Despite Vicodin’s reputation as one of the most powerful and widely abused opioids in the country, primary care physicians are prescribing a generic version of the painkiller to Medicare beneficiaries in high numbers, potentially contributing to an epidemic that has gained national attention in the last couple years.
A recent analysis of Medicare’s prescription drug program found that in 2013, more than half of prescriptions for generic Vicodin, known as hydrocodone acetaminophen, came from family-practice or internal medicine physicians. According to the report, nearly 691,000 surgeons, dentists, and pain relief specialists prescribed the painkiller to more than eight million Medicare Part D program beneficiaries.
A significant number of patients featured in the study included those under the age of 65 who were designated as disabled. This group accounted for nearly 45 percent of the claims, with a significant number receiving more than 10 hydrocodone acetaminophen prescriptions. Use also varied across the country, with the generic Vicodin accounting for four percent of prescriptions doled out in Alabama, Oklahoma, and Michigan.
“It’s striking that the drug prescribed to the most beneficiaries is a narcotic painkiller that can be addictive,” Walid Gellad, an associate professor at the University of Pittsburgh School of Medicine, told the Wall Street Journal.
Clinically, Vicodin relieves moderate to severe pain. However, the high potential for addiction has concerned medical professionals and lawmakers, especially as the number of prescriptions topped 130 million at the turn of the decade. Even as the number of prescriptions fell by eight percent between 2013 and 2014, the medication known as hydrocodone acetaminophen has remained the second-most prescribed drug in the United States for several years, according to data compiled by IMS Health, a healthcare industry information company.
If left unaddressed, Vicodin addiction can cause liver damage or failure, urinary system issues, and jaundice. Other telltale signs of addiction include social isolation, neglect of family, and engagement in a criminal lifestyle — especially if patients find themselves in desperate need of the medication. Experts say that addicts often find it difficult to quit because of withdrawal effects including depression, insomnia, diarrhea, bone pain, and intense sweating.
Overall, prescriptions for painkillers have nearly tripled over the past two decades as fatal overdoses of opioids reached epidemic levels, exceeding overdoses from illegal drugs like cocaine and heroin, according to the Centers for Disease Control and Prevention. Every day, more than 100 people succumb to painkiller abuse, with Vicodin, Oxycotin, and Percocet as the most common culprits. The majority of these deaths occur in the Southwest and Appalachian regions of the United States.
Even so, many doctors say they feel compelled to prescribe the generic medication to their patients to show that they’re paying attention to patient pain. For example, Brian Powderly, a doctor from West Virginia who prescribed painkillers to Medicare patients at a higher-than-average rate in 2013, told the Wall Street Journal that the elderly patients in his nursing home suffer from a host of chronic illnesses that demand long-term care. After she surrendered her medical license in March after being accessed of violating state prescribing laws, Dorothy Gillespie, a Mississippi-based internist, contended that she followed what she believed to be common protocol among pain specialists.
Last week, during a House Energy & Commerce Oversight and Investigations Subcommittee hearing on the best way the government should combat the opioid abuse epidemic, a group of expert witnesses discussed the public health challenges in this area. While many cited approaches combining medication and behavioral therapy for addicts, Dr. Nora Volkow, the director of the National Institute on Drug Abuse, took primary care physicians to task, saying that they need to find alternatives to pain medication that don’t cause long-term health complications.
“[We need] to develop better strategies for the management of chronic pain. Physicians are forced — their patients are suffering, they don’t know what to do and give an opioid, even though the evidence does not really show us they’re effective for chronic pain, but there are not very many alternatives,” Volkow said during her testimony on Friday.
Lawmakers have attempted to tackle the epidemic by requiring drug makers to create abuse-deterrent technology that turns pills into gel so that users won’t be tempted to crush and snort or chew them to get high. In 2013, the Food and Drug Administration drafted guidance on how pharmaceutical companies could adopt the technology after Congress threatened to rescind $20 million in funding. On a state level, lawmakers have started implementing prescription monitoring programs that have been touted as effective methods of tracking opioid use.
But some concerned medical professionals aren’t waiting on lawmakers to act before they change course. One recent study found that the majority of primary care doctors have expressed concern about opioid abuse and have made an effort to prescribe fewer painkillers to their patients. Some physicians have also looked beyond prescription medication to explore other potential methods of pain management like acupuncture, chiropractic, psychotherapy, and physical therapy, especially since a growing contingent of Americans have turned to alternative medicine in recent years.