Tree-Hugging Dirt Worship

February 11, 2012

I’m all fo’ Zohydro

Filed under: Uncategorized — Tags: , , , , , , , , , — paragardener @ 7:57 pm

Lately I’ve seen rumors flashed about Zohydro, a new super-painkiller “10 times stronger than Vicodin” that will create a new category of pill addict. This appears to be some mix of brazen scaremongering and bleak ignorance. I think, if released for doctors to prescribe, Zohydro will be less problematic than Vicodin for both pain patients and “street” users.

The scaremongering began December 26 of last year, when the Associated Press issued a hatchet job on the proposed new pill. The piece was entirely focused on the potential abuse potential of Zohydro. It quoted anonymous “critics” and anti-drug activists frequently, and barely laid out manufacturer Zogenix’s case for the pill. Newspapers and CBS News then repeated the story, sometimes making it more sensational in the process, thus creating the impression of widespread panic amongst authorities. I will now put this scare to rest with my incredibly influential blog.

What is Zohydro, really? It is time-release hydrocodone, an opioid drug already available in the popular form of Vicodin. Zohydro may be considered as time-release Vicodin, without the second ingredient acetaminophen (aka Tylenol).

Pain patients must take Vicodin every four to six hours, which is unpleasant. The pills aren’t small, and you have to carry them around like an addict because otherwise you’ll end up in pain and far away from relief. People lucky enough to sleep through the night will unluckily wake up unmedicated and in pain. To solve the problem, Zohydro contains several doses that gradually dissolve in your stomach. If the “super-pill” Zohydro contains 10 times Vicodin’s dose of hydrocodone, it also takes 3 times as long to release it. Clever people may be able to defeat Zohydro’s time release technology and get the entire dose at once, but even very stupid people can chew up a handful of Vicodin pills and achieve a similar effect. IMHO, extended release medication is nothing to be afraid of.

Each Vicodin pill also contains 500-750 milligrams of acetaminophen, aka Tylenol. That’s the equivalent of an extra-strength Tylenol, or more. According to a poison-control resource buried within NIH’s website, no one should consume more than 4,000 mg of acetaminophen in a day. Overdose causes the usual nausea-abdominal pain-convulsions pattern of poisoning, possibly leading to liver and kidney failure and death. Guess what, NIH? Vicodin addicts blow out that 4,000 mg limit each day and every day. They are killing themselves because there is simply no source of hydrocodone available that is not mixed with a second drug.

The safety of acetaminophen is questionable. Personally, I’d rather pop a hydrocodone (or heroin) pill than a Tylenol if I had an annoying headache, because acetaminophen stresses your liver and I drink enough alcohol to stress my liver already. A literature review published in the Annals of Pharmacotherapy found that patients with no risk factors were having their livers hurt by taking acetaminophen daily, even when they stayed below the accepted 4,000 mg limit. In January 2011, FDA asked pill manufacturers to keep acetaminophen to below 325 mg per pill, to limit the damage. Vicodin manufacturers are still putting out the same old formulations.

I wholeheartedly agree with my mortal enemy, the FDA, on this issue. Crank down the acetaminophen levels in our medicines! Tylenol is mixed into many, many common medicines for cold, flu and so on, despite all of the people with risk factors against it, and despite the risk of combining multiple medications that contain acetaminophen and accidentally overdosing.

So why are people slamming Zohydro for not  containing a deadly drug? Apparently, some people believe that lacing hydrocodone with poison is an appropriate “abuse deterrent.” According to the AP’s miserable excuse for a story:

At a conference for investors New York on Nov. 29, Zogenix chief executive Roger Hawley said the FDA was not pressuring Zogenix to put an abuse deterrent in Zohydro.

“We would certainly consider later launching an abuse-deterrent form, but right now we believe the priority of safer hydrocodone — that is, without acetaminophen — is a key priority for the FDA,” Hawley said.

Something that makes you puke when you take too much might be a good abuse deterrent. Something that gradually eats your liver without giving you symptoms is a sadistic and violent punishment on drug abusers, not a deterrent.

Apparently, the folks at FDA get it, but AP’s Zohydro story was driven by statements from organizations like National Coalition Against Prescription Drug Abuse, Advocates for the Reform of Prescription Opioids, and Physicians for Responsible Opioid Prescribing. I have to suspect that these groups are driven by a pleasure-hating Puritanical streak quite as much as they’re driven by a genuine concern for patients and addicts (I’m being totally unfair, to the Puritans).

Dave Masko, writing on Huliq, voiced the claims that “people in real pain live with it” (implication: people taking pain pills are all whiny hypochondriacs) and suggested that pain relief is a luxury comparable to getting drunk. Once we’ve identified painkiller users as escapist subhumans, I guess it is acceptable to deny them any relief or launch a deadly attack on them through their livers.

Hopefully there is reform in the medical establishment, based on evidence and reason, to allow safer pain pills onto the market. Hopefully, the AP will give equal billing to drug manufacturers and FDA as it gives to anti-drug scaremongers in future stories (maybe patient advocates could even sneak a quotation in there).

I’m all for Zohydro. Everyone has a right to try to manage their pain, damnit! These people raising trivial concerns about a less-dangerous version of Vicodin should really take a long, hard look at where they’re coming from. I hate it when people I know are hurt or killed by drugs — but would you really “protect” addicts from their own stupidity over and above patients’ rights to live without extraordinary pain?



  1. I was really hoping there would be no codeine in Zohydro. I am a baby about pain but can’t take most pain meds due to the codeine. “Something that makes you puke when you take too much might be a good abuse deterrent. Something that gradually eats your liver without giving you symptoms is a sadistic and violent punishment on drug abusers, not a deterrent.” Excellent point.

    Comment by cindy — February 11, 2012 @ 8:36 pm

    • Hmm, most pain meds do not contain codeine. Maybe you had a bad reaction to codeine so the docs do not want you on any opioids? That’s kind of harsh, as those are the major painkillers that actually work for a wide range of serious pains. If it’s as simple as no codeine, there is a zoo of pills available to you, morphine, oxycodone, and fentanyl, oh my!

      Comment by paragardener — February 12, 2012 @ 12:33 am

  2. Very interesting information. My husband has spinal stenosis & has been working with his doc to find just this sort of relief: slow release with no acetaminophen. Trick is that Medicaid has to cover it. We can’t afford health insurance that would treat his “pre-existing condition.”

    Comment by Cedar Kennan — February 11, 2012 @ 8:43 pm

    • I don’t know if this will help, but apparently a few people are being helped by an early phase of Obamacare called Pre-existing Condition Insurance Plan, PCIP. More people are eligible but are not hooking up with the program.

      It sounds to me like Zohydro will be released January 2013, if the process is not derailed. FDA sounds very friendly to it, but it still takes forever to license a new drug.

      Comment by paragardener — February 12, 2012 @ 12:45 am

      • Thank you!! I had no idea such a thing existed. Will be looking into PCIP.

        Comment by Cedar Kennan — February 12, 2012 @ 1:27 am

  3. Ethan — This blog post was sent to me by this service I signed up for that sends me lots of stuff on chronic pain and meds for it, wherever they might appear on the interwebs. This is a fantastic post because it explicates quite clearly (and reasonably) the mendacity of the the FDA’s claim that they keep us safe as well as the societal prejudice pain patients must endure! Please keep shining the light on the follies and deceptions of our current drug policy.

    Oh, and FWIW, there are no fentanyl “pills” for oral consumption as it’s bioavailability by mouth is negligible. There are fentanyl lozenges that allow for transmucosal absorption, and of course transdermal patches. I believe there are in addition intranasal formulations either now available or already approved for release in the very near future, and I hear an inhaler is in the process of being approved. All fentanyl products now on market except the transdermal patches are approved for breakthrough cancer pain only, but of course they can be, and are, prescribed off-label.

    Hope you’ve been doing well and must say that my quick review of many parts of your blog leaves me mucho impressed.



    Comment by mike — February 12, 2012 @ 9:48 pm

    • Hydro WITHOUT Tylenhell?! I am SO ECSTATIC! I have been on the magic hydro since 8 (chronic bronchitis) and am due to get my summer cold soon… ;) So finally the pharma man has decided that killing livers is out so we can step on the opiate gas. I will say this, hydro has only made me nauseous once and that was from my first use. NOTHING will stop an abuser no matter what crap you use as a “deterrent”. Will be asking the go old GP about this one.

      Comment by silvererieann — June 29, 2012 @ 4:25 pm

  4. Acetaminophen is the most popular painkiller in the US. It is best known by the brand name Tylenol but is sold under 97 different brand names. It is known as paracetamol in many parts of the world. It is also sold in combination with other drugs in more than 100 products.During cold and flu season, people who take acetaminophen for arthritis are at risk for acetaminophen poisoning. Taking just twice the recommended dose of acetaminophen can cause acute liver failure. Unfortunately, this has already happened to an alarming number of people because it isn’t hard to do. Two years ago, more than 56,000 people visited the emergency room due to accidental acetaminophen overdoses and 100 people died from unintentionally taking too much. Worse yet, the numbers appear to be growing.^

    Stop by our web blog too

    Comment by Broderick Caronna — February 7, 2013 @ 4:26 pm

  5. simply legalize codeine for OTC sales like they do in Australia!~!!!!

    Comment by ricky — November 11, 2013 @ 3:49 am

  6. Just let me run up behind those folks who oppose Zohydro…hit them in the lower back with a sledge hammer and then see what they say about pain management!!!!!

    Comment by ricky — November 11, 2013 @ 3:51 am

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