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Top 10 Painkillers in the US – Why Are Americans in Pain & Addicted To Opiods www.insta.doctor

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As part of federal efforts to curb prescription drug abuse, the US Drug Enforcement Agency (DEA) has reclassified hydrocodone-combination drugs (Vicodin/AbbVie) as a schedule 2 controlled substance.Capsule Production Line

That will mean physicians will no longer be able to write prescriptions for a 6-month’s supply, but will be limited to half that. Patients will now have to go to a physician’s office at least every 90 days to get a new prescription.

“That could mean a decrease in hydrocodone-combination sales—that’s probably why there was resistance from the drug companies–but for most doctors it won’t be that big deal,” said Mark Melrose, MD, commenting on the switch to schedule 2. Melrose is an emergency medicine specialist who is a partner in Urgent Care Manhattan, a two-location walk-in emergency care practice in New York City.

“If there’s a legitimate need for a patient to get Vicodin, why wouldn’t you prescribe it?” he said.

“Even when it was class 3, we still had to follow up with a written prescription and look up a patient on the prescription drug registry,” something most states have now, he said.

But even if the tighter controls mean some doctors will switch appropriate patients to schedule 3 drugs, like acetaminophen with codeine, alternative painkillers have a long way to go to topple the market leader, according to data from IMS Health.

Check out MD Magazine’s coverage of the 2017 list of top drugs by spend.

1. Hydrocodone-combination (Vicodin): 127,859,000 prescriptions

2. Oxycodone with acetaminophen (generic Percocet): dispensed through prescriptions 32,962,000 times.

3. Oxycodone HCL (generic OxyContin): 16,440,000 prescriptions.

4. Acetaminophen with codeine: 11,225,000 prescriptions.

5. Morphine sulfate: 9,658,000 prescriptions.

6. Fentanyl: 6,468,000 prescriptions.

7. Brand-name OxyContin: 5,659,000 prescriptions. Adding that total to its generic equivalent would not change the drug’s third-place ranking.

8. Methadone: prescribed 3,860,000 times, a drop of 4,090,000 prescriptions in the preceding year.

9. Hydromorphone HCL (generic Dilaudid): 3,587,000 prescriptions.

10. Oxymorphone HCL, extended release (Opana ER): with 756,000 prescriptions. Endo Pharmaceuticals has since removed the drug from the market after the US Food and Drug Administration (FDA) submitted a withdrawal request for the injection pain treatment, saying that it’s risks outweighed it’s benefits.

The DEA change is part of mounting concern about a national epidemic of prescription drug abuse. Earlier this year, the US Centers for Disease Control and Prevention (CDC) released a study showing that there is a wide variation in opioid prescribing patterns across the nation.

For instance, doctors in Alabama prescribed 142.9 opioid prescriptions for every 100 population, while doctors in New York prescribed only 59.5 such prescriptions for every 100 population.

But doctors in Maine prescribed the most long-acting extended release opioid pain-relievers, and physicians in Delaware prescribed high-dose opioids at the highest ate. Only two states were in the top 10 for all 3 categories, Tennessee and West Virginia.The CDC study used IMS data for 2012.

The more recent IMS data provided to HCPLive.com show that since then, total sales of codeine and codeine-combination drugs have dropped from 212,009.000 in 2012 to 201,493,000 in 2013.

Sales of morphine and opium derivatives rose to 22,329,000 in 2013 from 22,033.000 in 2012.

IMS, a commercial service, obtains its data from wholesalers.


Opioid medications, sometimes known as pain relievers, are the most widely prescribed class of drugs worldwide. While the United States represents about five percent of the world’s population, it consumes 80 percent of the global opioid supply. Not surprisingly, the U.S. is also suffering from the most severe opioid addiction and overdose crisis it has ever experienced. But, this didn’t happen overnight. Several factors contributed to the unprecedented use – and misuse – of opioids in this country.

In 1998, state medical boards changed the laws governing opioid prescriptions. Instead of limiting the use of opioids to treat severe cancer-related pain – which had consistently been the case before – they began allowing the prescription of opioids to treat moderate, non-cancer pain. This meant that people with back injuries, broken bones, toothaches and other ailments could now receive powerful opioids, dramatically expanding the medication’s supply.

In the same year, the pharmaceutical company Purdue Pharma, received government approval to market OxyContin, a powerful opioid medication, as a “minimally addictive” prescription opioid. The company claimed that less than one percent of people would become addicted to the drug despite little evidence to support this claim.

To promote OxyContin, Purdue Pharma pursued aggressive marketing strategies, spending over $200 million in 2001 alone. It also directly targeted doctors across the country with campaigns that misrepresented the safety of its product.

Between 1996 and 2000, sales of OxyContin increased from $48 million to $1.1 billion. From 1997 to 2002, OxyContin prescriptions increased tenfold. In 2003, approximately half of all OxyContin prescriptions came from primary care physicians, as opposed to oncologists, surgeons or other specialists who treat people with severe conditions. By 2004, OxyContin was the leading misused drug in the U.S.

Although much of the blame for the current opioid epidemic can be attributed to unscrupulous physicians and pharmaceutical companies, another important contributing factor is the human brain’s natural inclination towards becoming addicted to opioids.

When first used, opioids make the brain less sensitive to pain and produce feelings of pleasure or even euphoria. However, with repeated and prolonged use, the brain adapts and tries to return to its normal state, all the while becoming less sensitive to the positive effects of the opioids. This is called “tolerance.”

People who have used opioids for a while may become unable to tolerate the same level of pain or discomfort they more easily tolerated before they used opioids. Since their natural ability to feel pleasure becomes compromised by prolonged and repeated opioid use, they experience strong cravings for the drug and its euphoric effects. This occurs because the pathways linking certain pleasure centers in the brain – which communicate through natural chemicals, such as dopamine, and electrical impulses – are radically altered by drug use.

However, when someone uses specific drugs over time, such as opioids, the brain requires higher and higher levels of dopamine to feel the pleasure it once may have felt naturally. As a result, even actions such as eating, spending time with friends or family, and having sex stop feeling as pleasurable and the person craves the drug to simulate the pleasure he or she once experienced naturally or upon initial use of the drug.

Ultimately, the rise of opioid use and misuse in America can be attributed in large part to irresponsible advertising and marketing by certain pharmaceutical companies, which have led a generation of physicians and patients to underestimate the risks associated with an entire class of medication that directly manipulates the brain’s natural inclination toward addiction.

Fortunately, as we continue to learn more about the factors that contributed to the rise of this epidemic we also continue to learn more about how to prevent and treat it. We must change the way we address pain, prescribe opioid medications and treat addiction. While this epidemic has been in the making more than a decade, the time to act is now.

Evan Gilmer is a senior research associate at Center on Addiction

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