Experts, Lawmakers At Odds Over New Powerful Painkillers

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Critics say, with a prescription opiate and heroin epidemic, more drugs are unnecessary in a market they say is saturated with pain pills.(Photo: File photo (Flickr))
Critics say, with a prescription opiate and heroin epidemic, more drugs are unnecessary in a market they say is saturated with pain pills.(Photo: File photo (Flickr))

New powerful pain medications are drawing criticism from addiction stoppers. Ohio lawmakers are considering banning one of the drugs as the state copes with pain killer addiction. WOSU takes a look at how lawmakers, the courts and doctors are trying to balance pain relief with addiction prevention.

They are powerful painkillers — a new breed of opiate pain pills. These drugs are pharmaceutical industry firsts. And they have some state leaders and medical experts concerned.

Critics say, with a prescription opiate and heroin epidemic, more drugs are unnecessary in a market they say is saturated with pain pills.

House Bill 501 proposes to ban Ohio doctors from prescribing one of the drugs.

Representative Robert Sprague, of Findlay, co-sponsored the bill.

“This is a powerful opioid. And what is leading to the rampant use of heroin, and the supply of heroin on the streets, is people becoming addicted to the prescription opioids,” Sprague said.

Sprague wants to ban Zohydro. It is pure hydrocodone. Despite some objections, the FDA approved it late last year.

Another new drug, Moxduo, combines morphine and oxycodone in one pill. The FDA is reviewing it, and it, too, has received push back from experts.

What makes these drugs different from Vicodin and Percocet is neither Zohydro nor Moxduo has acetaminophen. Acetaminophen, taken in large doses, can cause liver damage, so the FDA strictly regulates its use.

Zohydro can be up to 10 times stronger than Vicodin.

“I find it absolutely terrifying and disturbing,” Lisa Roberts said.

Roberts is a long-time nurse at the Portsmouth City Health Department, the epicenter of the state’s prescription drug abuse problem. She said she watched pill mills increase exponentially, along with overdose deaths, crime and disgraced physicians.

Roberts supports the bill to prohibit Ohio doctors from prescribing Zohydro.

“It’s like you have more and more bigger bullets flying at you all the time, you know, with the approval of these blockbuster drugs.”

Some medical experts say the drugs needs what is called an abuse deterrent, something that keeps users from crushing it so it can snorted or injected. Neither Zohydro nor Moxduo Immediate Release has an abuse deterrent.

Critics, who urge the FDA to rescind its approval of Zohydro, say opiate addicts unfamiliar with it could easily overdose and die.

But some in the medical community say new drugs are essential.

“I believe there is a need for better pain relievers,” Dr. Paul Christo said.

Christo is a pain medicine specialist at the Johns Hopkins University School of Medicine in Baltimore. He said people do not respond to pain medications the same way.

He said the dual-opiate Moxduo could help chronic pain sufferers who can’t get relief.

“If you give me morphine for pain control, it may not do the same job, it may not work as well as it would for you,” Christo said. “So I think the idea here is that, OK, let’s use two different opioids, they may bind to different receptors and better reduce pain.”

Christo said he, too, worries about opiate addiction and the damage it causes. But he said the discussion needs to focus on safer administration.

“We examine whether they have any psychiatric diseases or illnesses, for example, that could predispose them to increased risk of using something like Zohydro or OxyContin,” he said. “And then we also make sure we do some urine drug testing, I mean, I do, to ensure that patients are using the drugs properly and safely.”

In Ohio, Representative Sprague doesn’t want anyone to get the chance to abuse Zohydro. But his bill to ban it could face roadblocks.

Massachusetts banned Zohydro this spring, but a U.S. District Court judge reversed the order saying federal law trumps state law.

Sprague finds that ruling disconcerting.

“Why don’t we have an option as a state to prohibit something to be sold that we know is going to kill our citizens,” he questioned. “How can a federal bureaucracy legalize one of these powerful pain medications, and they’ve done it in a way that overrides their independent physician panel that clearly voted no, 11 to 2, against the adoption of the drug.”

House Bill 501 is going through the hearing process, and the makers of Zohydro are expected to testify before a subcommittee this week.

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  • scott

    Zohydro er is VERY LOW on the totem pole of strength! There are MANY drugs out there that are much more potent, so why are politicians picking on this one? Furthermore, zohydro is NOT 10x more powerful, it’s an extended release pill designed to last 12hrs vs immediate release, and also comes in 10mg,20mg,30mg,40mg versions, yet the headline grabbing media only ever sites the strongest 50mg version which is reserved for only extreme need patients.

    The FDA WANTED pain meds to have less or no harmful acetaminophen, zogenix created zohydro er to fill this need, FDA approved it and stands behind it, yet all of these politicians (who are NOT doctors) are trying to look “tough on drugs” by singling out a drug that is actually LESS potent and BETTER for chronic pain sufferers!

    For goodness sakes, WV senator Joe Manchin who is against zohydro, his daughter is the CEO of rival drug maker MYLAN! Mylan pain drugs that are STRONGER than zohydro AND they were the #2 contributor to his campaign! They also make vicodin generics! (they stand to lose a lot of money from people switching to the safer zohydro pill.) Think about it folks. Why doesn’t anyone write a story on that giant conflict of interest!?

    • Maramascara

      The fact is that prescription drugs are a dirty business. You will find the prescription drug cartel clad in suits, ties, white lab coats. This drug cartel point fingers at poverty-level, small-time street drug dealers, let them take the prison time, bear the moniker “drug dealer”; however, the MAJOR dealers of drugs, and the people making the the greatest killing financially, are all “legitimate”, white collars. I did my college thesis on this.

  • davidbecker2

    Dr Christo fails to distinguish between the sensation of pain and the underlying pathology. Pain is more then a sensation. Opioids may help sometimes in the short run with the sensation of pain- in the long run they make the pathology of pain worse. Doctors should focus on helping the pathology of pain and not just comfort oriented care- opioids are just comfort oriented care- stem cells , electrotherapy, acupuncture, platelet rich plasma, diets etc get to the pathology of pain.

    • Ryan

      Oh yes, stem cells. Let me just hop on my plane with a mountain of cash and go get some magical stem cells lol.

      • davidbecker2

        Gee wiz ryan- they do it in NJ they do it in NY- less then a thousand-and in europe, panama and other countries cheaper then that- maybe you need to do some homework on the issue instead of displaying your ignorance.

    • Ty Ford

      Dr. Christo’s response was “edited for radio.” It’s a sound bite. The question itself lacks the proper context and construct. It’s NPR, not the American Pain Association. Before you tout your “shoulds” Go here for more:

      • davidbecker2

        The DEA has collected over 1200 tons of unused opioids in the last 4 years- that is over 20 billion unused pills or 33% of all prescribed opioids are unused- and likely much more than that is unused- and 6 million people each year misuse opioids.. Opioids only treat the sensation of pain. Dr Christos web page lists the AAPM,FSMB and ACPA as resources- the AAPM and FSMB has been under investigation for promotion of opioids. The ACPA has Dr Turk- who was part of the IOM report on pain and he may soon be implicated in a pay to play scheme with the FDA and pharmaceutical companies-regarding opioid regulation. Maybe you need to do more than skate on the surface of things- and yeah the 9 functions of my middle prefrontal cortex are well methylated- nothing like horizontal and vertical neural integration.

    • TyFord

      Good for you; I’m sure you were a real winner in the Debate Club. Your “facts” must be correct because I’m reading them on the Internet. Let’s see how you respond with a nice case of PHN, Pudendal Neuralgia or End Stage Pancreatic Cancer.

      • davidbecker2

        You have a framing bias. I help people in pain and so knowing about the person is more important then their diagnosis. Furthermore you frame the question in allopathic terms. But in any event the person’s goals are what I would first need to consider.

        • Ty Ford

          You are grossly myopic and have no clue as to my point of entry (which is anything but allopathic) or Dr. Christo’s approach. Instead of making assumptions and being argumentative for no particular reason than to empty your spleen, then back off and begin practicing what you preach, if possible.

          • davidbecker2

            Sounds like your habenula and amygdala are both hyperactive. Dr Christo is one of those neo pain specialists who knows little more than Bonica’s pain management. IF he would like to engage in a debate that is uninhibited robust and wide open Im sure I wont have to engage in multidimensional partnering to show him his approach is just another einshrankung of what is possible when it comes to pain care. And whether it is seifukujitsu, tit tar, ilf neurofeedback, two feather formula, Reams biological theory of ionization, complete cellular mind body alignment,biomagnetic pair,Spenglarsan, bioontology,Mickel technique, Perrin technique, kayakalpa, hirudotherapy or noesitherapy- i can name 5 treatments for every one treatment for pain that doctor Christo can name. And let me disabuse you if you think im boasting- not at all-its just those practicing Cnidian biomedical antipathic medicine like Dr Christo who thinks he has a biopsychosocial and progressive approach to pain really don’t fool pain care advocates like myself who have done our homework- but again bring the good doctor and we’ll see if he has done his homework.
            I practice what i preach- im the author of the american pain rights act and have 26 legislators in nys signed onto legislation requiring education in pain care- i dont think Dr Christo has gotten one legislator to sign onto one bill to improve pain care- all my legislators from my councilman, to my state legislators, to Congressman Engel and two federal senators have signed onto such legislation- what a coincidence.

          • Ty Ford

            Sorry, pardon my ignorance. I didn’t realize you were a troll.

          • davidbecker2

            Ty- do more homework on the issue. You can call me whatever you want but invite the good Doctor and youll see hes mostly hot air-like his colleagues in medicine-their moral and mental laziness is legion and frankly Christo is just another member of the AAPM wolf pack- i would tell him he is boring and a go along to get along kind of guy overstimating his abilities and underestimating the problem of pain in the U.S.

  • Ty Ford

    wait until you’re in real pain before you decide whether they should be used.

    • scott

      Yeah, kind of silly right? Zohydro is simply vicodin without the acetaminophen and extended release vs immediate release, that’s it! And there is all of this giant hoopla going on?! Let’s see; Less potent drug – check, Less damaging to liver – check, Giant political/money motivated me$$, – check check check!!

  • Michael Schubert

    The only people they can find to say it’s ‘terrifying’ is a nurse?!?!? Nurses follow physician’s orders. She obviously knows very little about medicine since she’s basing her ‘expert opinion’ on “watching pill mills”. How come NOBODY has stated the fact that hydrocodone does NOT provide a ‘rush’ like oxycodone, morphine, etc. because it needs to convert into the active metabolite hydromorphone in the liver to become effective. Anyone wonder why there has NEVER been an injectable hydrocodone product for use in hospitals, surgery theaters, etc?? Same reason, it would still take time to convert to become effective. It’s obvious the competition is behind this misinformation assault on the WEAKEST extended release opiate on the market, Zohydro has 3 YEAR EXCLUSIVITY, if Zohydro isn’t removed, the FDA cannot approve Purdue’s ER Hydrocodone product. And with $600 Million per quarter profit from OxyContin, and hundreds of millions invested in research, Purdue has the money and the motive to wage this well-coordinated misinformation barrage. Zohydro cannot become the next OxyContin, first of all it’s a different age and there are many more restrictions on opiates. Secondly, the next OxyContin is already here, it’s called Roxicodone 30mg. Immediate release and it DOES provide a ‘rush’ unlike injecting hydrocodone. Read about opiates here, then form your opinion.