The DEA War on Hydrocodone

The DEA wants to classify hydrocodone the same way it does oxycodone, a more powerful analog that is the active ingredient in the long-lasting painkiller Oxycontin. Oxycontin prescriptions cannot include refills. Oxycontin or hydrocodone alone are rarely the sole cause of a drug-induced death. More than 95 percent of these deaths are caused by "polypharmacy," the ingestion of multiple illicit compounds, usually laced with a lot of quite legal booze.

Picking on one drug won't do the trick, but picking on hydrocodone is a particularly bad idea, because the DEA's proposals could well kill more people from pain than they save from abuse.

How much pain and suffering does hydrocodone mitigate? There were 100 million new prescriptions for the drug last year in the United States, given to 38 million patients. (This doesn't even count in-hospital use.) Hydrocodone is by far the most prescribed drug in the nation.

Because there will be no more refills, DEA's proposal means at least 300 million office visits per year (figuring that most chronic pain prescriptions are refillable twice). Nowadays, one just doesn't walk in and out of a doc's office. Most pain doctors are so busy that appointments must be made months in advance, and appointment, travel and waiting easily burn half a day. That's 150 million worker days lost. Based upon average annual wages, employers will pay ( and you and I will shoulder ) about $13 billion in wages for doctor-visit induced absenteeism. And the office visits will add another $20 billion in cost, payable through the patient's insurance or someone else's taxes.

Add this to the fact that, according to Katherine Foley, a pain expert at Sloan-Kettering Cancer Center, pain already costs Americans $100 billion per year in treatment costs and labor-related losses. Making pain relief harder to get will only make it more expensive.

How risky is hydrocodone? According to the Drug Abuse Warning Network, a systematic effort to procure objective information on drug-related deaths, hydrocodone showed up in 46 bodies last year in Las Vegas, a town surely prone to a bit of drug abuse. The number of hydrocodone pills prescribed there in 2001 was around 27 million, and this doesn't even count the huge number that fly in with tourists, gamblers and others who engage in risk-taking behavior every weekend. I'd say it's a good bet that more people die in legal casinos and brothels in southern Nevada from heart attacks than are killed by hydrocodone.

Some other state data can be used to make fuzzy estimates of abuse-related deaths. In 2002, there were 150 findings of fatal concentrations of hydrocodone in postmortem examinations in Florida. Assuming conservatively that this may catch half the deaths, and way too conservatively that "Miami Vice" Florida is typical, this would maximize the number of deaths per year associated with fatal concentrations of this drug at around 6,000 nationwide.

Given the problem of polypharmacy, it's charitable to assume that the DEA's proposal may prevent half those deaths. Are 3,000 deaths pretty high overhead for pain relief? Well, consider NSAIDs. About 16,000 people who use these medications for arthritis alone die each year, due to the drugs' propensity to enhance internal bleeding. It would seem from this that DEA would save a lot more lives if it made ibuprofen harder to get, so that those with pain would have to switch to hydrocodone or oxycodone.

But that may be just one tip of the iceberg. Pain raises blood pressure and researchers have found that every 10mm increase in systolic blood pressure results, on the average, in a 40 percent increase in risk of stroke and a 30 percent increase in risk of heart attack for your age class.

So if hydrocodone became less available, we could expect potentially 8,000 more deaths from stroke and heart attack every year. And, although there's no way to reasonably estimate the number of people who will suffer bouts of depression, thoughts of suicide and actually commit suicide after being denied adequate pain medication because of the DEA's increasingly draconian measures, it's safe to assume that number will be in the millions.

Compare that with about 3,000 deaths that can prevented by the DEA's proposal. Those deaths are very unfortunate, but any "solution" that punishes the 38 million pain patients who use hydrocodone safely is not a reasonable solution.

Adapted from an article by Patrick Michaels, a senior fellow in environmental studies at the Cato Institute.

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