A 2012 DEA report revealed that in 2010, U.S. pharmacies dispensed enough Vicodin to give 24 tablets of 5 mg each to every single person in the country.
The current epidemic in prescription drug abuse is partially due to Vicodin, the most widely prescribed drug in the country.
Despite accounting for only 4.6% of the world’s population, Americans consume 99% of the world’s hydrocodone, the primary ingredient in the drug. Because of the evident problem with the drug, a panel of experts has recently voted in favor of increasing the drug from a Schedule III to a Schedule II medication, with the aim of making the drug much more difficult to prescribe.
What is Vicodin?
Vicodin is a painkilling mixture of hydrocodone (a narcotic, opioid drug) and acetaminophen, which is used to heighten the effects of the hydrocodone. The drug is intended for the treatment of moderate to severe pain, and produces its effect through the drug’s action on the opiate receptors within the brain. When taken according to doctor’s guidelines, it shouldn’t be particularly habit-forming, but if the prescription is made for an extended period of time, tolerance and addiction become much more likely. It isn’t intended for chronic (ongoing) pain, but the problem is that acute (temporary) pain often continues and becomes chronic, meaning that repeat prescriptions or transitions to other opiates are surprisingly common.
Schedule II vs. schedule III
Substances are classified according to their potential for abuse, possible medical uses and their risks. Medicines, like Vicodin, containing up to 15mg of hydrocodone per dose are classed as Schedule III. Oxycodone (the main ingredient in OxyContin) is in the more tightly-controlled Schedule II. Schedule I is a classification reserved for illicit substances which are rarely (usually never) used medically, such as LSD, heroin, ecstasy and peyote.
As a Schedule III substance, Vicodin is legally defined as having the potential for moderate to low physical dependence and high psychological dependence. Under the current legislation, a single prescription can be used for five refills, but if Vicodin is upgraded to a Schedule II substance, patients would need a new prescription for every refill. This is very similar to the system as it currently stands for OxyContin.
Reducing access to reduce addiction
The theory behind this approach is that upgrading Vicodin and make it even more difficult to prescribe will reduce the number of people receiving excessive amounts of the drug and therefore reduce overdose and addiction rates. It’s hard to deny that if the FDA does decide to go with that approach, there will be a reduced number of prescriptions available. However, that doesn’t mean that there are no downsides to the approach.
With the risk of addiction and the potential for overdoses, it’s easy to forget that Vicodin is a legitimate medicine that many people do need. If an elderly person, for example, needs more than a single prescription, it will mean traveling to the doctor to obtain a new prescription. This prevents phoned or faxed in prescriptions, which effectively condemns those in pain with difficulty traveling to more trips to the doctor.
It’s also worth stating that Schedule II classification clearly will not be a complete solution, because OxyContin, Sublimaze and Adderall are also in that schedule and they are still widely abused. For example, the Monitoring the Future survey in 2012 revealed that 7.5% of high school seniors had abused Vicodin in the previous year, but 7.6% had used Adderall without a prescription. Incidentally, the use of Adderall has increased from 5.4% in 2009, showing that things are getting worse despite its Schedule II status.
A combined approach
Although there are problems with the approach, it is likely to have a positive effect by simply reducing the amount of prescriptions that can be written. Likewise, prescription drug monitoring programs enable healthcare providers and state governments to keep track of who is distributing and receiving prescriptions of Vicodin and other narcotic medicines. This helps to combat people who “doctor shop,” aiming to receive several prescriptions for an exaggerated or fictitious condition. These approaches are currently being implemented alongside education for both health care providers and the public.
This seems like a positive approach to the issue, but the focus should always be on education. The assumption that prescribed medicines are somehow safer than illicit drugs is often misguided, and this is particularly true in the case of narcotic painkillers like Vicodin. The new scheduling will undoubtedly have some effect, but without a multi-faceted approach, it becomes entirely meaningless. The illusion of safety created by a doctor’s prescription needs to be broken down if the country is ever going to step out of the shadow of prescription drug abuse.