New powerful pain medications are drawing criticism from addiction stoppers. Ohio lawmakers are considering banning one of the drugs as the state copes with pain killer addiction.
WOSU takes a look at how lawmakers, the courts and doctors are trying to balance pain relief with addiction prevention. They are powerful painkillers -- a new breed of opiate pain pills.
These drugs are pharmaceutical industry firsts. And they have some state leaders and medical experts concerned. Critics say, with a prescription opiate and heroin epidemic, more drugs are unnecessary in a market they say is saturated with pain pills.
House Bill 501 proposes to ban Ohio doctors from prescribing one of the drugs. Representative Robert Sprague, of Findlay, co-sponsored the bill.
"This is a powerful opioid. And what is leading to the rampant use of heroin, and the supply of heroin on the streets, are people becoming addicted to the prescription opioids," Sprague said.
Sprague wants to ban Zohydro. It is pure hydrocodone. Despite some objections, the FDA approved it late last year. Another new drug, Moxduo, combines morphine and oxycodone in one pill. The FDA is reviewing it, and it, too, has received push back from experts.
What makes these drugs different from Vicodin and Percocet is neither Zohydro nor Moxduo has acetaminophen. Acetaminophen, taken in large doses, can cause liver damage, so the FDA strictly regulates its use.
Zohydro can be up to 10 times stronger than Vicodin.
"I find it absolutely terrifying and disturbing," Lisa Roberts said.
Roberts is a long-time nurse at the Portsmouth City Health Department, the epicenter of the state's prescription drug abuse problem.
She said she watched pill mills increase exponentially, along with overdose deaths, crime and disgraced physicians. Roberts supports the bill to prohibit Ohio doctors from prescribing Zohydro.
"It's like you have more and more bigger bullets flying at you all the time, you know, with the approval of these blockbuster drugs."
Some medical experts say the drugs needs what is called an abuse deterrent, something that keeps users from crushing it so it can snorted or injected. Neither Zohydro nor Moxduo Immediate Release has an abuse deterrent.
Critics, who urge the FDA to rescind its approval of Zohydro, say opiate addicts unfamiliar with it could easily overdose and die. But some in the medical community say these new drugs are essential.
"I believe there is a need for better pain relievers," Dr. Paul Christo said.
Christo is a pain medicine specialist at the Johns Hopkins University School of Medicine in Baltimore. He said people do not respond to pain medications the same way. He said the dual-opiate Moxduo could help chronic pain sufferers who can't get relief.
"If you give me morphine for pain control, it may not do the same job, it may not work as well as it would for you," Christo said. "So I think the idea here is that, OK, let's use two different opioids, they may bind to different receptors and better reduce pain."
Christo said he, too, worries about opiate addiction and the damage it causes. But he said the discussion needs to focus on safer administration.
"We examine whether they have any psychiatric diseases or illnesses, for example, that could predispose them to increased risk of using something like Zohydro or OxyContin," he said. "And then we also make sure we do some urine drug testing, I mean, I do, to ensure that patients are using the drugs properly and safely."
In Ohio, Representative Sprague doesn't want anyone to get the chance to abuse Zohydro. But his bill to ban it could face roadblocks.
Massachusetts banned Zohydro this spring, but a U.S. District Court judge reversed the order saying federal law trumps state law. Sprague finds that ruling disconcerting.
"Whydon't we have an option as a state to prohibit something to be sold that we know is going to kill our citizens," he questioned. "How can a federal bureaucracy legalize one of these powerful pain medications, and they've done it in a way that overrides their independent physician panel that clearly voted no, 11 to 2, against the adoption of the drug."
House Bill 501 is going through the hearing process, and the makers of Zohydro are expected to testify before a subcommittee this week.