Zohydro Media Frenzy - Identify the True Problem

Zohydro is a new formulation of the commonly abused drug hydrocodone.  It is set to be available this month, March 2014, and this has many upset.  There is no denying there is an epidemic of opiate/opioid use in the United States.  There is no doubt that this drug will be abused when released to the public for use.  Denial of either of the two previous statements could hardly be argued, but the media has created a storm out of this drug's release that is not appropriate.  No surprise that major media is creating frenzy over an issue that hardly deserves it (especially in comparison to the hundreds of much stronger prescription opioids that have been around for years, which created this epidemic that is ravaging through lives exponentially). What's worse is the misinformation presented as fact that is surrounding this drug.  Many articles I read were repeatedly inaccurate in reference to information regarding current and future opiate analgesics

Let's begin with some facts that should not be skirted around. As stated before, this formulation of hydrocodone will be abused and there will be diversion.

ACETAMINOPHEN TOXICITY 
Hydrocodone is nearly always prescribed in a formulation with acetaminophen.  There is an obvious need for a formulation of solely hydrocodone, which is zohydro.  Acetaminophen absolutely destroys livers when used inappropriately.  Most addicted to hydrocodone are literally killing themselves with the high doses of hydrocodone/acetaminophen ingested, reason being - acetaminophen toxicity.

The idea of using acetaminophen as an abuse deterrent is ethically wrong.  At what point did the concern of patients' possible opiate dependency surpass the physician's promise to protect from harm.  Opiate Dependency is not inherently harmful, but ingesting an extra two or three thousand milligrams of acetaminophen over the daily limit would absolutely qualify as inherently harmful.  

The hundreds of thousands who are abusing hydrocodone formulations are ruining their livers, day by day.  With no real cure for this opiate epidemic in sight, why not spare the health of those abusing the current formulations, with pure hydrocodone formulations.  Surely, an addict will get their fix before worrying about ingesting too much tylenol. In reality many addicts are unaware of the fact that acetaminophen overdosing is poisoning their liver.


For example, an individual buying hydrocodone off the streets has developed a tolerance of 100 mg / day.  This person usually is ingesting a 10 mg hydrocodone / 325 mg acetaminophen formulation.  Their daily acetaminophen intake is usually 3250 mg, the recommended daily limit is commonly between 3,000 mg - 4,000 mg daily.  Unfortunately for this user, today they are only able to find Vicodin formulated with 5 mg hydrocodone / 500 mg acetaminophen.  To maintain their daily dose of 100 mg of hydrocodone, this individual would ingest 10,000 mg of acetaminophen.  This amount would lead to acetaminophen toxicity, and cause severe liver damage.

In fact, in 2011 the FDA asked all manufacturers of prescription acetaminophen combinations to have no more than 325 mg per tablet and display on the bottle that acetaminophen can cause severe liver damage.

CURRENTLY AVAILABLE MEDS
Many of the articles about the Zohydro drug becoming a terrible problem on the streets seem to have the idea that a 50mg hydrocodone capsule is uncontested as the most potent opiate painkiller available.  This is simply false.  Hydrocodone is a mild opioid compared to morphine, oxycodone, hydromorphone, oxymorphone, etc.

Morphine is available in 200mg tablets - Approximately 4x potency of 50 mg zohydro
Hydromorphone is available in up to 64 mg tablets - Approximately 6x potency of 50 mg zohydro
Oxymorphone is available in 40 mg tablets - Approximately 6x potency of 50 mg zohydro
Oxycodone is available in 80 mg tablets - Approximately 2.5x potency of 50 mg zohydro

Scholarly Reference for Opiate/Opioid Comparisons
MUSC.EDU Opiate/Opioid Dosage Comparison Chart

ABUSE DETERRENT 
A valid argument is that this Zohydro formulation should be released with abuse deterrent technology.  Okay, that would be nice, but most opiate pain killers do no have abuse deterrent technology.  Also, many addicts have found easy ways around these deterrents.  At the end of the day, the abuse still happens. There is no technology to be added to a pill that can make an addict facing acute withdrawals say, oh no thank you.

Let's center our attention on the whole system. From pharmaceutical companies, all the way down the line.

Thanks for reading, and Take Care