Wednesday, July 1, 2009
FDA Recommends Ban on Vicodin/Percocett
I must admit my jaw dropped when I read the headline about the FDA recommending a ban on two popular painkillers...Percocet and Vicodin. Both of these drugs are combination drugs, which means they combine another ingredient with acetaminophen (AKA: Tylenol). Tylenol is available over the counter and Percocet and Vicodin both require special "secure" prescriptions, yet it is the acetaminophen component that the FDA is worried about.
In 2005, over 28 billion doses of these meds were bought by patients in the U.S. (Don't you wonder who counted?) Let me repeat...28 billion. The FDA expressed concern because of tylenol overdoses and liver damage from too much acetaminophen. They reported more than 400 people die and 42,000 are hospitalized every year from overdoses.
None of the policywonks asked, but I could tell them that pain control is a huge problem for physicians and patients. We try to use as little drug as possible but pain that does not respond to over the counter medication like ibuprofen, naprosyn (NSAIDS) or Tylenol require prescriptions. Oxycodone and hydrocodone (the ingredients in Percocet and Vicodin) are not available without combining with another pain reliever like aspirin, tylenol or ibuprofen, except as controlled release form (Oxycontin and Oxyir).
Doctors have had their hands tied by the regulations about pain relief. In California we are required to take courses in "pain management" and can have our license removed if we don't manage pain or if we manage pain too well (and over prescribe narcotics). Patients can sue us for being left in pain and they can sue for becoming addicted to pain medication. We are damned either way.
Many physicians just opt out completely and send patients to expensive "pain management clinics". I just paid $808 for renewal of my controlled substance prescribing license and the idea of opting out looks appealing if the FDA bans these drugs without offering a substitute for patient care.
Posted by Toni Brayer, MD at 7:00 AM