opiates reclassified:hydrocodone, tramadol. zolpidem ER visits doubled

in response to the public health crisis related to prescription opioid diversion/ street availability/ deaths, there have been a couple of very-long-past-due changes by the DEA:
1. Hydrocodone (found in Vicodin, Lortab) is now being considered a Schedule II drug (as with all the other strong opioids), to take effect in 45 days.  it was really egregious that this had not been before, since it has the same morphine-equivalent strength as morphine!!!  so, will soon need to be handled as the others (written script for one month only, no refills permitted), and (hopefully) will have tighter govt regulation.   see https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-19922.pdf​ if you would like the gory details.
2. Tramadol, a lower potency opioid (10 mg of tramadol is considered 1 morphine equivalent), is now Schedule IV (as of 8/18/14), which means that it is in the same group as benzos (ie, needs written/signed prescription with DEA number, and can get up to 6 months with refills) -- note: tramadol can lead to overdose, though typically at very high doses and esp if snorted, and can be associated with withdrawal symptoms. Codeine (as in acetaminophen with codeine), for reference, is Schedule III (same restrictions as Schedule IV) and is a little more potent than tramadol: 10mg of codeine is 1.5 morphine equivalents.

zolpidem ER visits:
there was also a pretty striking article in SAMHSA news (Substance Abuse and Mental Health Services Administration, part of HHS since 1992) finding a doubling of ER visits from zolpidem overmedication: 21824 visits in 2002-6, 42274 in 2009-2010 (and 47% led to admission, 1/4 to intensive care). 68% in females. other drugs were involved in 57% of them:  benzos (26%), narcotics (25%), alcohol (14%). in 2013, because of the increasing number of adverse effects from zolpidem (esp drowsiness, dizziness, hallucinations, agitation, sleep-walking), the FDA recommended decreasing the maximal dose in women to 5mg (still 10mg in men). no data yet on changes in ER visits after this FDA recommendation. for the article: http://www.samhsa.gov/newsroom/advisories/1408111602.aspx

Comments

Post a Comment

if you would like to receive the near-daily emails regularly, please email me at gmodest@uphams.org

Popular posts from this blog

cystatin c: better predictor of bad outcomes than creatinine

  another article found significant discordance between creatinine and cystatin C in assessing renal function,  finding that the latter correlated most strongly with both renal and non-renal adverse clinical outcomes (see   ckd cystatin c better than creat AJKD2023  in  dropbox or doi: 10.1053/ j.ajkd.2023.04.002)   Details: -- 158,601 adults who were in the Stockholm Creatinine Measurements (SCREAM) project and had testing of creatinine and cystatin C on the same day during a healthcare encounter, from 2010-2018     -- >400,000 outpatient tests were done for both creatinine and cystatin C levels -- mean age 62, 48% female -- mean eGFR by creatinine (   eGFR cr ) 80; mean eGFR by cystatin C ( eGFR cys  ) 73 -- mean stage of renal insufficiency: 39%  eGFR cr   90+; 38%  eGFR cr  60-89; 12%  eGFR cr  45-59; 7.1%  eGFR cr  30-44; 3.2%  eGFR cr  15-29, 0.7%  eGFR cr ...
Read more

diabetes DPP-4 inhibitors and the risk of heart failure

the FDA just came out with a safety alert about 2 DPP-4 inhibitors and the increased risk of heart failure (released 04/05/2016)(see  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm494252.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery ​ ). details: --saxagliptin and alogliptin were singled out because of 2 clinical trials in diabetic patients with heart disease. in each trial more patients taking these meds were hospitalized for heart failure vs those on placebo     --in the saxagliptin trial: 3.5% were hospitalized for heart failure (vs 2.8% on placebo). risk factors included prior heart failure or kidney disease     --in the alogliptin trial: 3.9% were hospitalized for heart failure (vs 3.3% on placebo) --recommendation by the FDA:     -- we should consider stopping these drugs if the patient develops heart failure ...
Read more

UPDATE: ASCVD risk factor critique

I decided to do an extensive update of my prior ASCVD (atherosclerotic cardiovascular disease) risk analysis and critique of risk calculators, with much more information about the “non-traditional” risk factors. I felt that there should be more data/clarification, since I think we are really undertreating/not preventing the most common cause of death by relying on the current ASCVD risk calculators   -- Cardiovascular risk models:      -- many of us rely on the various cardiovascular risk models to determine the appropriate approach to patients, and these are often integrated into the electronic medical records      -- these risk models have several very important limitations:          -- they are typically based on community data, eg from the Framingham study etc. But, in clinical practice, we are dealing with the individual and not the community:          ...
Read more