The importance of the appropriate management of chronic pain is finally getting some attention. Unfortunately, it’s also seems to be the next “new” illness for money mongers and pharmaceutical companies to make billions more in revenue. This article from the New England Journal of Medicine gives insight to and hints at the perpetrators of this problem. http://www.nejm.org/doi/full/10.1056/NEJMp1404181
My opinion is that slow release formulations of narcotic pain medications are best for chronic pain, in most circumstances. Some of the caveats include older patients, those with liver or kidney failure and people who use pain medication infrequently and sparingly. One of the goals of pain management is to reduce the pain level and improve function on a regular and long term basis. This means using medications that last longer and prevent changing levels of pain severity throughout the day. Long acting pain medications also fix the “pill popping” phenomenon during which every 3-4 hours another dose of medication is needed to prevent severe pain from returning. Fast acting or regular formulas of pain medications typically only last 3-4 hours whereas slow release formulas work for 8 to 24 hours per dose. Less pills, better pain relief and increased activity is my mantra for pain management.
There has been considerable debate regarding the new slow release medication, Zohydro. It’s a long acting Vicodin (Hydrocodone). Vicodin is the most prescribed narcotic in the country for acute and chronic pain. It’s also most likely the “gateway” prescription that leads to addiction if not used and monitored appropriately. Zohydro could be a very useful medication in specific groups of people such as those having severe post- operative pain expected to last more than 2 weeks and older patients who don’t tolerate stronger narcotic medications but have chronic pain 24/7.
On the other hand, Zohydro will be lethal for specific groups of people. Unlike the current slow acting narcotic pain medications, Zohydro has no safe guards against tampering. That means it can be crushed and snorted or injected for an immediate “high” for drug addicts. That in turn means that it will ultimately be the next hottest drug available on the street. The end result of all of this is more accidental overdose deaths that could have been prevented.
Apparently, the FDA commissioner, Margaret Hamburg, isn’t so concerned about this. As a matter of fact, she also supports and approved a new drug, Evizio, an injectable naloxone, which is the antidote for narcotic overdose, ahead of schedule. Hamburg and other supporters believe that if doctors take extra steps and jump through even more hoops, then patients won’t abuse medications like Zohydro. This is the wrong idea. Patients who want to abuse medications will find a way. Enough burden is already on us doctors without the fear of having our medical license taken away because we didn’t follow another “prevention” algorithm before prescribing controlled substance medications when we deem it appropriate. The FDA has approved Zohydro even though doctors are telling them that risk of Zohydro is too great to put it on the market, as is. How does it make sense to ignore the recommendations of doctors who may be ultimately blamed in the event of adversity regarding the medication? Why does that make sense to Hamburg? My guess is that the almighty dollar is involved, as usual, despite the harm it may cause many people. How convenient that now we also have the antidote for overdose in Evizio that was fast tracked through the FDA. This is not a coincidence; Zohydro and Evizio will not be affordable and these medications will be very profitable.
I personally do my best to try to identify the high risk patients and not prescribe narcotic medications to them, but the nature of the addict is to be deceptive in order feed the habit and they are quite good. Just look at a few of my bad YELP reviews for some examples of this. Addiction is an illness. It is reckless for the FDA to approve a new narcotic pain medication that doesn’t have basic safeguards against abuse and misuse when accidental overdose of prescription pain medication is the leading cause of death in this country today. Shame on the FDA. Shame on people who value money over lives.