Vicodin addiction is a growing crisis in the United States. While illegal drugs like cocaine, marijuana, methamphetamine, and heroin remain in the headlines many individuals may be surprised to know that Vicodin addiction could lurk right behind them as one of the most widely-abused drugs of addiction. In fact, the federal Drug Enforcement Administration believes Vicodin may be the most abused prescription drug in the country. Nationwide, its use has quadrupled in the last ten years, while emergency room visits attributed to Vicodin abuse soared 500 percent.
Vicodin® is a trade name for hydrocodone, which is an orally active analgesic and antitussive Schedule II narcotic that is marketed in multi-ingredient Schedule III products. It can produce a calm, euphoric state similar to heroin or morphine–and despite such important and obvious benefits in pain relief, evidence is pointing to chronic addiction. Vicodin has an analgesic potency similar to or greater than that of oral morphine. Sales and production of this drug have increased significantly in recent years (a four-fold increase between 1990 and 2000), as have diversion and illicit use. Other trade names for hydrocodone include Anexsia®, Hycodan®, Hycomine®, Lorcet®, Lortab®, Tussionex®, Tylox®, and Vicoprofen®. These are available as tablets, capsules, and/or syrups. Generally; this drug is abused by oral rather than intravenous administration. Currently, about 20 tons of hydrocodone products are used annually in the United States.
Subject to individual tolerance, many medical experts believe dependence or addiction can occur within one to four weeks at higher doses of Vicodin. Published reports of high profile movie stars, TV personalities and professional athletes who are recovering from Vicodin addiction are grim testimony to its debilitating effects.
Vicodin is structurally related to codeine and is approximately equal in strength to morphine in producing opiate-like effects. The first report that Vicodin produced a noticeable euphoria and symptoms of addiction was published in 1923; the first report of Vicodin addiction in the U.S. was published in 1961.
Every age group has been affected by the relative ease of Vicodin availability and the perceived safety of these products by professionals. Sometimes seen as a “white-collar” addiction, Vicodin abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely Vicodin abuser is a 20-40 yr old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, Vicodin-related deaths have been reported from every age grouping.
Vicodin abuse has been escalating over the last decade. There has been large scale diversion of Vicodin and other hydrocodone drugs . For example, an estimated 7 million dosage units were diverted in 1994 and over 11 million in 1997. In 1998 there were over 56 million new prescriptions written for hydrocodone products and by 2000 there were over 89 million. From 1990 the average consumption nationwide has increased by 300%. In the same period there has been a 500% increase in the number of Emergency Department visits attributed to hydrocodone abuse with 19,221 visits estimated in 2000. In 1997, there were over 1.3 million hydrocodone tablets seized and analyzed by the DEA laboratory system. A recent petition submitted to the DEA has requested a review of the control status of all hydrocodone-containing products.
There are over 200 products containing hydrocodonein the U.S. In its most usual product forms hydrocodone is combined with acetaminophen (Vicodin, Lortab), but it is also combined with aspirin (Lortab ASA), ibuprofen (Vicoprofen), and antihistamines (Hycomine). Both tablet and liquid forms of hydrocodone are available (e.g., Tussionex)
Vicodin is regulated by state and federal law, but it is not controlled as closely as other powerful painkillers. The lack of regulation makes them vulnerable to widespread abuse and addiction through forged prescriptions, theft, over-prescription, and “doctor shopping.” Vicodin pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.
Vicodin is abused for its opiate-like effects. It is similar to morphine in relieving abstinence symptoms from chronic morphine administration. The Schedule III status of hydrocodone-containing products has made them available to widespread diversion by “bogus call-in prescriptions” and thefts. Three dosage forms are typically found (5, 7.5, and 10 mg) and their behavioral effects can last up to 5 hours. The drug is most often administered orally. The growing awareness and concern about AIDS and blood-borne pathogens easily transmitted by syringe needle use, has made the oral bioavailability of hydrocodone attractive to the typical opiate abuser.
As with most opiates, the adverse effects of Vicodin abuse are dependence and tolerance development. Its co-formulation with acetaminophen has also increased the likelihood of acetaminophen-induced hepatic necrosis with high dose acute dosing, but slow escalation of dose over time seems to protect the liver during high dose chronic exposures seen with this drug.
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