Posted on 04/23/2004 4:22:42 PM PDT by neverdem
Worried that millions of Americans are using prescription opiate painkillers to get high rather than to ease severe chronic pain, drug makers are working on ways to prevent abuse.
Cooperating closely with government officials and pain specialists, the companies are educating doctors, rewriting warning labels and tracking pills as they move from pharmacy to patient.
They are also reformulating pills with added ingredients. One combination blocks euphoria. Another produces a nasty burning sensation.
"The problem of prescription painkiller abuse is much bigger than people realize," said Dr. Clifford Woolf, director of the neural plasticity group and professor of anesthesia research at Massachusetts General Hospital in Boston and Harvard Medical School.
"No other drug type in the last 20 years had been so abused in such a short period of time," he said. "It's an epidemic."
According to the Substance Abuse and Mental Health Services Administration, more Americans abuse prescription opiates than cocaine and the abusers far outnumber those who misuse tranquilizers, stimulants, hallucinogens, heroin, inhalants or sedatives. After marijuana, pain pills are the drug of choice for America's teenagers and young adults.
How modern painkillers came to be abused is a story of good intentions gone awry. The painkilling action of the opium poppy has been known for thousands of years. Misuse of painkillers also has a long history. A century ago, mothers routinely rubbed tincture of opium on the gums of teething babies to soothe the pain, then took a nip for themselves.
If the medicine was not locked up, other family members often helped themselves. Indeed, the problem got so bad that makers of paregoric, the most popular liquid opiate, added camphor to their formulations to set off a gag reflex.
In recent decades, doctors stopped prescribing opiates because 5 to 10 percent of people who took them became addicted.
Fear of addiction led to the undertreatment of pain and to untold suffering, said Dr. Russ Portenoy, chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York.
The 50 million Americans with chronic pain needed help. It arrived five or six years ago when pharmaceutical companies put very large doses of opiates into slow-release formulations. A person who swallows such a pill feels no euphoria but is relieved of pain for up to 24 hours.
The new painkillers were heavily marketed to primary care physicians, Dr. Portenoy said. It was thought that the drugs would not be abused because addicts would not be tempted by sustained release painkillers.
Unfortunately, addicts quickly found that they could grind the pills, swallow or snort the powder and get a high dose of opiates delivered directly into their bloodstreams. They also liked the fact that the drugs were pure and the exact dosage was known.
To counter abuse, drug makers are developing ways to reformulate prescription painkillers. Purdue Pharma in Stamford, Conn., which makes OxyContin, is thinking of adding a second drug, called an opiate antagonist, that neutralizes the effects of the opiate.
The antagonist would be walled off using polymers or some other sequestering technique, said Dr. David Haddox, the company's vice president of health policy.
A patient who swallowed the drug would get full pain relief, as intended. But if someone tampered with the pills, the antagonist would be released.
Then, Dr. Haddox said, one of two things would happen: "If you are a recreational drug user, you feel nothing. The effect is canceled out.
"Why abuse something that has the same effects as a glass of water?"
"But if you are physically dependent," he continued, "you get no euphoria and it might cause withdrawal. You'd get a double whammy."
A second approach is to mix in a chemical irritant like capsaicin, the main ingredient of hot chili peppers, said Dr. Woolf, who has a patent on the idea.
Because the esophagus and stomach do not have many receptors for hot peppers, patients could take the pills as prescribed and find relief, he said. But the lining of the nose and cheeks are loaded with pepper receptors, and anyone who ground up such a pill would get a burning feeling in the chest, face, rectum and extremities, as well as paroxysmal coughing.
Reformulations are a promising avenue, but there are risks.
"We want to make sure that a patient who has need of an opioid does not suffer side effects from a second drug for which he or she has no need," Dr. Haddox said.
"We need to make sure the antagonist doesn't leak," he added.
Approaching the problem from another direction, drug companies and the federal authorities are trying to educate doctors and crack down on doctors who, for whatever reason, dispense painkillers inappropriately.
The Food and Drug Administration, Dr. Portenoy said, is going after doctors who are "duped, dishonest, disabled or dated."
For example, the agency is relabeling prescription painkillers to warn primary physicians of the risks involved. Some doctors, he said, are using the new drugs for broken fingers rather than devastating chronic pain.
New labels are also being introduced to tell doctors how to recognize patients who may be prone to abuse — those with a personal or family history of alcohol or prior drug abuse or mental health problems like bipolar disease, for example — and if the doctor is suspicious, how to monitor those patients with urine tests or other methods.
Some patients go doctor shopping, obtaining prescriptions from a dozen or more family physicians. Others tamper with prescriptions. To address this, drug manufacturers are providing doctors with tamperproof prescription pads that make forgeries difficult. When a prescription is photocopied, the copies say "void."
Doctors are also being taught how to write prescriptions more carefully. Instead of writing 14 pills, which a patient could alter to 140, the doctor writes out the word fourteen. Doctors are also being urged to lock up their prescription pads in the same way they would personal checks.
The Drug Enforcement Administration registers all people who handle opiates, inspects the documentation of opiate distribution, controls imports and exports and oversees the amount of the drugs produced, bought, sold or otherwise transferred. Yet, despite these controls, large amounts of prescription painkillers are being stolen once the drugs move into the hands of pharmacies, doctors and patients. Armed robberies, night break-ins and employee thefts are common.
In the face of so much criminal activity, the drug agency is stepping up efforts to prosecute dishonest pharmacists and doctors who sell opiates for personal profit and to use computer search programs and other means to close down so-called pill mills on the Internet. Electronic prescription monitoring systems are being enlisted. If the same prescription goes to 15 pharmacies, the computer system will sound an alarm.
Still, drug addicts will continue to find ways to foil the efforts to foil them.
People who came to like paregoric learned to boil the liquid, which removed all traces of camphor. The dregs were pure tincture of opium.
What protects your right to breath? You right to marry, or not? Or, maybe you have it backwards: Does the Constitution (a) enumerate our rights, or does it (b) enumerate the powers of government?
Now go back to the Prohibition amendment question.
Do you abstain from consuming psychoactive substances? We are way into "meaning of "is" territory here. What's so hard about "teatotal?"
Firstly, I was talking about the more common anti-depressants like Welbutrin and the opiate pain killers. One is a stimulant, the other is a depressant and no reputable doctor would prescribe both at once. Unless he's a quack.
It seems that there are other anti-depressant/pain killer treatments that would not cause drug interactions as you and some other posters have pointed out. I'll take your word for it.
And as far as what my "condition" is, I have a terminal illness which I rarely discuss in online forums anymore, because it only lead to problems in the past online.
But I can assure you I am doing well for now, am still working full time and am very thankful to God for that!
I agree 100%.
As someone who used to be depressed to the point of being suicidal in my late teens and early 20's(and attempting it more than once) I found that certain narcotics were very helpful psychologically.
I'm not talking about getting high every night to numb the pain of being depressed.
I'm talking about short term use of narcotics to break the patterns of negative thinking that keeps people trapped in depression day after day, week after week, often for years on end.
I know this from experience. I would get stuck in ruts of depression that I couldn't seem to get out of no matter how I tried. I would become so negative as to drive everybody away who wanted to help and would become physically ill, on top of it repeatedly.
However, I discovered that certain drugs, especially narcotic pain killers would as you said, elevate my mood. And not only that, they would break the self-feeding pattern of negative thinking, which would free me from the depression.
AND NOT JUST when I was taking the narcotics, but even long after I would stop taking them.
There is also a growing body of evidence that SSRI's actually induce mental illness in the long term, and are actually quite dangerous.
Yes they are. And the idea that person has to keep taking them EVERYDAY is no good, not only physically but mentally.
I think they make people into zombies.
Whatever. The fact is Ultram is classified as a synthetic opiate. Look it up.
A "teatotaler" is someone who does not drink alcoholic beverages.
You were asked a perfectly good and legitimate query,and supplied a ridiculous answer.
OK, so where do you draw the line? Would a teatotaler be OK with kava kava? Nicotine? St. John's wort? How about recreational scorpion stings (yeah, that's a current thread on FR)? Nitrous oxide (be sure to buy food-grade)?
How do you define it? Anything but alcohol? Or what?
Of course not. But a majority of people did. Twice. The fact that they did, especially the second time, shows me that the American populace in general is ignorant. Listen to some of Sean Hannity's "man on the street" interviews if you need more proof.
My back acted up a couple of days ago. Thankfully 1000mg of asprin put paid to that, but I have great sympathy for those who have pain that over-the-counter stuff can't handle.
Get over your druggie ideals, that's soooo old.
Celebrex is an NSAID which means it's an anti-inflammatory the same as motrin, aspirin and vioxx.
Here's some information about your so-called non-addictive painkiller Ultram:
http://www.orthomcneil.com/healthinfo/painmanagement/products/ultramfaq.html
Who Should Not Take ULTRAM®? Cases of abuse and dependence on ULTRAM have been reported. ULTRAM should not be used in opioid-dependent patients. Since ULTRAM can reinitiate physical dependence, it is not recommended for patients with a tendency to drug abuse, a history of drug dependence, or chronically using opioids.
Additionally, anyone who has had an allergic-type reaction to either ULTRAM or any product containing an opioid medicine (like Tylenol®* with Codeine) should not take ULTRAM.
Can I Take ULTRAM® Along with Other Medications? There are certain medications that should be used with caution while taking ULTRAM. These other medications include tranquilizers, sleeping pills, antidepressants, and opioid pain medicines. Be sure to talk with your doctor about all other medicines you are taking before starting your prescription for ULTRAM.
Does ULTRAM® Have Side Effects? All medicines, including ULTRAM, can cause side effects. People who experienced side effects with ULTRAM in medical studies usually did so at the beginning of treatment. The most frequently reported side effects experienced with ULTRAM were constipation, nausea, dizziness, headache, somnolence, and vomiting. Patients should talk to their doctors about any side effects they experience while taking ULTRAM.
ULTRAM may impair your ability to drive a car or operate machinery.
Why would Ultram impair your ability if there wasn't some type of kick or high associated with it?
Seizures have been reported in patients taking ULTRAM.
Patients with a history of severe, life-threatening allergic (anaphylactoid) reactions to codeine and other opioids may be at increased risk and therefore should not receive ULTRAM
From the pdf file on Ultram: Ultram is a centrally acting synthetic opoiod analgesic.
Ultram may induce psychic and physical dependence of the morphine-type (u-opioid)
Ultram can be addictive per the manufacturer of the drug in the same manner as morphine.
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