FDA On Removing Vicodin, Percocet From Market & Limiting APAP: Merged Thread

[static_mind]

Fuck hey, I had an operation here in Aus and all I was scripted was 30mgCodeine500APAP.

Pretty much everyone I know after an operation just had to suck it up.

However while in medical care the medics pretty easyly gave morphine shots. Talking to one he said pain was relevent to each person and its wrong to deny pain relief to someone of a painkiller that might seem excessive to ones experence but someone might be very sensitive to pain. So in the ambo if people kept saying they were in pain they would keep going up. Start off with that green whistle thing and move on to morphine.

He said even known junkies who were just trying to score given their shot of Morphine because theres no way of knowing if they really are in pain and in which case it would be wrong to make the assumption they are scoreing and not give them meds.

He said Heroin ODs were usally just monitored in hospital and only given narcan if they were in danger. From experence junkies get angry after narcan and sometimes collapse in the street outside the hospital as it wears off. So they would jsut watch them till they were sober enough and let them go.

Probably irrelevent but iv got a little buzz and thought some of you might find it somewhat intresting

 

[skuttlebutt]

Horray! now mabe I'll see less drunk idiots at parties popping 5 percs while drinking and wondering why they turned green and puked everywhere. I actually have had random people tell me that they purposly take more tylenol with their percs cause they think it makes them more fucked up. I mean thats just natural selection at its finest. is it just me or are there alot of really stupid people? anyway, im surprised the FDA is actually doing something smart for a change, saving dumb people from themselves because god knows I cant talk any sense into them.

 

[qwe]

if oxy 80 mg's are prevalent on the street, making hydro/percocet CII is going to A) make it less available to people who are in pain, and B) not effect the black market much

do they think hardcore addicts/dealers are going to just switch to codeine? no, they're gonna switch to fuckin heroin if they dont have oxy/dilaudid sources

which may actually be what certain people want now that i think about it...

 

[Tchort]

Percocet is CII The big difference would be Hydrocodone-only products becoming more prevalent, as they are CII vs Hydrocodone + one non-narcotic ingredient = CIII.

However, while Percocet is CII already, it is considered easier to get because of the non-narcotic ingredient: makes doctors more comfortable about prescribing it.

That seems to be what this is all about. These products are so widely prescribed because of the comfort level in prescribing them vs opioid-only products.

 

[garuda]

which may actually be what certain people want now that i think about it...

Bingo, by making pain meds super hard to acquire for normal people(addicts will just keep working til they get it, you can't stop them) they will make everyone turn to illicit street sources diverted from other patients or imported from overseas.......making everyone a criminal...hmmm.

 

[ChemicalSmiles]

This is never going to happen, and if it does ... Im cool with having no acetaminophen in my pills. :D

 

[Tchort]

With the new group of combination products, I'd be willing to bet we see a Hydrocodone combination product containing Orphenadrine, Phenyltoloxamine, Amitryptaline, Dextromethorphan, Diclofenac, Etodalac, etc.

New brand name drug = big business. A new Vicodin- without APAP. Still meets the CIII rules. Business as usual.

 

[StaffWriter]

you are an idiot


you can get oxycodone without APAP in many forms

I'm assuming the FDA is feeling pressure from recent overdoses in the news and will soon make it more difficult to get drugs that are CIII. How does this rationale make me an idiot? Yes, I know oxycodone preparations can come without apap or perhaps with ibuprophen in the formulation called Combunox.

 

[oh-pana321]

i personally doubt this change will happen soon, if at all.

its just unfair to those who've tried other meds and these narcotic/apap formulation seems to work best for them.

lets say they replaced the compounded opiates with the pure opiates for the people already prescribed them.. i think it'll increase the chance and amount of prescription drug abuse because they can now afford to take higher doses. it has been made very clear that tylenol in higher doses is dangerous, and its up to the doctors and patients to determine whether an apap formulation would be the best for the person when considering amount taken and how many times they take it daily. if someones taaking 2 pills a time 4x a day, of course its better to just prescribe them a non apap med. but for those taking like 4 pils a day, then i think its safe to be taking compounded opiates

and also, i can see doctors being much more reluctant to prescribe oxy or hydro in pure forms so more people who have legit chronic pain will have to suffer and ddeal with shitty tramadol or codeine

personally, i plug my opiates so apap isnt a problem for me

 

[sarsXdave]

I'm surprised it's gotten this far, but still expect a move to tramadol, at least to fill a lot of the 5/500 generic Vike and 30/300 generic T3 niches.

As far as ibuprofen goes, I'd be annoyed. Ibuprofen would seem work better than APAP for the types of pain that one gets hydro for (like back pain). But, it would mean a lot of new formulations without generics available. I'm only aware of Vicoprofen and Combunox, each available in only one strength.

US's Hycodan tablets are 5mg hydro/1.5mg homatropine, where Canada's are hydrocodone only. I could see that being a way they'll go, too.

 

[Colmes]

Ok so they take Opiate/APAP products off, what do they replace it with for similar pain? Pure oxycodone, hydrocodone? I thought they were thinking about it, and it ultimately came down to darvocet, which they allowed to stay on the market, despite its danger and uselessness for anything. I didnt read the entire thread, and the original is dated july 1st, so...yeah

 

[sarsXdave]

Ok so they take Opiate/APAP products off, what do they replace it with for similar pain? Pure oxycodone, hydrocodone? I thought they were thinking about it, and it ultimately came down to darvocet, which they allowed to stay on the market, despite its danger and uselessness for anything. I didnt read the entire thread, and the original is dated july 1st, so...yeah

Well, our general consensus was that they'll probably find something else undesirable to add to our opies or just give less-desirable opies like tramadol. However, the argument of those on the panel for this move is that all docs have to do is prescribe the amount of pure opioid and the amount of acetaminophen separately. In the media, to show the other side, there's lots of quotes from patients, drug reps, and doctors saying that they're scared of losing what works for them and that we're lessening choices, but neither is true.

Theoretically, this allows for much more fine tuning of opioid:APAP ratios, it makes it simpler (and cheaper, with mass production) to have 2.5/5/7.5/10/15mg hydrocodone tablets and 325/500/650 APAP tabs than to have Norco (always 325mg APAP), Vicodin (variable amounts of APAP), and Lortab (always with 500mg APAP), each on of them having at least 3 different formulae (5, 7.5, and 10mg of hydrcodone). Anyone who's pain was taken care of with a generic 5/500, can have pain taken care of with a 5mg hydro and a 500mg APAP. Whether they actually do this most likely depends on how hard the DEA wants to scrutinize them, as a doc prescribing lots of schedule II meds would currently be watched very closely.

But, shit, if I wasn't on dexamphetamine I would've told you to JUST READ THE GODDAMN THREAD. We had discussed most of these issues.

 

[d3viant]

personally, i plug my opiates so apap isnt a problem for me

Correct me if im wrong, but if you're plugging APAP it's going to end up in your bloodstream and eventually your liver anyway - so how does this help?

 

[djsim]

I'm assuming the FDA is feeling pressure from recent overdoses in the news and will soon make it more difficult to get drugs that are CIII. How does this rationale make me an idiot? Yes, I know oxycodone preparations can come without apap or perhaps with ibuprophen in the formulation called Combunox.

It doesn't make you an idiot.
Idiotic is someone who expects to abuse Vicodin for 6 months and have no liver damage. Or someone who smokes/IVs their fentanyl patches. Or wants to IV Soma.

 

[jzilla]

Correct me if im wrong, but if you're plugging APAP it's going to end up in your bloodstream and eventually your liver anyway - so how does this help?

[/offtopic]

APAP is very poorly absorbed rectally. So if you take and crush say, eight vicodin 5/500's, right there is what? Four grams/4,000 milligrams APAP, right? Well, by plugging that mixture, you're actually receiving a lot LESS APAP, than the four gram mark.

And a LOT of it, will just be waste. And you'll get rid of it the next time you go to the bathroom. You'll be absorbing the goods, while, bypassing destroying your live. If you decide to plug your compounded opiates.

In some ways, it's kind of similar to doing a CWE. Because, if you're doing a CWE, it's to remove the APAP. But, you don't get ALL of the APAP out, just MOST of it. So, you're taking a reduced dose of the drug, which is saving your liver. So, it's basically the same concept, just.. with plugging. You're receiving a reduced dose of the APAP, rather than taking the full amount.

I hope this helps.

/ontopic.

I'm personally not a fan of them removing the narcotic/apap formulations. Because, there IS a good synergy between the two, for a lot of people. But another a reason I disagree with it, is because what about those who need a narcotic for pain management, but don't need extended release oxycodone, or any extended release medication, for that matter.

I'll use my dad for my example. He's prescribed 10/325 Norco's, four/five a day. And that's good for him, they work well. He and his doctor both agreed that it worked well enough that he wouldn't need to be moved up the "narcotic chain." Now, if they're going to ban the narcotic/apap formulations, where will that leave my dad? Not to mention, other patients like him. I mean, is the DEA/Doctors/FDA just going to leave them out in the cold, to deal with no only their pain, but also the withdrawals of long term opiate use? It just doesn't make much sense to me. But, I guess the "people" have no real say over it, though.

/rant, lol.

 

[djsim]

APAP is very poorly absorbed rectally. So if you take and crush say, eight vicodin 5/500's, right there is what? Four grams/4,000 milligrams APAP, right? Well, by plugging that mixture, you're actually receiving a lot LESS APAP, than the four gram mark.

And a LOT of it, will just be waste. And you'll get rid of it the next time you go to the bathroom. You'll be absorbing the goods, while, bypassing destroying your live. If you decide to plug your compounded opiates.

In some ways, it's kind of similar to doing a CWE. Because, if you're doing a CWE, it's to remove the APAP. But, you don't get ALL of the APAP out, just MOST of it. So, you're taking a reduced dose of the drug, which is saving your liver. So, it's basically the same concept, just.. with plugging. You're receiving a reduced dose of the APAP, rather than taking the full amount.

Exactly. I'd still recommend a CWE, but it's probably a more efficient way to extract APAP from small numbers of pills. That being said, I wouldn't want anyone to quote me on that and boot 15g of APAP only to find out they had some wierd polymorphism and got liver failure.

I'm personally not a fan of them removing the narcotic/apap formulations. Because, there IS a good synergy between the two, for a lot of people. But another a reason I disagree with it, is because what about those who need a narcotic for pain management, but don't need extended release oxycodone, or any extended release medication, for that matter.

I'll use my dad for my example. He's prescribed 10/325 Norco's, four/five a day. And that's good for him, they work well. He and his doctor both agreed that it worked well enough that he wouldn't need to be moved up the "narcotic chain." Now, if they're going to ban the narcotic/apap formulations, where will that leave my dad? Not to mention, other patients like him. I mean, is the DEA/Doctors/FDA just going to leave them out in the cold, to deal with no only their pain, but also the withdrawals of long term opiate use? It just doesn't make much sense to me. But, I guess the "people" have no real say over it, though.

I really don't see APAP formulations being banned any time soon. It just too useful for everyday people. It's not like pseudoephedrine where other alternatives are available; if you have a peptic ulcer aspririn and ibuprofen are out of the question.
The way I understand it, Vicodin will go from S3 ==> S2.

 

[d3viant]

APAP is very poorly absorbed rectally

Thanks for clearing that up, sorry to go offtopic.

 

[jzilla]

Exactly. I'd still recommend a CWE, but it's probably a more efficient way to extract APAP from small numbers of pills. That being said, I wouldn't want anyone to quote me on that and boot 15g of APAP only to find out they had some wierd polymorphism and got liver failure.



I really don't see APAP formulations being banned any time soon. It just too useful for everyday people. It's not like pseudoephedrine where other alternatives are available; if you have a peptic ulcer aspririn and ibuprofen are out of the question.
The way I understand it, Vicodin will go from S3 ==> S2.

Yeah, but I still think if it went from a SIII to a SII, it'd still be a pain in the dick. Just for the simple fact that, the people who do take vicodin/whatever, would then have to get a physical Rx every month. Which, for some people, would just be a big hassle. Because, how it is now, where you can just call the doctor for a refill on your norco's, and they can phone them in, and you pick 'em up. It's just convenient for a lot of people. But, I do see your point. I just think they need to make it the minimal amount of apap, and still keep it a SIII, at least, in my opinion.

...And yeah, I hope no one does like 30 7.5/750's, then has their liver shut down. I'd feel kind of bad about that, lol. Just remember people: use common sense!

Thanks for clearing that up, sorry to go offtopic.

No problem, man. Always glad to help.

 

[Colmes]

I know they'd use tramadol, since that what is most similar to an actual opiate, below vicodin and percs... but still. tramadol i think is prescribed for a lower level of pain generally than percs or vicodin

 

[StaffWriter]

The most reasonable outcome (for the FDA at least) is to drop high apap formulations and reschedule Hydrocodone to CII leave the rest of the prescription guidelines for tramadol and codeine preps. That's the likely senario. I guess we will see.