ZOHYDRO: What weighs more – A pound of feathers or a pound of hydrocodone?

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Is morphine more potent than morphine [extended release, MSContin et. al.]?
Is oxycodone more potent than oxycodone [extended release, OxyContin]?
Is hydromorphone more potent than hydromorphone [extended release, Exalgo]?
Is oxymorphone more potent than oxymorphone [extended release, Opana]?
Is hydrocodone more potent than hydrocodone [extended release, Zohydro]?

In a recent survey of pharmacy students, 100% of those surveyed responded with “no” when asked “is the hydrocodone in Zohydro more potent than the hydrocodone in Vicodin?”  That same question was posed to medical doctors at an informal meeting, just days ago, where all agreed that the hydrocodone in Zohydro is identical in potency to the hydrocodone in Vicodin.
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

Even Wikipedia got it right, “In the field of pharmacology, potency is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity.”

The amount of drug in a single tablet has nothing to do with potency.

Then why do medical people quoted in the media keep getting it wrong?  Is it because the media asks the question to several people until they hear the answer they want, or is it because neither one knows the correct answer? Or are they using misinformation and scare tactics to sell stories?  It’s probably a bit of each.  Nevertheless, it doesn’t change the fact that…
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

Drilling down a bit, let’s use the example of hydromorphone (Dilaudid).  Most believe that the approximate equivalence to morphine is as follows;
Oral morphine 100mg = Oral hydromorphone 25mg
This means that you need 4x less oral hydromorphone compared to oral morphine for the same response…

Translation, hydromorphone is 4x more potent than morphine because you need 4x less for the same response.
That my friends, is POTENCY.
To remind you, it takes the same amount of HYDROCODONE to do the same thing as HYDROCODONE, because…
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

Last week CNN reported on Zohydro, the soon to be marketed extended release hydrocodone.  In that piece, a Dr. Stephen Anderson is quoted as saying “You’re talking about a drug that’s somewhere in the neighborhood of five times more potent than what we’re dealing with now.  I’m five times more concerned, solely based on potency.”  From NPR’s morning news: “When Zohydro is released next month, it will be one of the most powerful prescription painkillers on the market.  Its highest dosage will contain 5 to 10 times as much hydrocodone as the widely used Vicodin.”  Did he say “most powerful?

I personally am 5-10x more concerned about any clinician that is able to prescribe these drugs without knowing the definition of potency, pharmacology 101.

It’s not “5x more potent” and it’s not “more powerful” because…
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

The potency of a drug is based on the concentration of drug or chemical compound needed to have a desired effect.  An EC50 value is determined for all drugs, which is the concentration at which the half-maximal effect of the drug will be achieved.  This EC50 value is the same for all hydrocodone products.  Meaning that the amount of hydrocodone needed to have the desired pharmaceutical effect would be the same for both Zohydro and the current immediate release hydrocodone products.   

Fab3-feathers-Zohydro-2
Left to Right:
Dr. Mary Katie Cronin (PGY1 Pharmacy Practice Resident), Dr. Annette Payne (Clinical Psychologist), Ms. Michaela Gardinier (Pharm.D. Candidate, 2014)

Changing the formulation in which a chemical compound is placed, will have no effect on the potency of that chemical compound.  It’s a trick question like – which weighs more, a pound of feathers or a pound of gold? Sure, different formulations will have an effect on how long it takes for the drug to enter the blood stream, how long until you get the desired effect, and even alter how the drug is released from the formulation.  But potency will always remain the same because…
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

Now that we know all hydrocodone products are equal in potency, we can move onto the real issue with Zohydro – the lack of abuse deterrence.  Whatever the reasons, Zohydro is not in an abuse deterrent formulation and that is a real issue at hand.  This is an area that groups such as PROMPT and PROP are likely in agreement because there is a real potential for abuse since hydrocodone can be crushed, affording abusers the opportunity to have a large milligram quantity in a small pile of powder for snorting…this is the very reason that OxyContin 160mg tablets were removed from the market.  It is also the reason why, after OxyContin was reformulated, the IR form of oxycodone 30mg became more highly desirable on the street.

More perspective and potential advantages of Zohydro:

Hydrocodone, milligram for milligram is equipotent to oral morphine.  It falls within the most popular of opioid classes, the phenanthrenes.  Drilling down a bit, it specifically is a dehydroxylated phenanthrene.  From a therapeutic standpoint, it is important to have a sizeable armamentarium of opioids from which to choose.  The reasons for this are many; there are inherent biological and polymorphic patient variables, including opioid receptor differences that affect response; some patients are able to tolerate certain chemical classes and not others, and the pharmacological differences make certain opioids more or less effective for some kinds of pain (i.e. neuropathic vs. visceral vs. somatic) as opposed to others.

As outlined in Hydrocodone: Potency, Popularity, Politics, & Practicality, Hydrocodone tablet/capsule and or liquid combinations include one of the following; acetaminophen (most popular, and branded as Vicodin®, Lortab®, and Norco®), aspirin, ibuprofen, or hydrocodone bitartrate and homatropine methylbromide (Hycodan® for cough).  There is no maximum daily dose of hydrocodone alone; it is however limited by the patient’s level of opioid tolerance, development of side effects, or exceeding the dose of whichever drug happens to be combined into the hydrocodone dosage unit.

In 2011 the FDA released a safety announcement to drug manufacturers regarding prescription medications containing acetaminophen.  That same statement was released again in 2014, this time directed to health care professionals in effort to limit the prescribing and dispensing of combination products containing more than 325mg of acetaminophen.  The FDA highlighted the risks of liver injury with daily acetaminophen doses greater than 4000mg by adding a Black Box Warning to these products.

Zohydro does not contain acetaminophen…HUGE ADVANTAGE for certain patients!

Just for fun, I would like to point out that all the warnings and precautions for Zohydro are the same as that for immediate release hydrocodone formulations, except for the acetaminophen.  There is no warning that states “Zohydro is 5x more potent than other hydrocodone products”.   And why is that?
HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

But, for those of you who keep asking me, I’ll be crystal clear.  I am in favor of having extended release hydrocodone available to select patients that need it.  I would prefer it was available in a formulation that has abuse deterrent technology.  However, FDA regulation does not require an abuse deterrent formulation of other extended release products, and Zohydro is no exception, nor should it be singled out.

As always, comments are encouraged and welcome!

Michaela GardinierA special thanks and acknowledgement go out to Student Pharmacist Michaela Gardinier for her thoughtful contributions, writing, and research time.  Ms. Gardinier is a Pharm.D. Candidate, 2014 at Albany College of Pharmacy and Health Sciences.  Over the past two years, she has taken a special interest in the practice of pain management and is now on a learning rotation with Dr. Fudin.

28 thoughts on “ZOHYDRO: What weighs more – A pound of feathers or a pound of hydrocodone?

  1. My doctor has just started me on Zohydro 20 mg bid. However Medicare wants me to take MS Contin Morphine Sulfate instead. I have Chronic pain not tolerated on Fentanyl patches because the 3rd day there is no med left in patch and my bp reaches stroke level. I have already had one stroke directly related to my painting level over time which pain meds were not controlling. Sometimes it’s not your doctor but an Insurance company or the CDC stopping your doctor from giving u the meds u need.

  2. I used to be an anesthesiologist for 3-years and was asked by my attending if I’d be interested in a Pain Management job offer. Ironically, it paid 20% more than being an anesthesiologist which my salary was already absurd! The point is I had patients in my waiting room trading say a 10/325 Norco for 40mg OxyContin plus $60! I can spot an addict before they open their mouth, just own up to it and maybe you and your physician can come to some agreement but until you literally learn about MEDICINE, PHARMACOLOGY, THEN PHARMACEUTICALS WILL NEVER MAKE ANY SENSE TO YOU!! Pills are like algorithms, if you don’t know what an algorithm is then God help you cause nobody else can!!

    Dr. I will not write you for #125 Percocets, let alone 2-tablets of 5/325 Norco that hospitals give to those who are junkies but didn’t here it from your ER Doctor

  3. I was just switched to 15mg zohydro twice daily for 3 blown out disc in my lower back. The pharmacist said it’s the equivalent to taking 1.5 10mg norco, which would be 15mg of Hydrocodone. I think what these people saying its 5xs more potent are accurate in a way because zohydro can be perscribed up to 50mg which in theory (and according to your Hydrococone is Hydrocodone is Hydrocodone theory) would be 5 10mgs norcos which is 5x the strength of one pill.

    As a review these 15mg tablets have not done anything for me.

  4. I was put on norco 5/325 for lumbar arthritis, L5 S1 bulging discs and fibromyalgia . I was takin one every 6 hrs , so 4 a day, very low dose, but i stuck with scedule. Went to see my pain management Dr. And advised they were no longer working as well ,probably tolerance, asked him to put me on a higher strengthe 7.25/325 only because i didnt wasnt mre tylenol. Instead he put me on morphine es 15mg x2 every twelve hrs, does nothing and makes me sick, tried for a month and a half befor i called his office, i only get to see him every 3 months, he had his nurse call me back to tell me he wasnt going to change it no what, i am 57 and have never taken drugs or akcohol . Why am i being treated this way?

  5. Great job, Jeff. to HS – this is what Jeff and I describe as “neuromysticism” – which is a DEA and media-fueled effort to “create science” in its absence. And kudos to Zogenix for Zohydro’s incredible safety history since it was released!!!!

  6. Hydrocodone is Hydrocodone? In theory yes, but in relevance, no. I have torn disc’s S1 L5. Along with steroid injections I was on Vicodin first, then switched to Norco, now I am taking Zohydro as of today. The difference? Energy and quality of life. I was switched to Zohydro because I was starting to need more and more Norco to conquer what is commonly referred to as ‘the edge’ of pain, so my doctor has switched me to Zohydro for the extended release effect, but I am not feeling anything but zoned. Norco not only took the edge off, but I was able to move around, be completely coherent and focused and do work without feeling zoned. My energy levels are lower on Zohydro 20mg. I took my first pill around 1 pm. Picked my son up from school, sat on the couch around 2 pm and came from a zone around 239pm. That’s 39 minutes of lost time staring at the TV with my son. It felt like I went to sleep and work up but I know I wasn’t asleep. I don’t like it, I still feel pain.. Norco kept me focused, alert and pain free. Maybe Ill give it a month to work, but switched from 4 x 5/325 Norco a day to 2 x 20mg of Zohydro a day, I m not feeling better at all. I have a pretty high tolerance to Opiates but how can you say anything without your doctor or the feds thinking your an addict. I am addicted, yes… not to pain medication but to enjoying life without the pain. I feel happy whenever I can accomplish something without the pain. Whenever I can pick my son up and tickle him, without feeling the pain. There is such a bad stigma around these drugs, i feel such hate for the idiots who abuse them and ruined it for others. But in reference to the article… there is a difference. Hydrocodone is not just hydrocodone.

    1. Ashley,

      Thank you for sharing! Hydrocodone is in fact hydrocodone; how it is formulated and the relative peaks and troughs based on that formulation is quite a different story as you well pointed out. Best of luck. Dr. Fudin.

    2. Ashley,

      Hydrocodone is hydrocodone ,,, Zohydro is extended released hydrocodone without the acetaminophen and this may be why your feeling this way, the peaks in between the release of hydrocodone compared to Norco that puts out all 20 mgs of hydrocodone at once plus a lot of acetaminophen, YUK . Maybe Zohydro isn’t releasing enough hydrocodone for your particular type pain and you might be experiencing some withdrawal from the gaps in release of hydrocodone . I’m not a doctor like Dr. Jeff but have had similar problems with time released opioids . Kadian did this same thing to me a long time ago, too long of gaps in the time release version of morphine , I felt it didn’t work at all. So my doctor prescribed the fast acting morphine MSIR for break thru pain and that did the trick and made the Kadian work better. I no longer take this type medication because of tolerance.
      Ask your doctor if he can allow you Norco for break through pain and you will not have this problem of being drowsy, it fills in the gaps, just a thought.

  7. I am a long time spinal cord disease sufferer and have been on Norco’s morphine etc etc.
    I have been taking Zohydro 50mg for 2 months now and I have to say it is much better at reducing pain then the same amount of hydrocodone claimed in Norco’s by a bunch. It also does not damage my liver a nice bonus. I am convinced that these drug companies are using inferior or less than claimed hydrocodone in their pills and thus higher profit margins. That’s never happened before.
    I think that this Zohydro is far superior at relieving pain then anything else that I have tried (for now)

  8. Jeff,

    I love your use of the rhetorical question. Since reading your post, I have on several occasions posed your question and have actually gotten the answer, “A pound of hydrocodone, of course!” Sadly, this illustrates how the debate is shaping up.

    What’s sad is that the grandstanding and hand wringing over this “cousin to Avinza” has taken the focus off of the disease (addiction) and placed it on a molecule (hydrocodone). What a waste.

    Your post inspired my post on the same subject over at:
    http://jamespmurphymd.com/2014/03/18/is-there-method-to-this-march-madness

    Thanks,
    Pat

  9. Gawker has just published an incredibly alarmist, inaccurate piece on Zohydro.

    Painkiller 10 Times Stronger Than Vicodin to Hit the Market This Month

    The first sentence reads:

    A new opiate called Zohydro, developed by Zogenix and approved by the FDA, will enter California markets this month, despite the protests of a number of doctors and experts. Zohydro is ten times more potent than Vicodin.

    I will link back to this blog post in the comments over there.

    Apologies if my html is screwed up. I am a beginner.

    1. Robin,
      Do you suffer from chronic pain ,or is it your taking these medications for another reason.
      Abuse of any chemical is going to ruin someone’s life eventually. If you suffer from chronic pain
      and your not getting the pain relief you need your doctor has not titrated you up to an effective dose.
      When I first started to have severe chronic pain in 1996 doctors only gave me 2 Vicoden 3 times a day. My chronic pain was greater than what the Vicoden could do for my pain and I had to take more to get the relief I needed and I ran out of my medication too soon. This looked like abuse when in fact I had no life because the chronic pain had robbed me of that nice life I use to have. When a new doctor correctly titrated me up to an effective dose of a time released opioid I got my life back. I know this sounds confusing, and I hope whatever the problem is you get things straightened out.

  10. Good clarifications. Now send this blog to Public Citizen, NPR, Medpage Today and other well-meaning but misguided orgs / media / groups jumping on PROP’s bandwagon. It is disappointing to hear these groups blindly repeating inaccurate half-truths and imprecise language. What ever happened to the investigation in investigative journalism?

    1. I am in Severe Severe Chronic Pain from DDD herniated disks, Missing disks and a pinched Spinal Cord, Sciatica, torn Lateral ligatures Ect Ect.l-1 -l5 and S1, I have been battling the pain all my life from a misdiagnosed condition as a child but for past 4 years have been almost totally bedridden daily, I’ve been on Duragesic 100mcg every 48 w 30mg Oxy IR 3 x daily as bt, Oxycontin 2 60mg tablets 3x daily with the 30mg IR with it, tried Demoral, Was on Methadone 30mg 3 x dailyvw 30mg Oxy too, Now trying Ms Contin 60mgs 4x daily with 30mg Oxys 4 x daily and I am really struggling, I DO NOT IN ANY WAY ABUSE MY PRESCRIBED MEDS, Nor do I use illicit drugs or drink alcohol, I am only 33 years old! I just want to be able to live a normal life, SSI Disability keeps denying me even though I can’t even get out of bed, Saying I can be a phone operator for a living!!! I’ve worked Full Time for 15-16 years of my life!! Construction at that 10-12 hour days, This disease hit me and I can’t even get approved for Medicare! I want people too know that we overlook that people are in Severe Severe Pain and can not ABSOLUTELY even Survive without Ooiod/Opiate pain medications, Well not just opiods but a mixture of Meds thatvwe have to suffer dearly for a long time to find, I have lost all hope and I am totally depleeted of my zest for living, Very hopeless BC I just want my Pain controlled and it’s so so so hard to do, So next time you think everyone is a “Junkie” BC they take legitimately prescribed pain meds nomatter what the med and automatically think that these people “Don’t need that high of a Dose” how the HeLL!!!!!!!l do you know what I need or how much Pain I go through on a Daily basis, I have lost all my Friends, Girlfriends, everything I loved to the immense pain I go through and BC I was uninsured doing construction Building your nice comfy quality built Home for you, Until you experience the pain keep your mouth shut is my opinion, Drugs abuse will be rampit nomatter what you do, Cartels will find new drugs and new ways to keep it coming, I myself don’t know where to even purchase a pill if I run out or a bag of cannabis illegally even if I needed too, I have to suffer through it, People with SCP are being decimated by this crap about pain medicine, Now we have 13 year olds shooting Heroin!!! Leave our Meds alone, I agree there are junkies but they are VERY VERY easy to spot compared to soneone in acute Severe Pain, Pain Medications do not get people in pain high nomatter what the medicine, I’m in USA BTW,Virginia, If you are really in Severe Pain it’s all just like taking an aspirin for a headache, Pain/Headache just slowly dissapates except we know our pain is coming back w a vengeance in 4-12 hours!! And we live with it Day and Night 24/7, I can’t even throw the ball to my fog like I used to anymore, Please keep making good pain medications BC there are millions of TAXPAYING! VOTING! Citizens out there that are uninsured and SSI Disability just doesn’t give a damn nomatter how long you have worked, even if it’s a lifelong disease and inoperable, and even if pain medication like Morphine, Fentynl, Oxycodone, Dilaudid, Oxy Morphine, Ect didn’t exist speaking for myself I would not be able to handle life anymore and would use my pistol or rifle one last time, Not that I’m suicidal but Pain can get so bad it’s just unbearable to even continue to live. This is how my life is going as of today,,My only hope is finding the cheapest combination of Meds to be able to take a short walk in the Park. I wish this Country would not letvwell meaning, Loving and kind people like myself, Also hard working Americans fall through the cracks and just let us flop like a Fish out of Water, It makes my faith in my Country go down the tubes BC I’ve bleed and literally broke my back paying for Policeman, Ambulances, Roads Ect through taxes yet none of those services apply to me just BC I worked for a company that had no insurance when my Disease took full affect…Again not everyone is a Junkie and most all people in Severe Pain do the best hey can to take meds as prescribed and are Definitely!!!! Not selling the very Meds that keep us alive, Literally, People who have never experienced debilitating pain for a month or year or two straight need ponder the thought, “Would I say the same thing if it happened to me” I’m 33 years young and let me tell you it hit my faster than lightning strikes the Rooster on the Barn, God Bless all who are suffering and keep advocating and making doctors understand that your pain is Unbearable!!! Keep your chin up and Hydrocodone is Hydrocodone you fools ” people that say it’s 50x stronger than this or that” A 50 mg Zyhydro is simply 5 10mg/325 Tylenol Norcos or Vicodins wo the Tylenol, And in my opinion Hydrocodone is as week as Aspirin for Severe Pain, Trust me I am not by any means Opiate Naïve! My suffering is a testament to that. Thank You…Andre’ K. Cooley Richmond Virginia.

      1. Hello Andre’…

        So Sorry About All This Pain You Are Experiencing. But My Only Question Is This:

        Within The Laws Of All 50 States Which ‘Limit’ A Pain Patient’s Daily Amount… Just How Are You Allowed To Go Over Either 100 mgs-To 120mgs Of Opiates A Day ? Some States Are Talking About 90 mgs Per Day. As You Know… If You Take A 20 mg Tablet Of Say Oxycodone Or Oxycontin That 20 mgs Automatically Changes Into A 40 mg Tablet. Same With Dilaudid And For Sure The Now Off The Market Opana. So To Explain Further: That 20 mg Tablet That Now ‘MAGICALLY’ Changed Into A 40 mg Tablet Counts Against Your Daily Amount. Hope I Made Sense. I’m @ 120 mgs Daily {Which Is The Maximum Amount I Can Have.} I Take 4-30 mg Tablets Of MS Contin ER. I Hope Everything Gets Better For You. Take Great Care.
        Sincerely, Brother Will

      2. Ssdi,turn me down,said not insure work my whole life,stroke ,can not walk,no hope Dr gives me norco ,barley helps scare to ask for something stronger

  11. Its inevitable that chronic pain sufferers are going to want to try this new Zohydro now that they got the wrong information thinking Zohydro will be five times more potent than what we’re dealing with now. When I think of five times more potent , I think compared to what, after all HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!

    So when pain sufferers switch from Methadone or OxyContin to Zohydro thinking its the most powerful prescription painkillers on the market I cant wait to hear their response in pain relief. Just keep in mind that HYDROCODONE is HYDROCODONE is HYDROCODONE is HYDROCODONE!
    Its as simple as that.

  12. I’ll play a bit of the devil advocate role. If hydrocodone is such a valuable opioid to have in our therapeutic armaeterium then why is the United States the country that consumes “99% of the world’s supply” – maybe clinicians that could have it in other countries are not interested. Hydrocodone is popular in this country because just for a little while longer it will remain a schedule III drug – five refills over the phone, don’t need to see the problem pain patient in the office. Pass Go, collect $200. Many clinicians think that because hydrocodone has been a schedule IIII agent it is less potent and maybe also thought less addicting than schedule II agents. There is so much prescribed in this country that you would think clinicians would know everything there is to know about the agent since it is used so frequently. Unfortunately, like many drugs prescribed this is just not the case. That’s why when folks make these remarks about Zohydro being 5x the potency of the current hydrocodone products it is just further evidence regarding the lack of fundatmental knowledge of opioids.

    After many years of taking care of patients I have never really felt that I was without other options by not having a single entity hydrocodone product (immediate release or sustained release), I have always been in the habit of just not using hydrocodone in my patients. I suspect there are a few patients that based on their opioid receptor configuration, pharmacogenetic profile and other yet unappreciated variables that hydrocodone is the ideal opioid for them. But why aren’t other countries that can have hydrocodone (I’m not talking about India, most of Africa or Eastern European states) utilizing it like we do in the United States – I suspect that they feel they already have plenty of opioid options to chose from for their patients – just saying.

    I agree with Dr. Fudin if we are going to have a new sustained release formulation of any opioid appear on the market then let us please place it in the best abuse deterrent technology currently available to us to protect as many folks as possible.

    1. Thats just what MNK is on the verge of offering to the marketplace pending FDA approval: Xartemis- A combo acetaminophen and oxycodone hydrochloride that is an Extended Release and may be Abuse Detterent. Seems as if it will nicely fit an unmet need.

    2. I’ve heard that the 99% number is a result of the majority of other countries not having hydrocodone available to use. They won’t, don’t, and can’t prescribe them. So it appears as if the country that can is abusing and using more. Red herring.

      1. You are correct Marsha. The following is an excerpt from the “In press” textbook chapter, Atkinson TJ, Fudin J. The problem with chronic pain and opioid medications. In ed., Peppin J, Kirsh K, Coleman J. Pain and Prescription Drug Diversion: Healthcare, Law Enforcement, and Policy Perspectives. Publication pending. Oxford University Press. 2013.

        The resultant sensationalized statistics are too often reported in reputable peer-reviewed journals lending them an apparent legitimacy. Recent examples include the claim that the “United States representing less than 5% of the world’s population, are by far the largest group of opioid users consuming 80% of the world’s supply of opioids” or “Americans use 99% of the hydrocodone available globally.”10,11 These statistics have been widely publicized and published by a variety of organizations and yet are misleading.
        The claim that Americans use 99% of the hydrocodone available globally is a half-truth. Hydrocodone in this regard can be compared to American football in a worldwide sense because no other country chooses to use it. Just as the rest of the world plays soccer and calls it football, we use hydrocodone (which mg for mg is equivalent to oral morphine) in combined formulations with acetaminophen, aspirin, or ibuprofen. In Europe, it’s more common to see dihydrocodeine, a codeine derivative and weaker analgesic compared to hydrocodone, used for mild to moderate pain or simply morphine itself. Hydrocodone is in Canada only in a cough syrup or elixir but not otherwise used for pain treatment. Hydrocodone has also been used in Australia but has largely been replaced by morphine. Ignoring this exclusivity of hydrocodone skews the picture of why the U.S. consumes the worldwide majority of hydrocodone and the reasons why hydrocodone has been prescribed more than any other prescription drug in the US. The practical reality is that hydrocodone has become a favorite of physicians across the country because it is the only opioid analgesic of significant potency that over many years was not a schedule II controlled substance by United States federal regulation. Hydrocodone combination products are schedule III controlled substances because it was originally believed the combination with acetaminophen or ibuprofen were less abusable compared to other products and potentially more effective in treating pain.12 This means physicians can write prescriptions for hydrocodone with up to 5 refills and avoid multiple patient visits for prescription renewal which is frequently required of oxycodone and nearly all other chronic opioid analgesic therapy.12

        References:
        10. Manchikanti L, Fellows B, Ailinani H et al. Therapeutic Use, Abuse, and Nonmedical Use of Opioids: A Ten-Year Perspective. Pain Physician 2010;13:401-435.
        11. Ioam.statistics
        12. Donovan KJ, Fudin J. How Changing Hydrocodone Scheduling Will Affect Pain Management. Practical Pain Management. 2013 June; 13(5):69-74.

    3. Protect How? Just lets more Heroin and Cocaine on the Streets for our Kids to get to instead of a pill out of your medicine cabinet, It’s already happening, The Heroin Epedidemic has risen 400% as a response to your Wax coated pill deturent crap that Ruins the pain killing properties of the medication for people that need it, Yet brings more drugs to our kids BC kids are going to find a way to get high and there are PLENTY of scumbags out there just drooling to hell with a nice strong bag of Heroin, “Can’t get Vicodins BC anymore, Don’t worry try this” is all they have to say. It’s happening at an alarming rate in Virginia in direct response to your Oxycodone/Pain Pill battle, It’s just like Prohibition, How many lives do we have to see lost for nothing BC Naïve scared peole who hear something on the news take it to alarming levels and bring on Terrible drug epedimics in response, I’ll bet you don’t even suffer from a toothache, Well if there can’t crush the pill they damn sure can cook up raw opium or Heroin which is what all pain pills are made from!!! I’m mad BC your messing up Meds that kill pain by screwing up the formulation BC it won’t digest like it should but you people gave opened a literal “Pandora’s Box” or more fitting “Paregorics Box” Food for thought.

  13. Sadly, many people are simply imprecise in their choice of terms.
    My guess (my hope?) is that these “experts” are trying to express their concerns about the lack of abuse deterrence/resistant delivery provisions in this formulation by using (incorrectly) terms that are media friendly.

    Unfortunately, we often don’t get a chance to know if they really know that what they’ve said is incorrect or not. I have regretted (on occasion) asking a simple, clarifying question of an “expert” when I realize that they actually don’t know that what they’ve said is incorrect. Now, I usually try to frame my questions in such a way as to give the individual the opportunity to “put the paint brush down – and strip away from the corner” 😉

    I think you’ve pointed out these errors while trying to put the very real concerns about this product into a clearer light. Nicely done.

    Thanks

    Doug

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