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How Much Does It Hurt?

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The emergency room of the main Staten Island University Hospital sits on Seaview Avenue, just up the road from the waters of lower New York Bay. It is impossible to think about the pending landfall of Zohydro on Staten Island without recalling the days prior to the arrival of Hurricane Sandy. Everyone knew the storm was coming, but they didn’t know when exactly it would arrive, where exactly it would hit, whether it would be one more overblown forecast or worse than anyone could possibly have imagined. As it turned out, Sandy sent seawater surging half a mile inland, right up to the entrance of the ER.

As if awaiting a different kind of storm, physicians on Staten Island are hunkered down, wondering what will happen with the arrival of Zohydro. As recently as mid-May, longtime ER physicians in New York like Lewis Nelson were having a hard time determining whether the drug had reached local distributors or pharmacies.

But on Opiophile’s “Zohydro” thread, the first reports trickled in on April 10. “Swim [someone who isn’t me] has 50 10mg Zohydro ER,” someone wrote. “They are in capsules that are nearly empty but contain little white, bead-like particles. Anyone with experience with this? Suggestions as to how to maximize their effect?” Within hours, someone had replied, “I believe junkie code says you must try a new pharm using each ROA [route of administration] and then give a full MLA style report on the phile. So I would snort one, eat one, iv one, plug one, and umm don’t smoke one. And don’t do them all at the same time!” Even allowing for zonker-braggadocio, it wasn’t an encouraging sign.

Many primary-care physicians, including on Staten Island, are now refusing to prescribe prescription painkillers; some even have signs in their offices saying so. First responders on Staten Island now carry naloxone (Narcan), a drug that can immediately reverse the effects of opioid overdose. And Zogenix has insisted, as it did during the approval process, that it is targeting only a “small subset” of about 90,000 chronic-pain patients.

It is entirely possible that the intense public scrutiny of Zohydro will hinder overprescription of the drug; Nima Majlesi suspects problems might not arise for another two or three years, by which time tamper-resistant forms of long-acting hydrocodone might be on the market. His emergency-room colleague on the south campus of the hospital, James Kenny, tends to agree. Down on the more affluent South Shore of Staten Island, where an equestrian course begins one block away from the hospital on Seguine Avenue, Kenny has already moved on to the next stage of heartbreak in the opioid epidemic.

“Yesterday, we had a 16-year-old come in, lethargic, and we reverted her with Narcan. She woke right up, tearfully admitting that she’s been snorting heroin for months,” he says in his basement office. “Her mom had no idea at all.” The surge in heroin use on Staten Island, he adds, “absolutely” started with prescription-painkiller addiction. Kenny argues that all the drug-company education programs and government restrictions on drugs like Zohydro are fine and necessary. “But,” he says, “that’s closing the barn door after the horse is gone.”


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