Hydrocodone, a prescription drug, is a highly addictive medication with a split personality. On the one hand, it often is a blessing to those in severe pain. On the other, it can be a curse, a drug that -- in the wrong hands -- is the United State's second most abused medicine. A new formulation of the drug, which could reach the market by 2013, could exacerbate both the benefit and harm provided by the painkiller. That's reason for considerable concern in a nation where abuse of prescription drugs, already a major problem, continues to grow.
Currently, hydrocodone is a component in more than 400 branded drugs. In every instance, it is used combined with another, non-addictive drug like acetaminophen, The new drug, in development by four companies would provide hydrocodone in pure form. Experts rightfully worry that the pills would quickly become a drug of choice because abusers would simply crush it to get an immediate high. There's reason for such worry.
OxyContin or oxycodone, another powerful, addictive painkiller, is the nation's most-abused medication. Despite efforts to make it tamper-resistant, abusers still can crush it to obtain a quick high. The fear is that the new hydrocodone formulation, once approved, would quickly travel oxycodone's path from highly regulated prescription medication to widely available street drug.
Manufacturers and others say that is unlikely to occur. They say that current law requires those who will take the new drug to visit a physician each time they want their prescription refilled. In the best of worlds, that might work. In the real world, the law might not be much of a safeguard. The parade of physicians -- so-called "pill-mill docs" -- who run afoul of the law for indiscriminately writing prescriptions attests to that.
The obvious way to end that possibility is to ban the new drug. It's not as simple as that. Pure hydrocdone, many scientists agree, can serve a useful purpose. It could treat chronic pain more efficiently than many painkillers currently available without the risk of liver damage associated with some combination formulations containing hydrocodone. There are persuasive arguments on both sides of the issue.
The price of U.S. painkiller abuse already is high. Deaths attributed to hydrocone use continue to grow. Emergency room visits related to hydrocodone have quadrupled in less than a decade and now cost hospitals millions annually in unreimbursed care. No one wants a new drug to increase those costs or to elevate the potential for abuse.
Food and Drug Administration officials and scientists will have to decide, probably this year, if the benefits of the new medication offset the risks yoked to its potential for addiction. That won't be an easy decision to make, but fact, not emotion or cash-bearing pharmaceutical company lobbyists, should determine the fate of the new drug.