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Hydrocodone - a mix of synthetic codeine and acetaminophen - is the most abused prescription drug in the United States, according to the Drug Enforcement Administration.
Nine years ago the Nevada Board of Pharmacy considered moving hydrocodone to Schedule II, but ended up voting against the plan, according to its attorney, Louis Ling.
Hydrocodone-containing products are in tablet, capsule and liquid forms. A variety of colors, markings, and packaging are available.
The major source of Hydrocodone to the street has been through bogus call-in and forged prescriptions, professional diversion through unscrupulous pharmacists, doctors, and dentists, and large-scale thefts. The pills have been sold for $2 to $10 per table
an orally active analgesic and antitussive Schedule II narcotic that is marketed
in multi-ingredient Schedule III products. Hydrocodone 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. Trade names include Anexsia®,
Hycodan®, Hycomine®, Lorcet®, Lortab®, Tussionex®, Tylox®,
Vicodin®, 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.
has been escalating over the last decade. There has been large scale diversion
of hydrocodone. 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 hydrocodone in 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.,
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 hydrocodone 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
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