On the Front Lines of the Opiate Epidemic

If battle lines were drawn for the war on drugs, Kentucky would be on the frontlines and Eastern Kentucky would be Ground Zero. In the past decade, opiate overdoses have killed over 125,000 Americans, over twice the number of Americans killed in the Vietnam War. In Kentucky, overdose deaths outpace car accidents or any other accidental cause of death. Yet the mantra continues to be insufficient access to pain medications?

I commend Representative Hal Rogers’s opposition to Zohydro’s availability in Kentucky. As a Board Certified Interventional Pain Specialist, I trained at Johns Hopkins and MD Anderson, two nationally leading institutions in the arena of pain management. I choose to work in southeastern Kentucky because of the enormity of the opiate epidemic in that region.

The scale of this problem is as staggering as a national disaster. Prescription drug abuse outstrips cocaine and heroin abuse combined and serves as a gateway to other forms of addiction. Nearly 50% of Eastern Kentuckians have friends or family who abuse opiates. This region has some of the highest rates of opiate overdose in the country, up to 7 times the national average. Within this population, a medication like Zohydro has a greater potential for harm than good.

The premise that Zohydro is a safer medication is poorly justified. The current alternative to Zohydro is a generic product that has 325mg of acetaminophen, which is a supplement with very modest tamper-resistant measures. Zogenix, the manufacturer of Zohydro, argues that their product is safer because of the absence of acetaminophen.

However, for every 1 death from acetaminophen-related overdose, there are 30 deaths from opiate overdoses annually. And for every 1 opiate-overdose, there are 825 recreational opiates users at risk for addiction or overdose. Without acetaminophen and no tamper-resistant influences, there is nothing to prevent the rampant abuse of Zohydro through injecting, snorting, or smoking.

Zogenix also argues that Zohydro allows for higher doses of painkillers. Accounting for the maximum daily dose of acetaminophen, current hydrocodone formulations allows for 6-10 pills per day. Zohydro will carry as much as 10 times the amount of hydrcodone as one pill of the currently available product. Outside of terminal illness or a short-term emergency, there are far better treatments available prior to needing this level of opiate dosing. In situations where higher doses are needed or acetaminophen-combined pain-relievers cannot be used, there are dozens of alternative medications, let alone other methods of treatment.

Hydrocodone, the opiate found in Zohydro, has been the #1 selling prescribed medication in the country since 1997. In a culture where there is a pill for every ailment, we do not have a shortage of opiates in Kentucky. What we lack is a better understanding of how to heal pain safely and sustainably. There are alternatives to consider prior to a path of opiate escalation.