Vicodin and Its Addictive Nature

¶ … Addictive Nature of Vicodin According to statistics provided by the Department of Health and Human Services, an estimated one and one-half million people in the United States started taking prescription painkillers for "non-medical" purposes in 1998, three times as many as in 1990. One of the most heavily abused painkillers is Vicodin. Properly used, Vicodin is one of the most commonly prescribed pain medications, especially for those suffering from lower back pain, arthritis, post-operative distress, malignant cancer or sports injuries. It is not time-released, and therefore provides almost instant relief.

Vicodin is a compound of two drugs: acetaminophen (found in Tylenol) and hydrocodone bitartrate. Both are painkillers, but together they are far more effective than either one individually. Twenty tons of Vicodin are produced annually, and it is marketed under a plethora of brand names including Anexsia, Bancap-HC, Ceta-Plus, Co-Gesic, Dolacet, Hydrocet, Hydrogesic, Hy-Phen, Lorcet, Lortab, Margesic-H, Maxidone, Norco and Zydone. Hydrocodone bitartrate is an opioid-based medication, a semi-synthetic derivative of opium.

It acts on the central nervous system as well as on smooth muscle, producing a feeling of euphoria and allowing the patient to dissociate from the pain. By depressing the function of the central nervous system, hydrocodone bitartrate reduces the sufferer's anxiety and induces restful sleep. However, while highly effective in diminishing pain, it is also highly addictive, both physically and psychologically. Addiction can begin within a few days of use, and the tolerance level rapidly rises, requiring more pills to achieve the same result.

The normal dosage is an average of six pills per day, but the addict may increase consumption to as many as one hundred per day. Acetaminophen, while not addictive in itself, is extremely harmful in prolonged or large dosages; when the craving induced by the hydrocodone bitartrate leads to increased consumption, the damage done by acetaminophen escalates. The first effects are generally experienced as hives or rash, facial swelling, dry mouth, yellowing of skin or eyes, constipation, nausea, dizziness and fluctuating heart rate.

Continued over-consumption produces anxiety, blood disorders, difficulty urinating, hearing loss, itching, blurred vision, hallucinations, and severe confusion. In the final stages of abuse, deafness, convulsions, liver failure, brain damage, coma and death are common. At any stage of use or abuse, accidental death can result when driving or using machinery while taking Vicodin. When combined with alcohol, which it frequently is in order to heighten its effect as tolerance rises, the potential danger is even more severe.

Serious damage or death is also even more likely when Vicodin is used in conjunction with anti-anxiety drugs (Valium, Librium), anti-depressants (Elavil, Tofranil), anti-histamines (Tavist), MAO inhibitors (Nardil, Parnate), anti-spasmodics (Cogentin), carbamazepines (Tegretol), tranquilizers (Thorazine, Haldol), other narcotic analgesics (Demerol), or other sedatives (Halcion, Restoril). Even used properly while under the care of a physician, Vicodin is a potent and potentially dangerous drug. Pregnant or breast-feeding women are cautioned against taking it because of the danger to the fetus or baby; it is not recommended for children.

Elderly people must be very careful because of its narcotic properties and its propensity to harm liver and kidney function. Because it increases fluid pressure within the skull and spinal cord, those with head or spinal injuries cannot take it. Similarly, it can be counter-indicated for those with liver or kidney disorders, underactive thyroid, Addison's disease, enlarged prostate or urethral stricture. It suppresses the cough reflex and can harm those who suffer from lung disease. It can also interfere with diagnosis and treatment of abdominal disorders.

In spite of all these cautionary factors, professional athletes are susceptible to acquiring a Vicodin addiction because of their wish to continue playing in spite of painful injuries. Brett Favre, the Green Bay quarterback, had to undergo treatment to break a Vicodin habit, as did Darryl Strawberry. Middle-aged back-pain or arthritis sufferers frequently are at risk because of the chronic nature of their pain.

In the last few years, Vicodin has emerged, because of its euphoria-producing properties, as the drug of choice among those who are not pain sufferers -- young singers, hip-hop artists and actors. Eminem has a Vicodin tattoo on his arm and makes reference to the drug in his lyrics; there is a photograph of a Vicodin tablet on the jacket of his Slim Shady album. David Spade joked that he found some in his gift basket at the Golden Globe Awards.

Matthew Perry, Chevy Chase, Courtney Love, Michael Jackson and Sonny Bono are other well-known Vicodin abusers. There are several reasons for its popularity.

As a prescription drug, it does not carry the stigma associated with "street drugs." Its reputation as a pain medication, the legitimate use of which may accidentally lead to addiction, makes the user less likely to be seen as a stereotypical addict - a "junkie." Because it is carefully manufactured under controlled conditions, it is uniform and pure, uncontaminated with cleanser, baby powder and other additives used to "stretch" street drugs. In many cases, thanks to health insurance plans, it is free or low-cost.

Generally the abuser is not at risk of a prison sentence, even if caught committing fraud to get the drug; in fact, unfortunately, abusers are frequently not even forced to seek treatment for their addiction. Dr. Bernstein of the Weismann Institute in Beverly Hills, speaking of Hollywood's attraction to Vicodin, says: "Vicodin is given out very freely.

If doctors don't get you Vicodin, you can get it on the street, you can go to an emergency room, you can go to Mexico, and you can buy it off the Internet now." For the affluent recreational users, costs associated with getting the drug or being treated for its abuse are far from being prohibitive. The Vicodin addict generally does not have to lurk around disreputable areas of the city, attempting to score the drug.

A typical scenario might be as follows: Following an injury or surgery, the patient is prescribed Vicodin. Noticing that the pills are not giving the same measure of relief as they did at first, and fearing that the pain will escalate, the patient begins to take more than prescribed. He or she may be able to get the physician to increase the prescription by complaining of severe and persistent pain. If the doctor becomes reluctant or suspicious, the patient begins to "physician-hop," getting prescriptions from several doctors at once.

If this proves ineffective or inconvenient, the next step is fraudulent altering of the prescription (increasing the quantity), phoning it into the pharmacy himself or herself, or ordering online. The patient may call the physician's office, posing as a claims investigator, in order to obtain the DEA number needed to place a prescription order.

If attempts to obtain the drug through fraud are not successful, the addict may ask a friend to get a prescription and sell it to him or her, or may attempt to buy from a drug dealer. In some cases, the sufferer is desperate enough to attempt to rob a pharmacy. The drug can be mixed with street drugs such as heroin (another opium derivative), and the pills can be crushed and snorted or injected.

Physicians must walk a thin line; on one hand, they must carefully monitor the patient and ensure that abuse or addiction is not taking place, but on the other hand, they must ensure that the patient's suffering is assuaged. One of the effects of Vicodin can be mental confusion. Hence, it is easy for an addict to accidentally overdose, in an attempt to achieve the wished-for euphoria.

Symptoms of an overdose include a bluish tinge to the skin, a cold and clammy feeling, sweating, sleepiness, low blood pressure, limp muscles, nausea, slow or troubled breathing and a slowed heartbeat. In some cases, the addict slips into a coma and dies. Emergency room visits involving Vicodin increased from 6100 incidents in 1992, to more than 14,000 in 1999.

The addict may finally recognize the fact of his or her addiction because of physical symptoms, inability to carry on with work, intervention by family and friends, accidental overdose leading to hospitalization, intervention by the physician, or through being arrested for fraud or burglary. In some cases, the addict may attempt to overcome the addiction on his or her own, through quitting "cold turkey." This measure is almost never successful and may even be fatal.

Once addiction has taken place, the patient must accept treatment to overcome it or death from the drug is almost certain. Treatment normally consists of detoxification, recovery and after care. Withdrawal symptoms include restlessness, bone and muscle pain, insomnia, diarrhea, vomiting, cold flashes, involuntary leg movements, watery eyes, runny nose, sweating and panic attacks. There is a wide variety of treatments available to the addict, some involving a stay at a hospital or residential treatment center and some oriented toward an outpatient approach.

Every situation is different, and only a trained physician can determine the best treatment for each patient. One program, Narconon, established in 1966, uses a drug-free withdrawal approach incorporating vitamins, sauna treatments to sweat the residual amounts of the drug out of the patient, and exercise. After detox, the patient participates in a series of workshops aimed at increasing sociability, effective communication, stress management and reassertion of values and ethics. The clinic claims a 78% success rate.

Other recovery centers hospitalize the patient during detox, which is supervised by a doctor who administers drugs if needed. A controversial approach is known as "rapid detox." The patient is sedated, thus sleeping through the withdrawal period. Drugs are administered to break the opiate's connection to the brain; a second drug, a narcotic antagonist known as Naltrexone, blocks the cravings. The procedure takes only two days, but costs up to $10,000, an expense not covered by health insurance.

While some patients and doctors swear by this procedure, other medical professionals question its efficacy and safety. A New Jersey rapid detox facility had seven patients die, out of the 2350 treated over a seven-year period. Other centers recommend a medical detox, with drugs to alleviate the addict's discomfort as he or she undergoes withdrawal. They also see the value of Natrexone once detox is over, as it not only effectively blocks the craving for and effects of Vicodin but also is not addictive or mood-altering in itself.

It works by blocking the nervous-system proteins that act as opiate receptors; a patient taking an opiate while on Natrexone will not experience a high. Naltrexone is taken for six months to one year after detox, either orally or through a pellet inserted in the abdomen, which dispenses medication for six weeks at a time. By contrast, methadone, which for many years has been used to treat heroin addiction, can create its own dependency. The heroin user merely trades one addiction for another.

Methadone is normally dispensed at clinics and serves a much less affluent sector of society than the average Vicodin-dependent patient. These public and private clinics tend to have long waiting lists. Most physicians stress the need for psychological counseling to prevent re-addiction. In many cases, the prognosis for Vicodin addicts is much more hopeful than that of those suffering from dependence on other drugs. Many have strong, stable support systems and are balanced individuals who slipped into chemical dependency without appreciating their danger or without consciously espousing a criminal mentality.

In some circles, Vicodin is seen as a "boomer" drug, and addiction to it a result of boomers' well-publicized impatience with discomfort or pain. Socially it is at the opposite end of the spectrum from crack cocaine, and if treated in time, can be defeated with little risk of recidivism. Treatment is least effective when the patient experiences severe chronic pain. Breaking the addiction to Vicodin essentially leaves the sufferer back where he or she started.

There are few medications as effective in relieving acute pain; the patient must either cope with on-going agony, alleviated only moderately by less effective drugs, or go back on Vicodin and risk becoming addicted all over again. Effects on society are relatively mild as drug addictions go. Health plans may.