Schedule Change for Hydrocodone

[Dave ARNP]

Please be advised that a petition has been submitted to the DEA requsting that all products containing Hydrocodone (Lortab, Lorcet, Vicodin, Norco, Maxidone, Tussionex, ect...) be changed from a CS Schedule III to a CS Schedule II.

This would put it on par with drugs like Morphine, Fentanyl, Methadone, all Oxycodone containing drugs and so on.

While I completely agree that Hydrocodone is a very popular drug of abuse, I could not disagree more in making a change to the level of restriction of the drug. Changing this drug a Schedule II will be a HUGE blow to those practicing pain management.

I encourage you to contact your state DEA offices, your legislators, and local NP's/MD's/DO's and voice your concern about the possible change.

If you have any questions about what problems a possible change could cause, feel free to post them. I'll do my best to respond.

Dave

[NRSKarenRN, BSN, RN]

Legend Drug - A drug which has on its label "caution: federal law prohibits dispensing without a prescription." (H)

http://www.insweb.com/learningcenter/glossary/health-l.htm

[Dave ARNP]

Guess I shoulda cleared Legend drug up before now

We refer to all non-controlled subtances as legend drugs. It's either controlled, or legend.

Dave

[P_RN, ADN, RN]

Dave I've always wondered why Codeine is a II and Tylenol #3 with the same amount of codeine is a III. The APAP is as much a danger as the narcotic . Ultram is a good analgesic but I also recall Talwin injectable was once touted as not habituating. Docs would write for 30cc bottles for patients. I think ultimately Ultram will be considered habituating.

I wonder about such things randomly.

[Dave ARNP]

Okay, lemme address T3 verses straight Codeine first.

DEA scheduling is all about how big of a potential for abuse there is. Sometimes they get it right, sometimes they don't. IMHO, Ultram should be a schedule II. But I'll digress.

Pain medication usually comes in two forms. Pure and compounded.

When we speak of a pure form, we're referring to a medication that is not compounded with anything. Basically this means it's pure drug. Compounded drugs commonly have another agent combined in the tablet/injection. These combinations are designed to enhance the medications effects, or decrease side effects.

Here are some example of pure medications:

Oxycontin

Methadone

Codeine

Oxy IR/Oxyfast

Roxicodone

MS Contin

Kadian

Avinza

Duragesic

Actiq

Demerol

Talwin

Darvon-N

Numorphan

Dilaudid

Oramorph

Here are some examples of compounded medications:

Lortab/Vicodin/Norco/Lorcet/Maxidone/Anexisa (Hydrocodone and APAP)

Percocet, Tylox, Roxicet (Oxycodone and APAP)

Mepergan (Demerol and Phenergan)

Tylenol II, III, IV

Fioricet w/Codeine

Darvocet

Empirin w/Codeine

Soma Compound w/Codeine.

Talacen

Now, on to the question at hand.

Why is codeine a class higher than codeine combined with APAP.

This answer is simple. "Straight" codeine has a higher abuse potential.

One of the things people look for in drugs of abuse, is their ability to isolate the pure opioid away from any compound. Abusers are smart enough to realize that you can only take so many Lortabs before the amount of APAP becomes toxic. In some instances, mainly liquid preparations, the active opioid can be isolated from the compound (APAP) and abused. When dealing with Codeine, you already have the drug isolated. There's no need to seperate it. Ofcourse with Tylenol III, you've got to pull away the Tylenol.

Thus, "straight" codeine has a higher abuse potential.

This clear things up?

Dave

[Dave ARNP]

Here is a page from http://www.dea.gov

Codeine

Codeine is the most widely used, naturally occurring narcotic in medical treatment in the world. This alkaloid is found in opium in concentrations ranging from 0.7 to 2.5 percent. However, most codeine used in the United States is produced from morphine. Codeine is also the starting material for the production of two other narcotics, dihydrocodeine and hydrocodone.

Codeine is medically prescribed for the relief of moderate pain and cough suppression. Compared to morphine, codeine produces less analgesia, sedation, and respiratory depression, and is usually taken orally. It is made into tablets either alone (Schedule II) or in combination with aspirin or acetaminophen (i.e., Tylenol with Codeine, Schedule III). As a cough suppressant, codeine is found in a number of liquid preparations (these products are in Schedule V). Codeine is also used to a lesser extent as an injectable solution for the treatment of pain. Codeine products are diverted from legitimate sources and are encountered on the illicit market.

[ChicagolandRN]

Dave,

I know you're very passionate about pain mgmt. What resources would you suggest for me? I'm an onc RN and I plan to eventually go into hospice. I like to be knowledgable enough to offer my 2 cents about what my pts are getting. Thanks!

[Dave ARNP]

My new favorite place is http://www.painedu.org

They have a bunch of free CME's that are WODNERFUL!

I also am using their SOAP for narcotic prescribing, and have ordered their book (which is free, too!)

I would suggest this place to start!

Dave

[P_RN, ADN, RN]

The reason I asked is in ortho/pain management we'd get a LOT of people who had great pain. Some minded doctor's orders for meds but some especially the younger men would pass around formulae for distilling the codeine out of a T#3. It's pretty easy to get a hit of over 100 mg using some of these techniques. All it took was water, 30 or so T#3, a coffee filter and a microwave.

[Dave ARNP]

There are all sorts of tricks that I have heard on ways to seperate meds at home.

The BEST one I've seen was in a physician disciplinary action notice from a board of medicine against a MD. They actually told her in her orders how you could sperate the Hydrocodone out of Tussionex and thus didn't like her prescribing patterns.

Seeing as how they have an open records policy I would just said "it can be done" and left things at that.

Dave

[aimeee, BSN, RN]

Now that I know that the narcotic portion can be separated from the APAP, this all makes more sense. I had no idea that was possible.

[Dave ARNP]

Oh yes Aimee.

I'd rather not discuss the exact how's and why's on a public board... but if you ever have some great urge to know. PM me.

You would be amazed at how easy someone can make the procedure when they're trying to get high.

-Dave