidote for overdose is N-acetylcysteine (NAC). Scads of good studies on that! I think there are other analgesics that may be a better bet in general (wben not necessarily needing to resort to opioid therapy). But if acetaminophen is the one for you, use NAC.
I use it anyway as part of a comprehensive strategy to manage Hep C infection. And I NEVER use Tylenol.
Also medical mj should be legalized. Republicans under Bush 1 stopped providing it (the Public Health Service used to provide it to people with wasting due to HIV, cancer pain, glaucoma and pain from some other disease - they grew it in Louisana)around 1989, on bogus, cooked data re it's being harmful and no better than available alternative, legal meds. How do they have the right to tell someone in pain - particularly if they're dying - what feels better for them. Clinton's admin decided to keep the ban in effect - no doubt due to a hostile Congress. The DEA's fear (fantasy?)that kids will use mj as a gateway to addictive drugs like heroin or chrystal meth etc,needs to be publicly examined and weighed against the harm the ban does - the pain it causes and the societal cost of encouraging drug cartels we must fight and the cartels' funneling money to terrorists.
My VA HIV doc (who for some reason refuses to prescribe pain medications ("see your regular doc") recently told me to stop using naproxen (Aleve) which I have been using for a long time due to pain in a bad hip. (I already had one hip replacement.) I have been taking two pills a day and it works pretty well for me. He told me to stop taking the naproxen (due to kidney toxicity) and instead use acetaminophen or Vicodin for pain. (With liver toxicity?) BTW my liver and kidney tests are all normal. And I dont drink at all. My regular doc already refused me Vicodin once before and instead put me on morphine pills which I hated because they messed up my thinking so bad. So I instead kept using the naproxen which he approved of. So now I have to go back to him and ask him for the Vicodin he doesnt like to prescribe (because they are short acting vs morphine which lasts 12 hours). Since my pain is for a chronic condition that is what he wants to prescribe. And now they might remove Vicodin (which works well for me) from the market. What a mess!
So what are we going to do for those who really needs this? Like me.