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When Painkillers Meet Politics

by Jason Poquette, BPharm, R.Ph

I believe it was George Burns who once quipped “sincerity – if you can fake that, you’ve got it made!”  That quote comes to mind as I ponder the rather unusual move made this month by Massachusetts with respect to a recently approved prescription painkiller – Zohydro ER.

Massachusetts Governor Deval Patrick this month instituted measures to ban the sale of this FDA approved narcotic painkiller manufactured by Zogenix.  Our doctors may not prescribe it, our pharmacies cannot carry it, and our patients will not get it…at least for now.  Zohydro ER is an extended-release prescription narcotic analgesic that contains only hydrocodone and is approved for chronic pain which is unresponsive to other treatment options.  It’s for serious pain.  The medication is classified as a schedule II controlled substance and, like Percocet or Oxycontin, has a high potential for addiction or abuse. 

So why would Massachusetts ban the sale of an FDA-approved prescription drug?  According to Patrick, “Zohydro is a dangerously addictive pharmaceutical painkiller…and is not available in an abuse deterrent form.”  In other words, the governor is saying it might be abused, and the misuse of such a potent drug could have fatal consequences.  By “abuse deterrent” he is referring to technologies like those used in Purdue’s Oxycontin to prevent it from easily being crushed and then snorted or injected.  These technologies, by the way, are NOT currently available in most of the extended release narcotic prescription products.

His concerns, by the way, are not unreasonable.  The Bay State, as with many States in our nation, is in the thick of a serious battle with prescription addiction and drug abuse.  Massachusetts has seen the number of deaths due to prescription drug overdose increase by 47% since 1999, though our numbers are still fewer than most states.  Currently the number of deaths due to prescription drug overdose exceeds those caused by heroin and cocaine combined.  Pharmacy robberies, predominantly by those seeking narcotics, were up 98% in 2013 from the previous year.

But does this ban make sense and is it consistent with other recent decisions made by our state?  That’s a question worth pondering. 

The fact is that Zohydro ER could easily be seen as a safer alternative to the already available hydrocodone products which contain varying amounts of acetaminophen (arguably even more dangerous than hydrocodone in high doses).  Products like Vicodin, Lortab or Norco all contain hydrocodone and acetaminophen, are routinely prescribed, and contain no abuse-deterrent mechanism.  Furthermore, though Zohydro ER contains from 10mg to 50mg of hydrocodone per capsule, the total daily dose of hydrocodone which could be consumed by the products mentioned above is in the same ballpark as Zohydro. 

To ban Zohydro ER, while hundreds (even thousands) of prescriptions for other hydrocodone products are flying off the pharmacy shelves, seems gratuitous at best.  And to do so on the basis of taking the high road in the fight against addiction, while we are busy opening the doors to medical marijuana and casino gambling, just doesn’t pass the sniff test in my opinion.

Sometimes in the midst of political pressure it is more convenient to shoot a big target than to shoot the right target.  When politicians are only fishing for attention, a red herring is just as fine a catch as any.  But our problem with prescription addiction and abuse won’t go away with the swipe of a pen.  And some problems take more than sincerity to fix.

Jason Poquette, BPharm, R.Ph, is a practicing pharmacist who lives in Whitinsville. His columns comment on drugs and pharmaceutical issues in the news. He maintans the blog