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

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