Hydrocodone chemical structure
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Lortab

Hydrocodone or dihydrocodeinone (marketed as Vicodin, Anexsia, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Norco, Tussionex, Vicoprofen) is an opioid derived from either of the naturally occurring opiates codeine or thebaine. Hydrocodone is an orally active narcotic analgesic and antitussive. The typical therapeutic dose of 5 to 10 mg is pharmacologically equivalent to 30 to 60 mg of oral codeine. more...

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Sales and production of this drug have increased significantly in recent years, as have diversion and illicit use. Hydrocodone is commonly available in tablet, capsule and syrup form.

As a narcotic, hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. It may be taken with or without food, but should never be combined with alcohol. It may interact with monoamine oxidase inhibitors, as well as other drugs that cause drowsiness. It is in FDA pregnancy category C: its effect on an unborn embryo or fetus is not clearly known and pregnant women should consult their physicians before taking it. Common side effects include dizziness, lightheadedness, nausea, drowsiness, euphoria, vomiting, and constipation. Some less common side effects are allergic reaction, blood disorders, changes in mood, mental fogginess, anxiety, lethargy, difficulty urinating, spasm of the ureter, irregular or depressed respiration and rash.

Hydrocodone can be habit-forming, and can lead to physical and psychological addiction. In the U.S., pure hydrocodone and forms containing more than 15 mg per dosage unit are called hydrocodone compounds and are considered Schedule II drugs. Those containing less than 15 mg per dosage unit are Schedule III drugs. Hydrocodone is typically found in combination with other drugs such as paracetamol (acetaminophen), aspirin, ibuprofen and homatropine methylbromide. In the UK it is listed as a Class A drug under the Misuse of Drugs Act 1971.

The presence of acetaminophen in hydrocodone-containing products deters many drug users from taking excessive amounts. However, some users will get around this by extracting a portion of the acetaminophen using hot/cold water, taking advantage of the water-soluble element of the drug. It is not uncommon for addicts to have liver problems from taking excessive amounts of acetaminophen over a long period of time--taking 10–15 grams of acetaminophen in a period of 24 hours typically results in severe hepatotoxicity. It is this factor that leads many addicts to use only single entity opiates such as OxyContin.

Symptoms of hydrocodone overdosage include respiratory depression, extreme somnolence, coma, stupor, cold and/or clammy skin, sometimes bradycardia, and hypotension. A severe overdose may involve circulatory collapse, cardiac arrest and/or death.

How Supplied

Notes

  1. ^  Tarascon Pocket Pharmacopoeia.

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Today's professionals find relief from painkiller dependency
From Los Angeles Business Journal, 5/31/04 by Clifford A. Bernstein

When asked what victims of drug dependency look like, most people would depict a dirty and destitute street addict, arms etched with track marks from shooting up heroin, stealing from the local convenience store just to feed his daily habit. Or she may be a prostitute, numb to the sad fact that she is selling herself for a line of cocaine. However, you would not likely hear someone describe a business professional tackling client meetings who also visits multiple doctors to get prescriptions for Vicodin. Unfortunately, prescription medicine is now second only to marijuana among the drugs most abused by adults and young people, and many of those battling dependencies to prescription painkillers could be your closest colleagues.

According to the Los Angeles-based Waismann Institute's 2004 Opiate Dependency Report, 56 percent of their patients' opiate dependencies began with doctor-prescribed medication, which includes common painkillers such as OxyContin, Vicodin, Lortab and Percocet. Doctors often prescribe these medications to treat discomfort ranging from common ailments such as migraine headaches or a sports-related injury to chronic pain suffered by a cancer patient. For those seeking relief from pain, painkillers can enable them to function at work and home. The down side is that patients can find themselves unable to stop taking the pills in as little as two week's time. Although a negligent doctor over-prescribing medication to a patient can result in dependency, the 2004 Opiate Dependency Report indicated that of those that were prescribed OxyContin by their doctors, 73 percent claimed the prescribing doctors gave directions for use that were clear, easy to understand and enforced.

Dependency to prescription painkillers is a medical problem that can occur in anyone. As the body becomes tolerant to the original dose, the person may find himself needing to take more to achieve the same result. In this case, the body has developed an opiate physical dependency. Opiate physical dependency occurs when, due to continuous use of opiates, the person taking the medication now requires the medication in order to simply feel "normal." The body stops producing endorphins because it is receiving opiates instead. This results in the user's physical dependency to the external supply of opiates. A sudden discontinued supply of opiates will cause often unbearable withdrawal symptoms including irritability, profuse sweating, abdominal cramping and diarrhea. This agonizing withdrawal is the reason most of those with dependencies cannot stop taking the drugs. For the pain patient it is extremely difficult for them to distinguish between the original pain and the discomfort of withdrawal, providing even greater incentive for them to continue taking the drugs.

Although the drug addict on the street is easy for most of us to recognize, the professional suffering from an opiate dependency can go unnoticed even to those closest to them. This functioning dependent will typically maintain the same drive to succeed as they did before, easily hiding their dependency from others. This is what can make the problem more dangerous than the stereotypical addiction. Because functioning addicts know they are often the last people you would expect to be dependent on drugs, they can be even more compelled to hide the dependency due to the social stigma historically associated with drug addiction. They can't imagine explaining to their supervisors that they are seeking treatment for narcotics.

But everyone should know that opiate dependency is a serious medical issue for a growing number of people and, as with any other medical ailment, should be addressed with the correct medical treatment as soon as possible. Many executives rule out treatment because they could not imagine abandoning their workplace and family for a lengthy stay in a rehabilitation program. They also fear the social stigma of informing colleagues that they are battling a dependency to drugs. Many of these people have the same common misconception due to the stigma attached to a person who cannot stop taking drugs--that it must be cured using treatment that includes elements such as psychological evaluation and group therapy. The pain management patients described often don't need any level of social characterization or treatments that involve psychological reprogramming, making long term therapy an inappropriate treatment option. Since dependency for these patients began because their bodies developed a chemical imbalance due to prescription drugs, the reliance is purely a chemical issue and can be treated with medication like many other ailments.

The majority of my patients at the Waismann Institute seek out the treatment for this reason; they want to rid their bodies of physical dependency as quickly and discreetly as possible. Boasting a success rate of over 65 percent, The Waismann Method introduces special medications that facilitate the cleansing of opiates from the patient's receptor sites while he or she is under anesthesia, allowing him to return home within days. This method is ideal for people who need to return to normalcy quickly and confidentially, and relief for those that would otherwise continue to remain reliant on the drugs.

Prescription drug dependency is one of the fastest rising drugs of abuse among professionals as it is a medical reaction that can occur very easily. Every person prescribed opiate-based painkillers should be aware of the risks and talk to their doctor if they feel that they are becoming physically dependent on medication. There is help for this medical disease.

Dr. Clifford A. Bernstein, a board-certified anesthesiologist specializing in pain management and opiate dependency, is the Medical Director for the Waismann Institute, located in Beverly Hills. For more information, call (888) 987-HOPE or visit www.opiates.com.

COPYRIGHT 2004 CBJ, L.P.
COPYRIGHT 2004 Gale Group

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