The DEA wants to classify hydrocodone the same way it does oxycodone, a
more powerful analog that is the active ingredient in the long-lasting
painkiller Oxycontin. Oxycontin prescriptions cannot include refills.
Oxycontin or hydrocodone alone are rarely the sole cause
of a drug-induced death. More than 95 percent of these deaths are caused
by "polypharmacy," the ingestion of multiple illicit compounds,
usually laced with a lot of quite legal booze.
Picking on one drug won't do the trick, but picking on hydrocodone is a
particularly bad idea, because the DEA's proposals could well kill more
people from pain than they save from abuse.
How much pain and suffering does hydrocodone mitigate? There were 100
million new prescriptions for the drug last year in the United States,
given to 38 million patients. (This doesn't even count in-hospital use.)
Hydrocodone is by far the most prescribed drug in the nation.
Because there will be no more refills, DEA's proposal means at least 300
million office visits per year (figuring that most chronic pain
prescriptions are refillable twice). Nowadays, one just doesn't walk in
and out of a doc's office. Most pain doctors are so busy that appointments
must be made months in advance, and appointment, travel and waiting easily
burn half a day. That's 150 million worker days lost. Based upon average
annual wages, employers will pay ( and you and I will shoulder ) about $13
billion in wages for doctor-visit induced absenteeism. And the office
visits will add another $20 billion in cost, payable through the patient's
insurance or someone else's taxes.
Add this to the fact that, according to Katherine Foley, a pain expert at
Sloan-Kettering Cancer Center, pain already costs Americans $100 billion
per year in treatment costs and labor-related losses. Making pain relief
harder to get will only make it more expensive.
How risky is hydrocodone? According to the Drug Abuse Warning Network, a
systematic effort to procure objective information on drug-related deaths,
hydrocodone showed up in 46 bodies last year in Las Vegas, a town surely
prone to a bit of drug abuse. The number of hydrocodone pills prescribed
there in 2001 was around 27 million, and this doesn't even count the huge
number that fly in with tourists, gamblers and others who engage in
risk-taking behavior every weekend. I'd say it's a good bet that more
people die in legal casinos and brothels in southern Nevada from heart
attacks than are killed by hydrocodone.
Some other state data can be used to make fuzzy estimates of abuse-related
deaths. In 2002, there were 150 findings of fatal concentrations of
hydrocodone in postmortem examinations in Florida. Assuming conservatively
that this may catch half the deaths, and way too conservatively that
"Miami Vice" Florida is typical, this would maximize the number
of deaths per year associated with fatal concentrations of this drug at
around 6,000 nationwide.
Given the problem of polypharmacy, it's charitable to assume that the
DEA's proposal may prevent half those deaths. Are 3,000 deaths pretty high
overhead for pain relief? Well, consider NSAIDs. About 16,000 people who
use these medications for arthritis alone die each year, due to the drugs'
propensity to enhance internal bleeding. It would seem from this that DEA
would save a lot more lives if it made ibuprofen harder to get, so that
those with pain would have to switch to hydrocodone or oxycodone.
But that may be just one tip of the iceberg. Pain raises blood pressure
and researchers have found that every 10mm increase in systolic blood
pressure results, on the average, in a 40 percent increase in risk of
stroke and a 30 percent increase in risk of heart attack for your age
So if hydrocodone became less available, we could expect
potentially 8,000 more deaths from stroke and heart attack every year.
And, although there's no way to reasonably estimate the number of people
who will suffer bouts of depression, thoughts of suicide and actually
commit suicide after being denied adequate pain medication because of the
DEA's increasingly draconian measures, it's safe to assume that number
will be in the millions.
Compare that with about 3,000 deaths that can prevented by
the DEA's proposal. Those deaths are very unfortunate, but any
"solution" that punishes the 38 million pain patients who use
hydrocodone safely is not a reasonable solution.
Adapted from an article by Patrick Michaels, a senior
fellow in environmental studies at the Cato Institute.