Addiction specialists, medical professionals, and politicians have long questioned how easy it is to obtain a prescription for potent painkillers.
States have cracked down on "pill mills" that hand out narcotics to people who don't really need them, and a new hydrocodone painkiller hitting the market, Zohydro, has drawn sharp criticism because of its potential for abuse. The drug packs a high dose of hydrocodone and doesn't yet have tamper-resistant technology that would make it more difficult to crush and snort.
A federal judge recently blocked an effort by Massachusetts to ban the drug amid concerns that it would cause fatal overdoses.
But lost in the debate are the millions of people living with chronic pain. They say potent painkillers have allowed them to live productive lives — and that the backlash against them could put that in jeopardy.
Why Zohydro is different
Experts say that Zohydro could actually be highly beneficial for patients who use it responsibly and that it's up to the states to make sure that prescription drugs aren't falling into the wrong hands.
Zohydro is meant to be an extended-release pill, meaning the medicine is released slowly into your system instead of all at once. This makes it attractive for people looking to abuse pills — crushing or chewing an extended-release pill will release all the hydrocodone at once and provide a quick and dramatic high — but it's also ideal for the responsible treatment of chronic pain.
Zohydro's effects would last about 12 hours — much longer than the four to six hours of pain relief you'd get from a similar painkiller like Vicodin. For people whose pain is constant and ongoing, that's an important difference.
The drug also isn't cut with acetaminophen, which can cause liver damage in people who sometimes need a lifelong supply of hydrocodone/acetaminophen combination pills like Vicodin to treat chronic pain.
"With respect to having a product available for use for chronic pain, when the drug is used appropriately, yes, this is a good call," David Rosen, a former FDA official of 14 years who is now a partner at law firm Foley & Lardner , told Business Insider.
A necessary risk?
Some patients might not have much of a choice other than to take pills to help ease their debilitating pain. Conditions like spinal stenosis, permanent injuries, fibromyalgia, endometriosis and arthritis can cause chronic pain that isn't treatable with over-the-counter pain relievers.
"We have to have something to treat these patients," Rosen said. "For people with chronic pain, this is the only way that they can manage some sort of semblance of functionality as opposed to being totally debilitated — and even [with medication], it's very difficult."
But using narcotics like oxycodone and hydrocodone to treat chronic pain also leads to patients gradually building a tolerance and needing to keep increasing their doses to feel the effects. In some patients — about 3% — this can lead to abuse and addiction.
"You get addicted to these painkillers and it's very difficult to wean yourself off," Rosen said. "It's a delicate balance. That's why you need a pretty good interaction between the physicians, the caregivers, and the patients. And the pharmacists too. Unfortunately, sometimes we don't get that kind of dynamic interplay."
Sometimes, it's hard for doctors to closely monitor their patients' pain pill usage, which can create a dangerous situation.
The rise of prescription painkillers
This all began in the late 1990s, when doctors began prescribing more prescription painkillers as part of an effort to find ways to treat chronic pain. In 1997, two expert panels encouraged doctors to prescribe more prescription pain meds to promote "compassionate care," according to the Journal of the American Medical Association.
The rise in prescription pills also led to a rise in abuse and addiction. Some people got hooked on pills they obtained illegally, while others inadvertently became addicted to painkillers legitimately prescribed by doctors.
Eventually, this led to states passing laws designed to curb prescription drug abuse and overdose.
The chart below shows a sharp upward trajectory starting in the 1990s when states began passing more laws to regulate prescription drugs. Different types of laws — that strengthened regulations around ID requirements for picking up prescription pills, for example — were meant to stop people from gaming the system and obtaining pills without having a medical need for them.
But some chronic pain patients who need painkillers to live productive lives say that laws cracking down on abusers have made it nearly impossible for them to get the prescriptions they need in some states.
Chronic pain patients who have lifelong, debilitating conditions need regular refills of their prescription (unlike those dealing with shorter-term conditions who will eventually be weaned off the drugs), and it can be difficult to find doctors willing to provide this treatment.
"I cannot find any one willing, or qualified to take me," an Indiana patient told the Huffington Post. "I am a Christian and I do not believe in taking my own life, but I pray for an answer before I have no way to survive. I am not alone. There are so many pain patients whose lives are a living hell — waiting and praying to die."
While painkillers might be the right and necessary option for some people, they could be dangerous for others.
And people might have a false sense of security when it comes to pain pills because they're prescribed, even though doctors sometimes prescribe narcotics when other, safer options might be better.
Doctors need more continuing education and training to ensure they're properly prescribing, said p hysician and Duke behavioral scientist Peter Ubel , who wrote a book about how patients can work with their doctors to make medical decisions.
"Don't assume you're going to get the right response from your doctor," Ubel told Business Insider. "There's definitely misprescribing out there."
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