Lifeless: the coffee-filter treatment

say what now?

Riffington: I'm seeing a lot of misinformation in this thread. Let me explain.

1. Vicodin/Percocet are not on patent. The reason that I like to prescribe oxycodone with acetaminophen is that it works better. You get more pain relief than with the oxycodone alone. If you are taking a few percocet a day, then you will have better pain relief, less drowsiness, less itchiness, etc. than a person with just oxycodone alone.

2. Yes, you can get the same benefit from taking the two drugs separately. But I know patients. Most will just take the oxycodone because it has a stronger effect, and will think the acetaminophen isn't helping, so they won't take it very regularly. And so they don't get the full benefit.

3. The advisory panel isn't 100% full of crap (only 95%). Acetaminophen can be dangerous in high doses. If you need high doses of narcotics, I'm certainly not going to be prescribing percocet - I'm going to separate out the two drugs.

4. But the advisory panel is overly cautious. Physicians who are prescribing percocet and vicodin have a decent understanding of the dangers of acetaminophen. This is the proper job of the doctors, not of the government agencies.

/anesthesiologist

Still doesn't help the patients that take vicodin then take a over the counter cold medicine that happens to be laced with ace, dumb sure but the point being that behavior is out of the control of doctors.

Besides the advisory panel makes their recommendations off the numbers, we can complain all we want about skewed results but ultimately they can only make the best recommendation based on the information placed in front of them.

Certainly if you can recommend taking a combo drug, you can also recommend the taking of the pure version and a ace addition and achieve the same results.

On one hand you seem to support the drug decision making on the doctor and the patient, then turn around and claim that it's best patients take the combo drug because they may not follow your directions anyways? Your opinion seems to be at odds with each other or at least it would seem your saying YOU deserve the power of med recommendation not the FDA, when I'd argue that decision should be in the patients hands and not in your or the FDA's ultimately.

So for me the panel decision seems thoroughly thought out, and there is no loss here to the patient as long as they follow their doctors direction to also take ace. Nothing to see here.

ArgentCorvid: Lifeless: the coffee-filter treatment

say what now?

Are coffee filters fine enough to strain out the acetaminophen from the narcotic in solution?

Just a bit of additional info to augment what the MD said upthread:

Yes, they'll probably just put hydrocodone into a pill alone and prescribe it. But there's a problem, and it's the same situation as with oxycodone -- hydrocodone alone is C-II. That means no phone prescriptions, no refills. You have to have a paper scrip for each bottle of it. While this might be interesting to some doctors (more office visits, more $, yo), it will mean that the tens of thousands of people who need narcotics for a period of time will have to get themselves to their doctors offices (or, for a lot of them, I fear, they'll gum up the emergency departments). Additionally, doctors will be pressured, overtly or not, to write larger prescriptions, which tends to increase the chance that some people will increase their dosages. The pills will also have substantially more value as smuggled goods (5-10 mgs of drug are quite a bit smaller than 5-10 mgs bundled with 500 mgs of APAP -- more pills, less space, better contraband).

Don't get me wrong -- it's probably not the worst idea in the world to do this. However, there's a bunch more people out there than you think who are dependent on hydrocodone. This will cause LOTS of people to freak the hell out.

/recovering hydrocodone addict
//criminologist
///you'd think I'd know better

Shrew2u: The concern is the liver damage possible from use of acetaminophen, even in recommended dosages. If the FDA doesn't end up banning those combo drugs, some sue-happy shiathead will sue the pharma companies claiming, "You KNEW my liver would get farked, yet you left those killer combos on the market anyway..."

/tramadol ftw - far better for pain relief than vicodin

Ultram (Tramadol) also causes liver damage, but not as quickly, just FYI.

/Daily Tramadol user

Gyrfalcon: Aspirin is derived from salicylic acid--which is derived from a tree bark; arsenic is a heavy metal. Good god I'm so sick of people wanting "natural" alternatives to "drugs" when most drugs are, in fact, totally natural.

One of my favorite T-shirts evar was one that said "Drink up, Socrates, it's all natural!"

otterrr: A bunch of hype over nothing. They'll just start cutting it with ibuprofen instead, which is a better pain reliever, anyways.


Ibuprophen burns a hole through my stomach, thank you very much.

I've been on all the NSAIDS, and I know that some react badly with patients' stomachs. Acetaminophen (Tylenol) on the other hand is pretty universally harmless on the stomach lining, which is why it's mixed with everything on a lot of combo analgesic-painkiller meds.

That having been said... combo pills are idiotic, and I don't approve of them, unless it's a mandatory combination treatment regimen. Some AIDS treatments have set ratios of drugs, and combo pills there simplify things for people. (Instead of three different pills at different times and dosages, just one pill X times a day.)

However, painkillers, muscle relaxants, antinauseants and analgesics should be sold individually to avoid problems with one or the other.

Both Oxycontin and Hydrocodone are off patent by now, so some generic outfit will start producing their variety of the stand alone medications, and will likely make a nice few dollars over it too.

I perfer the old fashioned Codeine pills for pain emergencies. Don't need no prescription for 'em either here in Canada.

So let's summarize. The government prefers to reduce painkiller abuse rather than reduce pain suffering.

kidsizedcoffin: Shrew2u:
/tramadol ftw - far better for pain relief than vicodin

That stuff never touched any pain I had, they gave it to me when I hurt my foot. Vicodin helped a bit, but not in the small doses they prescribed...

It's the opposite for me and Mr. Shrew. He injured his back 30 years ago and still deals with flare-ups of pain. He switched from vicodin to tramadol because he'd gotten to a point where vicodin made him feel fuzzy without touching the pain. When I threw my back out toting the kids around recently, I found the same applied to me - my vicodin did nothing but made me a drooling zombie, while the tramadol addressed the pain without the fuzzy-headedness.

dahmers love zombie: Just a bit of additional info to augment what the MD said upthread:

Yes, they'll probably just put hydrocodone into a pill alone and prescribe it. But there's a problem, and it's the same situation as with oxycodone -- hydrocodone alone is C-II. That means no phone prescriptions, no refills. You have to have a paper scrip for each bottle of it. While this might be interesting to some doctors (more office visits, more $, yo), it will mean that the tens of thousands of people who need narcotics for a period of time will have to get themselves to their doctors offices (or, for a lot of them, I fear, they'll gum up the emergency departments). Additionally, doctors will be pressured, overtly or not, to write larger prescriptions, which tends to increase the chance that some people will increase their dosages.

Does this apply to the new e-scripts? Seems like that could be as easily authenticated as a paper script. If that were the case, the patient could still call their doctor for a refill, and thus the doctor can monitor when the patient is running out of his Rx.

I've had my go-arounds with Vicodin and its equivalents. I honestly don't understand how anyone can get addicted to it. Other than the obvious benefits, the downside for me has been horrible constipation and really bizarre dreams. Really strange, off the chart strange. When the need is gone, I'm off of it at the first opportunity.

Gyrfalcon

"Natural"??? Given that opium is a plant derivative, how much more "natural" do you want it to be?????

I would like to point out that Dogshiat is both all natural, and 100% organic.

Impudent Domain: Gyrfalcon

"Natural"??? Given that opium is a plant derivative, how much more "natural" do you want it to be?????

I would like to point out that Dogshiat is both all natural, and 100% organic.

I also would like to point out that tigers are all-natural, and can eat you.

Common Sense Advice From A Man Who has Been There And Done That:

When I broke my shoulder in a motorcycle accident, I told the doctor: "--make sure anything you prescribe doesn't react adversely with alcohol, I drink a lot of whiskey and beer."

He nodded knowingly and proceeded to prescribe opium-based narcotics for my pain, well aware I would keep drinking anyway. . . but also aware, alcohol dulls the performance of opiates, which is why junkies never drink.

I found I could manage the pain if I took about four times the dosage he prescribed, and I kept a four-ounce glass of whiskey on the nightstand, so I would have the remedy handy just in case I overdosed.

Worked out fine, but I was a little jittery when I ran out of drugs; predictable.

If Michael Jackson had cured his insomnia with a double-shot of brandy and a stick of Vancouver's finest, he would be alive today.

Shrew2u: kidsizedcoffin: Shrew2u:
/tramadol ftw - far better for pain relief than vicodin

That stuff never touched any pain I had, they gave it to me when I hurt my foot. Vicodin helped a bit, but not in the small doses they prescribed...

It's the opposite for me and Mr. Shrew. He injured his back 30 years ago and still deals with flare-ups of pain. He switched from vicodin to tramadol because he'd gotten to a point where vicodin made him feel fuzzy without touching the pain. When I threw my back out toting the kids around recently, I found the same applied to me - my vicodin did nothing but made me a drooling zombie, while the tramadol addressed the pain without the fuzzy-headedness.

It just may be the amounts prescribed, I have an unusually high tolerance for a lot of drugs. I get the fuzzy feeling fairly easily of vicodin, which can help take my mind off the pain, but the pain killing effects of a lot of drugs don't kick in at lower doses for me.

Last time I went in for surgery, to remove a tumor from my side, they didn't completely knock me out, but for the first 10 minutes of the surgery, I'm fairly certain they were tired of me saying ouch, and thus them having to try to numb me further. I have the same problem at the dentist.

Unfortunately morphine gives me migraines.

All of you farking nancies that are taking pills to cope with your pain grow up and quit being pathetic little biatches. Yes, I realize that pain is relative but you are not in pain. You are experiencing mild discomfort.

Weaver95:
As bad as that would be, if the FDA doesn't come up with a replacement for vicodin then I wish that everyone involved in removing that medication from the marketplace has 8 months of kidney stones.

I'll bet they find a way to reverse the ban after that.

I find myself heartily agreeing with you on this one.

ArmoredFelix: All of you farking nancies that are taking pills to cope with your pain grow up and quit being pathetic little biatches. Yes, I realize that pain is relative but you are not in pain. You are experiencing mild discomfort.

3/10 Nice try.

I'm currently on post surgery 'Vicodin', so I'm really getting a kick out of these responses.

The FDA will NOT be taking the ACTIVE PAIN KILLING INGREDIENT off the market. Hydrocodone and Oxycodone will remain. The APAP (aka Tylenol) is the chemical at issue with the FDA.

5mg Norco and 5mg Vicodin have the same strength of hydrocodone. IIRC, Norco holds their APAP steady at 325mg no matter what the Hydrocodone level, while Vicodin varies the APAP with the strength of the hydrocodone. So if they remove Vicodin, there is still Norco.

If some people are too stupid or lazy to find out what they are putting in their mouths....SCREW THEM.

Gyrfalcon: Aspirin is derived from salicylic acid--which is derived from a tree bark; arsenic is a heavy metal. Good god I'm so sick of people wanting "natural" alternatives to "drugs" when most drugs are, in fact, totally natural.

I think people have a problem with being prescribed medications that the doctor is paid(or otherwise enticed) to prescribe. Medications with horrible side effects. Medications where, when the patent has expired, the drug company fiddles with a molecule chain a bit, and rereleases it under a new name and a new patent and full price. Medicines that haven't been properly tested, or when they are tested, negative side effects are marginalized or ignored.

ArmoredFelix: All of you farking nancies that are taking pills to cope with your pain grow up and quit being pathetic little biatches. Yes, I realize that pain is relative but you are not in pain. You are experiencing mild discomfort.

Come on by and bring a chainsaw and I'll introduce you to my pain. Since it's mild discomfort, you should have no problem with it.

dahmers love zombie: /recovering hydrocodone addict

Please oh please tell me how you kicked this crap. My PM doctor thinks I'm not addicted because I don't take more than he prescribes and I don't do it for fun.

phenn: Also, when it comes to chronic pain, do you think there are other natural alternatives that may produce acceptable results?

I'm not speaking of the wild-eyed pain that cancer patients endure. I'm speaking of people with back worries, female problems, bowel disorder, etc.

There's a growing consensus among chronic pain physicians that the use of opiates for the treatment of non-cancer chronic pain is inappropriate and ultimately counterproductive. Opiates simply carry too much baggage and really don't work well for very long without escalating the dose - and then the patient is narcotic tolerant/dependent and still in pain.

Our clinic, for example, uses NO opiates for non-cancer pain. If there's an acute exacerbation of a chronic problem, sure, for a few days, but that's it. This pisses some patients off, especially if they were accustomed to getting narcs from other sources. It's hard to convince a person in pain that you have their best interest in mind when you're taking away their oxycodone.

One of the most frustrating things we deal with are patients who come in to us after failing therapy with their primary care provider, who has them on daily narcotics. The fibromyalgia patients on fentanyl patches always made me want to go find the prescriber and kick him in the nads.

The best long term results usually come from a multimodal approach involving non-narcotic medications - NSAIDs like ibuprofen, Tylenol, anticonvulsants like Neurontin, Elavil, Cymbalta (a serotonin/norepi reuptake inhibitor), sometimes muscle relaxants ...

... and psych assistance, if the patients are willing to accept that kind of help. (Chronic pain has profound mental health effects, and even a couple visits with a psychologist can do wonders for their coping mechanisms and help with their quality of life.)

... and lifestyle changes (especially weight loss) on the rare occasions when patients are willing to make them.


/ also an anesthesiologist

quantum_jellyroll: I've had my go-arounds with Vicodin and its equivalents. I honestly don't understand how anyone can get addicted to it. Other than the obvious benefits, the downside for me has been horrible constipation and really bizarre dreams. Really strange, off the chart strange. When the need is gone, I'm off of it at the first opportunity.

I have the same experiences with Vicodin as you do. I think you and I just don't have addictive personalities. If my wife took the same drugs I am currently taking for post surgery pain, she'd be hooked in no time because she DOES have an addictive personality.

This is all just lead up to the creation and introduction of Soma, isn't it? And I'm not talking about the muscle relaxer, I'm talking about the Brave New World stuff. They'll take away every damn useful drug and pain reliever we have, then all of the sudden "discover" this miracle cure-all drug that has no nasty side effects, other than sapping your will.

/OK I'll take my tin foil hat off now.

kidsizedcoffin: ArgentCorvid: Lifeless: the coffee-filter treatment

say what now?

Are coffee filters fine enough to strain out the acetaminophen from the narcotic in solution?

kidsizedcoffin: ArgentCorvid: Lifeless: the coffee-filter treatment

say what now?

Are coffee filters fine enough to strain out the acetaminophen from the narcotic in solution?

Acetaminophen dissolves very poorly in cold water and crystallizes if you dissolve it in boiling water and then cool it rapidly; so if you crush the vicodin, dissolve it in boiling water, put it in the freezer, then strain it with a coffee filter, you remove ~90% of the acetaminophen. YMMV, IANAD, but it kept me from puking all over my stitches.

Alacritous: I'll bet that shortly before or shortly after this ban takes effect that a product will come on the market conveniently that does the same thing as the banned combinations... Any money on which company it'll be that brings it?

One that gave huge amounts of campaign/lobbyist money to Obaqma and the democrats?

Benevolent Misanthrope: I heard a couple doctors on Diane Rehm discussing this the other day. They were complete nuts, both of them - and they are both powerful. As I recall one was on the approval board of the FDA and the other was part of the insurance lobby, maybe?

Anyway, the whole thing struck me as useless fear mongering and a way for insurance companies to save money by requiring an over-the-counter medicine to be purchased out of pocket, to supplement a cheaper drug.

Seems unlikely since vicodin is dirt cheap if you have a prescription.

WFern: Michael Jackson-related hype.

Not even close. Its due to the fact Tylenol kills people far more rapidly than all illicit drugs combined.

As someone who takes 3 hydrcodone daily for pain I am not getting a kick out of these replies.

jayhawk88: then all of the sudden "discover" this miracle cure-all drug that has no nasty side effects, other than sapping your will.

I think you just described marijuana.

As mentioned by other posters, hydrocodone itself is a schedule 2 drug. Getting a sched 2 drug rx'd for moderate pain? Hmm. I wonder if instead doctors will choose to rx higher doses of NSAIDs instead of dealing with all the restrictions and dea presence sched II drugs entail.

Cap Ten Oblivious: was to keep people from using it as a recreational drug.

Bingo! Vicodin is less restricted that hydrocodone because it is more dangerous. Banning vicodin will not make hydrocodone alone easier to get it will be just as restricted.

Proud2B_American: I'm thinking those aren't really intended for long term use anyway...I much prefer
Put it on for 3 days at a time...then replace....

Duragesic? Smoke it... very very carefully.

Mylan? Isopropyl extraction, then smoke it.

Enjoy your vicodins and your percocets, that what got me started. Now onto it's much more cost-effective big brother.



/Require 1,000mg of oxycodone daily.
//Not dicksizing, actually have a 2g/day iv diamorph habit.

This article is so full of shiat that it is not even amusing. They are only considering removing certain types of vicodin and percocet. Namely crap like Vicodin ES which contains more tylenol per tablet than anyone should take at one time. Instead of taking hydrocodone 10/650, they would rather people take 10/325. Oh noes!

Now, what IS going to suck is when they remove all of the tylenol containing products from over the counter. I cannot wait to here the QQ of people when they have to buy tylenol and cold medicine separately. I am sorry, but there are one to many farktards out there who think they can give their kids tylenol without reading the label on the tylenol containing cold syrup they just fed her.

Crackers Are a Family Food: The problem with that is that many people, such as myself, are allergic to NSAIDs, so those combos are out of the picture for us.

Oh yes, this. Also sensitive to pretty much any medication out there, even if I'm not allergic to it. I take a single Tylenol when I need it, and it works just as well or better than two does for other people.

I'm sure they'd love to take acetaminophen off the market completely for fear of the whole liver thing, but fark em. If you take it and are dumb enough to take enough to fark up your liver, you deserve what you get. Sadly, this crappy lawsuit-happy society of ours (that is in serious need of complete and total repair) would rather blame others than take personal responsibility.

Let me correct the article:

Oxycodone is available without the acetaminophen as OxyCodone, with brand names such as Roxicodone. I should know, I take it daily.
I have in the past taken Oxycontin (the time release version of Oxycodone) but switched to Fentanyl patches for long lasting pain control instead.

kidsizedcoffin: Last time I went in for surgery, to remove a tumor from my side, they didn't completely knock me out, but for the first 10 minutes of the surgery, I'm fairly certain they were tired of me saying ouch, and thus them having to try to numb me further. I have the same problem at the dentist.

Mr. Shrew has the same "slow to numb" problem. He made an agreement with his dentist - his dentist shoots him up as normal, then hubby sits in the waiting room reading a magazine until he's actually numb. It's usually 30-40 minutes before he's numb enough for dental work. Me, I have a high pain tolerance and low drug threshhold, so my dentist loves me - in, numb and out quick, never make a peep (just drool alot).

Cap Ten Oblivious: namatad: and in all fairness, why is the acetaminophen there in the first place?

I always thought it was to keep people from using it as a recreational drug.

Your user name is bang on target! If APAP is so dangerous then why not just ban all of it?

Obama is not in touch with Americans. He does not feel my pain like Clinton did.

namatad: no bet
but yah, there will soon be a hydrocodone only type pill
and in all fairness, why is the acetaminophen there in the first place?

It was put in there ostensibly to provide fever relief along with pain relief. I'm of the opinion that it was put there to allay the fears of the opiophobics in the medical machine that feared that someone might become "addicted".

Cap Ten Oblivious: namatad: and in all fairness, why is the acetaminophen there in the first place?

I always thought it was to keep people from using it as a recreational drug.

I owe you an apology for the previous post (I should read posts more carefully): I thought it said "Captain Obvious"

Shrew2u: /tramadol ftw - far better for pain relief than vicodin

Really? I'm not up to speed on the latest and greatest drugs, but I have taken Tramadol. It sorta sucks. In recommended dosages it's (to me) no better than a couple ibuprofen. The hydros or oxys actually eliminate or mitigate the pain in their prescribed amounts. I have to take so much Tramadol that I'm high as a kite (which is sorta awesome, don't get me wrong).

This is stupid. There is NO drug without side effects. As long as they are known, the decision is between you and your physician, not some huge government tumor.

As soon as VIOXX was taken off the market, I knew we'd be in for more of this shiat. Yes, it can cause complications with some people, but for many, it was really the best option.

Alacritous: I'll bet that shortly before or shortly after this ban takes effect that a product will come on the market conveniently that does the same thing as the banned combinations... Any money on which company it'll be that brings it?

Phizer? Bayer? Diet and exercise?

Filth and Disease Administration

Famine and Death Administration


Food and Drug Administration just doesn't cut it anymore, sorry!

abiigdog:
On one hand you seem to support the drug decision making on the doctor and the patient, then turn around and claim that it's best patients take the combo drug because they may not follow your directions anyways? Your opinion seems to be at odds with each other or at least it would seem your saying YOU deserve the power of med recommendation not the FDA, when I'd argue that decision should be in the patients hands and not in your or the FDA's ultimately.

A big part of prescription is knowing your patients, and helping them to find a medication (or combination) that will work for them. There are a large number of patients (probably a majority of the patients who have taken oxycodone) for whom a combination of acetaminophen/oxycodone is the best drug. For those patients, that's what they should be prescribed. Other patients should not.

But yes, the FDA (if it adopted this) would be overstepping its bounds. The FDA is there to make sure that drugs do what they say they do. The doctors are there to help patients get the medications most appropriate for them. Ultimately, the patient is the one taking the medication, so obviously they have the final say.

Even if it were shown that the practice of combining acetaminophen and opiates should stop (it has not), the FDA should not be the group making that recommendation. The American Academy of Pain Medicine is a more credible and less political organization, with a better understanding of the issues and the science.

Alacritous: Gyrfalcon: Aspirin is derived from salicylic acid--which is derived from a tree bark; arsenic is a heavy metal. Good god I'm so sick of people wanting "natural" alternatives to "drugs" when most drugs are, in fact, totally natural.

I think people have a problem with being prescribed medications that the doctor is paid(or otherwise enticed) to prescribe. Medications with horrible side effects. Medications where, when the patent has expired, the drug company fiddles with a molecule chain a bit, and rereleases it under a new name and a new patent and full price. Medicines that haven't been properly tested, or when they are tested, negative side effects are marginalized or ignored.

Which specific medications are you referring to? None of the dozens that had been mentioned on this thread, I hope.

Shrew2u:

/tramadol ftw - far better for pain relief than vicodin

You're a farking idiot if you think that. Period, no discussion.

I am in pain from getting a kick from all of these replies.

As a result, I will self medicate.

Riffington: Which specific medications are you referring to? None of the dozens that had been mentioned on this thread, I hope.

Vioxx (new window) is one that immediately springs to mind. There are others.

mattknows: Shrew2u:

/tramadol ftw - far better for pain relief than vicodin

You're a farking idiot if you think that. Period, no discussion.

I think it depends on the person. My GF has a cyst and the vicodin doesn't do jack for it. She took some tramadol, and it made her pain lessen and she was able to sleep. Different pain meds can bet better for different people and conditions.