Pain, Drugs, & Anger

New powerful painkiller has abuse experts worried

There. Fixed that.

This popped up as a news item while I was checking my email. Pretty much any time there’s news about advances in pain management, I read, so of course I clicked on this.

“The new pills contain the highly addictive painkiller hydrocodone, packing up to 10 times the amount of the drug as existing medications such as Vicodin.”

I have intense and unpleasant side effects from Vicodin, so I admit, my first reaction to this was a visceral kind of fear. I imagined my own hallucinations, space-time distortion, and nausea multiplied by ten. Admittedly, I think this would be a terrible medication for me personally.

“Critics say they are especially worried about Zohydro, a timed-release drug meant for managing moderate to severe pain, because abusers could crush it to release an intense, immediate high.”

Okay, two things:

First, while hydrocodone is not my friend, I would sacrifice my left eyebrow for a timed release version of an effective pain medication. It sucks to wake up in the middle of the night because my pain medicine has worn off and to stay away for an additional hour (or two, if I’ve underestimated and took too little, which I often do) waiting for the next dose to kick in. The five A.M. rise and shine time comes way too fucking soon. Also, not needing to worry about bringing a controlled medication into my workplace? Would be brilliant. Super bonus points if a time-release formula would mean that the brain fuzzies and nausea didn’t peak and fall erratically.

Second, it is maybe not the coolest thing to render invisible folks who might need or benefit from the medication by focusing instead on people who would not even pretend to take it as prescribed. I get that potential for abuse is a real factor to consider for any medication, but “moderate to severe pain” is also a real thing in the world. Saying, “We just don’t need this on the market,” is at best ill-informed and at worst dishonest and cruel.

“‘It’s like the wild west,’ said Peter Jackson, co-founder of Advocates for the Reform of Prescription Opioids. ‘The whole supply-side system is set up to perpetuate this massive unloading of opioid narcotics on the American public.'”

Totally agreed. Which is why my health care provider allows me 30 doses (where a dose lasts 4-6 hours — so something like 7-8 days) of a medication before I have to schedule an appointment, pay a copay, have a consult, and get a new prescription. Which is why I’m sticking with this health care provider: because her attitude toward pain medication is by far the most fair and reasonable one I’ve encountered from doctors so far.

Which is why, every time I’ve attempted to fill an opiate or opioid prescription, it’s been flagged at the pharmacy, and I’ve been told I can’t have this medication because of some untrue reason — for instance, the pharmacy tech claiming I want two kinds of pain medications when I don’t, saying I’m too soon for a refill when I haven’t had one in four months, that because this is a new medication I need to come back to speak with the pharmacist when he’s on duty (hello! how can the pharmacy be open with no pharmacist on duty?), etc.

Yep. This “massive unloading” is exactly like there are unwanted strange pills falling off a truck and into my mouth.

“Critics say they are troubled because of the dark side that has accompanied the boom in sales of narcotic painkillers: Murders, pharmacy robberies and millions of dollars lost by hospitals that must treat overdose victims. “

I get that there are a lot of reasons to be skeptical and suspicious of pharmaceutical corporations, as well as the reality that the FDA is a political entity that doesn’t always make decisions that are truly in the best interest of the public. Moreover, I would love to find effective pain management methods that didn’t create the potential for physical addiction. However, simply failing to meet the needs of people with chronic pain (which, even as someone with good insurance and access, the US medical system pretty well does) is not a viable option, not even in the meantime.

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7 comments on “Pain, Drugs, & Anger
  1. Shauna says:

    I appreciate the response you made to this. I skimmed the first part of the article, and was trying not to facepalm. As someone with occasional moderate-to-severe pain and frequent/near constant mild-to-moderate pain, I too, would love to see a time release on the meds I take when I need something extra to kill the pain. Usually, I take this extra when I’m just so freaking tired of being in pain that I don’t care about the soporific/fogging side effects; I just want the pain to stop for a while. If there was a way to do that and not get all the effects at once, that would be awesome. Unfortunately, as you point out, these articles and people tend to ignore those of us for whom the drugs are actually made in favor of scare tactics or a more interesting lede.

    • Tori says:

      Yup. I’d understand if the first point made was whether the benefits of the medication outweigh the dangers for the people who are meant to take it. I’m not sure of the facts on that with respect to these particular medications, but I think that would be a legitimate item for study — because, like, I would want to know about that before I potentially took a medication. (And to be fair, that does get a few sentences of mention later in the article, sort of.) But to primarily argue that a type of medication is bad because of its effects on people who were never intended to be prescribed it in the first place is preposterous.

      Unless, like, the medication was frighteningly explosive. Then its effect on non-patients would be a lot bigger deal to consider. ;)

      • Rowan says:

        The sad thing is though, there are medications like that (a pharmacist friend of mine discussed having to handle a med with caution and gloves because getting any of it on his skin instead of in the capsule would cause immediate skin issues requiring ER level attention) and they don’t get anywhere near this level of scrutiny.

        Bleh.

        (Apologies, I’m sure it was meant to be funny but I just had to highlight the absurd.)

        • Tori says:

          No worries. :)

          But yes, absurd. In a case where the medication could more readily affect non-patients: a) I did not even realize this type of medicine existed; b) no one is wailing about “what if they put it up their noses?” :P

  2. Podkayne says:

    Facepalm. Personal experience, as a pharmacy technician, I get to hear, and unwillingly participate, in plenty of discussions about controlled substances and the people who take them. Not to the point of not serving them — if a prescription is in due form and a refill is due I’ve never heard of any nonsense– but definitely constant, bone-wearying judgment.
    There’s definitely some kind of moral value assigned to pain, since I keep hearing other techs and pharmacists say things like “I barely take two Tylenol if I absolutely have to” in tones I can only describe as ‘virtuous’. I keep asking “What’s wrong with not wanting to be in pain if alternatives exist?” and the answer is always “Nothing, but…”

  3. progressivelements says:

    I’m incredibly lucky in that I do take a timed-release heavy-duty painkiller. It’s the only thing that has made me able to work and live my life. I’m terrified every single day that someone is going to decide I’m a “user” and take it away from me.

  4. CaitieCat says:

    Totally grokked, Tori: my only best response can be, move to Canada. OMM, we have it SO MUCH BETTER here in this respect, so far. Though there are rumblings.

    4x: I take 4 10mg slow-release oxy, and 3x5mg oxy/375 acet/day for a degenerative back condition that leaves me literally immobile without them. I also have muscle relaxants prescribed, though we have OTC availability for things like Robaxacet too (used to be on the shelves, til too much got stolen in cross-border “shopping” from US people desperate for relief – see also pseudoephedrine in Canadian pharmacies).

    My doctor gives me (I swear I’m not exaggerating) two three-month prescriptions at a time, the second one post-dated. She also sets “month” as 28 days, though she prescribes for 30-day months, meaning I have a couple of extra pills each month for emergencies, whatever.

    As to the addictiveness: oxy, while highly addictive for some, is rarely so for people with serious chronic pain. I have never experienced any euphoria from taking the oxy I take (55mg a day regularly, more as needed). Each year I try to take at least two one-week drug holidays, to see how I respond to the withdrawal: other than being in the usual hideous pain, I haven’t had any symptoms of it.

    The US media and government WILDLY overstate the difficulties with addiction, when compared to the rates found in countries with patient-focused prescribing schema.

    And frankly, what price addiction, if you still need the stuff for whatever it was prescribed for, the addiction isn’t going to come into it, is it? Unless, of course, the doctor is coerced into not letting you have what’s needed. The big sign is increases in dosage: in ten years, I’ve only gone up by 5mg daily twice. That’s normal with my condition (which gets worse until it gets better).

    But partly it’s fascinating to me that once again, it’s the moralizers of the US scene – the Republicans – who want to get more government involved, lest anyone inadvertently catch some enjoyment out of their meds once in a while. It’s a Puritan backlash against the drugs deemed “bad” by the US gov’t, while the ones deemed good (alcohol, nicotine, caffeine) are the pride of the free market. Funny, that.

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