What is Changing:
It seems that the Obama administration has really been pushing hard to have drug control across the country, illegal and legal. I mean we all know that those pesky Hyrdrocodones and Percocets and Oxys are really killing folks, and to be fair and balanced, they are with abusers, but so are a lot of other drugs. Make no mistake, these drugs are beyond dangerous and have killed people, created massive addiction, but saved a lot of people from dying from pain when used correctlyy. I for one do not write schedule II drugs, but I see the impact of these meds everyday.
There is however a very scary separate point that is being overlooked here. In the last two years, some of the most powerful prescription drugs have left as a schedule III drug status (most codeine based), which could be given by all doctors, even midlevel provides like NPs with a DEA number and is now have gone to level II categorization, which is out of reach of most providers because schedule two drugs have a whole other set of rules as a controlled substance and most will not prescribe them. Many codeine based products got pulled down to schedule two from schedule three. Various administrators thought that having it moved to a cat II drug would really change the massive pain drug addiction epidemic. Yeah…..lets all go celebrate, not as many drug users on the street — huh. NOT SO FAST, there is still going to be drug users, just less getting meds from controlled sources and the lack of them in the office has the potential to push these people to the streets, where there is no quality assurance on the product itself. Someone with real pain might easily turn to heroin now, and it is showing up, story after story. Now doctors are having to turn to other medications to help their desperate patients, some not designed for pain and, and some are not FDA approved drugs for various types of pain and then there is the topical pain cream debacle that is costing insurance companies for the time being, billions because they are compounded with multiple ingredients. Ten grand for a tube of cream that has some muscle relaxers in it is a joke. Sorry!
Something to now consider:
What we have left is drugs like tramadol for example. This is NOT a drug typically used as an acute pain medication. It is made for fibro patients with things like associated depression and seasonal affective disorder and is a compilation of medications that work on different neurological pathways for a certain condition. Some of these medications may not be good or work well for a patient that just had a small procedure and really hurt afterwards. It has three drugs, an SSRI, an SNRI and a synthetic opiate. Most people think that this drug is no big deal, until they have to come off of it after long use.
The average hydrocodone user comes off of it and goes into withdrawal and about a week later, the hell is over, because it is a ONE substance medications. With drugs like Tramadol, you have to take more to get the same effect so it is not as strong, so you get used to the transmitter changes from usage, the opiate still changes things and when you ever come off, multiple withdrawals can occur upon is stoppage if usage had a long duration, at the same time. This patient has the potential for drug discontinuation syndrome from losing the serotonin (which gives them the whirlies) , loss of attention span from the loss of the SNRI and then narcotic withdrawal from the synthetic Mu receptor manipulator for pain, which will give them flulike symptoms. It is a three in one withdrawal and some people are NEVER able to escape and it can be terrible. Imagine getting this because you had to take it because another more simple drug was not available that you could have taken for a few days while you were going through your pain.
In the end, drugs are drugs. When the decision is made to use them, there is almost always a consequence. The final example left is Tylenol with codeine which is left as a schedule III drug also. Again, just like Tramadol, another good drug, but when used long term, the tylenol will have the potential to do super damage to your liver, alter biotransformation and detoxification capacity is altered, and you still have the pain medication in it so you likely WILL NOT biotransform the med you are taking very well. Why is this still ok? It is not stigmatized because it is not as abused, but the physiological implications from multiple drugs in one pill is overlooked which can be more dangerous. Some people start taking WAY to much of this to compensate for their pain and the Acetaminophen can do SERIOUS harm. Debatably more harm than the codeine in it.
So I ask the question, do I want a drug that works, and easier to get off of at times, or do I want a weaker drug that creates less of a desired effect and has potentially way more issues when coming off or has a greater impact on normal physiology? Do we want to just get rid of medications that have been stigmatized as abusive, or do we need to look at all of them that we know actually causes the most physiological damage and make them classified as more dangerous due to side effects, not just from their misuse profile. I believe the classification systems or categories of medications should be based off of the physiological complications that are possible, not just the affinity for misuse. These are just thoughts and there are lots of angles to this. One to ponder over for sure.