Hydrocodone is the most frequently prescribed opiate in the United States with nearly 130 million prescriptions for hydrocodone-containing products dispensed in 2006. There are several hundred brand name and generic hydrocodone products marketed. All are combination products and the most frequently prescribed combination is hydrocodone and acetaminophen (Vicodin®, Lortab®, Lorcet®).
Hydrocodone diversion and abuse has been escalating in recent years. In 2006, hydrocodone was the most frequently encountered opioid pharmaceutical in drug evidence submitted to the National Forensic Laboratory Information System (NFLIS) with 25,136 exhibits; the System to Retrieve Investigational Drug Evidence (STRIDE) analyzed 654 exhibits in 2006. In the 2005 Drug Abuse Warning Network (DAWN) combination products were associated with more emergency room visits than any other pharmaceutical opioid with an estimated 51,225 emergency room visits. Poison control data, medical examiners’ reports, and treatment center data all indicate that the abuse of hydrocodone is associated with significant public health risks, including a substantial number of deaths.
CONTROL STATUS
When the CSA was enacted in 1971, hydrocodone as a substance by itself was placed in schedule II while products, containing hydrocodone in specified amounts and in combination with other active ingredients, were placed in schedule III and V. At that time, hydrocodone was primarily utilized as a cough suppressant with limited prescriptions. Today, hydrocodone products are increasingly utilized for pain management and are the most frequently dispensed opioid pharmaceuticals in the United States.
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STREET NAMES
Vikes, Hydro, Norco
SHORT-TERM EFFECTS
Hydrocodone in an analgesic and antitussive agent structurally similar to codeine but with effects more similar to morphine.
Hydrocodone is abused for its opioid effects. Widespread diversion via bogus call-in prescriptions, altered prescriptions, theft and illicit purchases from Internet sources are made easier by the present controls placed on hydrocodone products. Hydrocodone pills are the most frequently encountered dosage form in illicit traffic. Hydrocodone is generally abused orally, often in combination with alcohol.
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LONG-TERM EFFECTS
As with most opiates, abuse of hydrocodone is associated with tolerance, dependence, and addiction. The co-formulation with acetaminophen carries an additional risk of liver toxicity when high, acute doses are consumed. Data suggests that some individuals who abuse very high doses of acetaminophen-containing hydrocodone products may be spared this liver toxicity if they have been chronically taking these products and have escalated their dose slowly over a long period of time.
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TRAFFICKING TRENDS
Hydrocodone has been encountered in tablets, capsules and liquid form in the illicit market. However, tablets containing acetaminophen are the most frequently encountered products. Hydrocodone is not clandestinely produced and diverted pharmaceuticals are the primary source of the drug for abuse purposes. In 2006 alone, the DEA has documented the diversion of millions of dosage units of hydrocodone from illicit Internet sources. Doctor shopping, altered or fraudulent prescriptions, bogus call-in prescriptions, diversion by unscrupulous physicians and pharmacists, and drug theft are also major sources of the diverted drug.
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USE/USER POPULATION
Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by medical prescribers. Sometimes viewed as a “white collar” addiction, hydrocodone abuse has increased among all ethnic and economic groups. Of particular concern is the prevalence of illicit use of hydrocodone among school age children. In 2006, the Monitoring the Future Survey (commonly referred to as the high school survey) reported that 3%, 7% and 9.7% of 8 th, 10 th, and 12 th graders, respectively, reported non-medical use of Vicodin ® in the previous year.
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LEGISLATION
The DEA is currently reviewing a petition to increase the regulatory controls on hydrocodone combination products from schedule III to schedule II of the Controlled Substances Act (CSA). |
