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What is Hydrocodone?
A) Hydrocodone is an effective antitussive (anti-cough)
agent, and as an opiate it is also an effective analgesic
for mild to moderate pain control. Five mg of Hydrocodone
is equivalent to 30 mg of codeine when administered orally.
Early comparisons concluded that Hydrocodone and morphine
were equivalent for pain control in humans. However, it
is now considered that a dose of 15 mg (1/4 gr) of Hydrocodone
is equivalent to 10 mg (1/6 gr) of morphine. Hydrocodone
is considered to be morphine-like in all respects.
are over 200 products containing Hydrocodone in the U.S. In
its most usual product forms Hydrocodone is combined with acetaminophen
(Vicodin, Lortab), but it is also combined with aspirin (Lortab
ASA), ibuprofen (Vicoprofen), and antihistamines (Hycomine).
Both tablet and liquid forms of Hydrocodone are available (e.g.,
Tussionex) Hydrocodone will react as a normal opiate in the
available field test kits.
is abused for its opiate-like effects. It is equivalent to morphine
in relieving abstinence symptoms from chronic morphine administration.
The Schedule III status of Hydrocodone-containing products has
made them available to widespread diversion by "bogus call-in
prescriptions" and thefts. Three dosage forms are typically
found (5, 7.5, and 10 mg) and their behavioral effects can last
up to 5 hours. The drug is most often administered orally. The
growing awareness and concern about AIDS and blood-borne pathogens
easily transmitted by syringe needle use, has made the oral
bioavailability of Hydrocodone attractive to the typical opiate
with most opiates, the adverse effects of Hydrocodone abuse
are dependence and tolerance development. Its co-formulation
with acetaminophen has also increased the likelihood of acetaminophen-induced
hepatic necrosis with high dose acute dosing, but slow escalation
of dose over time seems to protect the liver during high dose
chronic exposures seen with this drug.
How is Hydrocodone used?
Hydrocodone when abused is taken orally, chewed, crushed (then
snorted like cocaine), or crushed (then dissolved in water and
injected like heroin).
products are in tablet, capsule and liquid forms. A variety
of colors, markings, and packaging are available.
The major source of Hydrocodone to the street has been through
bogus call-in and forged prescriptions, professional diversion
through unscrupulous pharmacists, doctors, and dentists, and
large-scale thefts. The pills have been sold for $2 to $10 per
tablet and $20 to $40 per 8 oz bottle on the street.
What are the effects of Hydrocodone?
Can you overdose on Hydrocodone?
Yes, overdose of Hydrocodone can be fatal. If you suspect an
overdose, seek emergency treatment immediately. Symptoms of
a Hydrocodone overdose include:
Is Hydrocodone addictive?
Yes, there has been an increasing trend of abuse in non-Chronic
Pain suffering persons. The abuser of these drugs has been shown
not to be the inner city youth, but instead a famous actor,
a suburban real estate agent, or your next door neighbor. First
time abuse of these drugs has been surging, most commonly with
the oxycodone and Hydrocodone type painkillers. The two differ
slightly in their chemical makeup but have a similar effect
on the body.
age group has been affected by the relative ease of Hydrocodone
availability and the perceived safety of these products by professionals.
Sometimes seen as a "white-collar" addiction, Hydrocodone
abuse has increased among all ethnic and economic groups. DAWN
data demographics suggest that the most likely Hydrocodone abuser
is a 20-40 yr. old, white, female, who uses the drug because
she is dependent or trying to commit suicide. However, Hydrocodone-related
deaths have been reported from every age grouping.
What are other medications that include Hydrocodone?
BRAND NAMES (of Hydrocodone with Acetaminophen):
Allay; Amacodone; Anexsia; Anolor Dh 5; Bancap-HC; Co-Gesic;
Dolacet; Dolagesic; Dolphen; Duocet; Gesic 5; Hy-5; Hy-Phen;
Hyco-Pap; Hycomed; Hycotab; Hydrocet;
w/Acetaminophen; Hydrogesic; Lorcet; Lorcet 10/650; Lorcide
Panseals; Lortab; Margesic; Medipain 5; Megagesic; Megamor;
Norcet; Oncet; Panacet; Polygesic; Propain Hc; Ro-Codone; Rogesic
#3; Senefen III; Stagesic; Tycolet; Ultragesic; Vanacet; Vapocet;
Vendone; Vicodin; Vicodin ES; Zydone
What are the statistics of Hydrocodone abuse?
Hydrocodone abuse has been escalating over the last decade.
There has been large scale diversion of Hydrocodone. For example,
an estimated 7 million dosage units were diverted in 1994 and
over 11 million in 1997. In 1998 there were over 56 million
new prescriptions written for Hydrocodone products and by 2000
there were over 89 million. From 1990 the average consumption
nationwide has increased by 300%. In the same period there has
been a 500% increase in the number of Emergency Department visits
attributed to Hydrocodone abuse with 19,221 visits estimated
in 2000. In 1997, there were over 1.3 million Hydrocodone tablets
seized and analyzed by the DEA laboratory system. A recent petition
submitted to the DEA has requested a review of the control status
of all Hydrocodone-containing products.
becomes legal drug of choice
By EMILY RICHMOND,
Las Vegas Sun
VEGAS (September 16, 2001 1:48 p.m. EDT) - When she needed a
fix, Helene would flip through the yellow pages, looking for
a doctor she had not yet fooled.
to hydrocodone, a powerful prescription painkiller, Helene became
an expert at "doctor shopping" - visiting numerous
physicians to obtain multiple prescriptions.
go to the doctor and say your back hurts, that was always good
for a few refills," said the Las Vegas woman, whose name
has been changed to protect her privacy. "Supply was never
state Board of Pharmacy's prescription drug-abuse task force,
which monitors drug prescriptions, eventually caught on. The
board sent warning letters to all of the pharmacies and doctors
that Helene had visited, along with a printout of her prescription
"One of my doctors told me I had been flagged by the state,"
Helene said. "He told me to be careful, and said I could
get in a lot more trouble than he would. And then he wrote me
another prescription anyway."
- a mix of synthetic codeine and acetaminophen - is the most
abused prescription drug in the United States, according to
the Drug Enforcement Administration.
painkiller tops the list of abused pharmaceuticals in El Paso,
Texas; New York City; San Diego; St. Louis; Atlanta; Chicago;
Dallas; and Miami. It's known as Vicodin, Percocet, Lortab or
Lorcet, and the roster of celebrities who have admitted addictions
includes Green Bay Packers quarterback and three-time NFL Most
Valuable Player Brett Favre, actor Matthew Perry and model Niki
doctors in 2000 wrote prescriptions for more than 42 million
doses of hydrocodone - or about 17 pills for every adult in
In most cases, patients receive a single prescription for eight
to 12 pills after dental surgery or because of an injury, according
to the task force. The so-called doctor shoppers are less common,
but are believed to be a significant portion of the hydrocodone
prescriptions. For people with chronic, debilitating pain, hydrocodone
can mean the difference between being able to function and being
bedridden, doctors say.
no question hydrocodone is effective, when properly prescribed,
and can provide immediate relief," said Dr. Godwin Maduka,
a pain-management specialist and anesthesiologist at University
Medical Center. "But we also know there's a tremendous
level of abuse occurring."
a difference between developing a tolerance for a drug and physical
addiction, Maduka said. Tolerance occurs when a medication is
no longer effective at reducing pain, even when a patient increases
the dosage. Physical addiction occurs when a patient has been
on a certain medication for such a lengthy period that they
go through symptoms of withdrawal if they stop taking it.
also a pharmacist, said by the time most patients arrive at
his Las Vegas Pain Institute, they've visited a long list of
primary-care doctors. Most pain patients are not abusers, but
have simply developed a tolerance for medications and need additional
help, he said.
It's the doctor shoppers who are at the greatest risk, Maduka
have no real way of knowing how many doctors a patient has seen
before us, how many other prescriptions they have in their pocket,"
One solution would be a centralized database in which doctors
and pharmacists could look up a patient's history before writing
or filling new prescriptions, Maduka said. The state task force's
reports are helpful, but are only triggered after a patient
has visited numerous physicians, Maduka said.
was introduced to prescription painkillers through legitimate
means. After dental surgery in the mid-1980s, her dentist prescribed
a painkiller. She discovered the pills numbed her physical pain
and gave her a sense of well-being. For the next 15 years, she
struggled to get out of the drug's grasp. When her husband said
he worried about how many pain pills she was taking, Helene
cut back. She even tried quitting, but the night sweats, nausea
and chills - symptoms of her withdrawal - always won out.
think of drug addicts as being out on street corners,"
Helene said. "I'm a housewife."
Tylenol is the nation's most popular over-the-counter painkiller
- 8 billion to 9 billion tablets are sold each year - and the
most common form of acetaminophen used in hydrocodone manufacturing.
is a very good medicine if you're having pain, but no one realized
it would have such a high potential for abuse," said Dr.
Caroline Riely, associate medical director of the American Liver
Foundation. "It's the codeine portion of the drug that's
addictive, but it's the acetaminophen that's destroying peoples'
say adults should not take more than four grams of acetaminophen
each day; just 10 grams can cause lifelong liver problems or
even death. Most hydrocodone pills come in either 2.5, 5 or
7.5 milligrams of synthetic codeine, each mixed with 500 milligrams
At the height of her addiction, Helene took up to 30 hydrocodone
pills each day - nearly four times the recommended limit for
"I know how lucky I am to still have a liver that works,"
Helene said. "Given everything I've done to myself, I shouldn't
still be here at all."
The state prescription-drug task force wants the pharmaceutical
companies to reduce the amount of acetaminophen in each hydrocodone
pill, a request echoed by medical professionals across the nation.
In response, at least one pharmaceutical company is now making
a hydrocodone pill with 250 milligrams of acetaminophen.
Consumer Products Co., a subsidiary of Johnson & Johnson,
the company that manufactures Tylenol, has added new warning
labels about acetaminophen's potential for damaging the liver,
especially when the drug is mixed with alcohol.
DEA's prescription-drug classification system is based on the
potential for abuse. Schedule I drugs include heroin and Ecstasy,
which are both illegal in the United States. Schedule II drugs
include powerful painkillers, such as codeine, morphine and
Demerol. Cocaine is a Schedule II drug because it has some legitimate
medical applications in hospital settings. Schedule III drugs
include hydrocodone and anabolic steroids.
III drugs are easier to prescribe and ultimately easier to get.
A doctor is permitted to phone in a Schedule III prescription
refill to a pharmacy. Schedule II refills may only be written
after the doctor re-examines the patient. The DEA also requires
more stringent record-keeping of Schedule II prescriptions,
and it tracks how many each doctor writes.
another state battling the hydrocodone epidemic, tried last
year to reclassify the drug as a Schedule II. But the new rules
were quickly derailed by protests from pharmacists, physicians
and patients who said it would make it unreasonably difficult
for people to manage day-to-day pain. Florida's attorney general
took the unusual step of passing an emergency ordinance, restoring
hydrocodone's status as a Schedule III drug.
years ago the Nevada Board of Pharmacy considered moving hydrocodone
to Schedule II, but ended up voting against the plan, according
to its attorney, Louis Ling.
argument that "carried the day" for the board was
doctors' testimony that moving hydrocodone to Schedule II would
make it unreasonably difficult for patients in rural areas to
get refills, Ling said.
call it the Las Vegas Cocktail, but you won't find it served
at hotel bars or table-side in the casinos. A potent mix of
hydrocodone and the muscle relaxer Soma gives the user a heroin-like
euphoria without needle marks. It's also one of the most popular
recreational drug combinations in the United States.
street value of the cocktail's ingredients is high. One former
Las Vegas physician-turned-dealer made as much as $1 million
selling the drugs on the black market, according to federal
Evangelista, banned from practicing medicine in Nevada, used
his Illinois DEA registration to buy more than 500,000 hydrocodone
pills. Evangelista, who pleaded guilty to drug trafficking in
1999, died in a federal prison last year.
is the nation's most abused non-controlled substance, according
to the DEA. Nevada's pharmacy board is considering reclassifying
it, making it more difficult for addicts to gather the cocktail's
Soma isn't a scheduled narcotic, Nevada officials aren't sure
how many prescriptions are being written each year.
"If we do schedule Soma and start to track it, we expect
the numbers to match those for hydrocodone," Ling said.
"And we know the two being used together can be a hallmark
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