Life Without Vicodin?

Last week, a federal advisory panel recommended that Vicodin, one of the most popular (and glamorous) prescription painkillers, be banned. Why? In addition to the narcotic hydrocodone, Vicodin contains acetaminophen, which, in large doses (the panel noted that many users need increasingly larger doses to maintain the same effect), causes liver damage. It also makes stressed people feel groovy: One movie studio’s execs celebrated “Vicodin Fridays” in the nineties. A warm, fuzzy Vicodin history:

First medical use of acetaminophen, derived from a by-product of coal-tar distillation.

The German pharmaceutical company Knoll synthesizes hydrocodone, an opiate painkiller chemically similar to codeine.

A researcher for the U.S. Bureau of Social Hygiene reports that although hydrocodone is an excellent painkiller and cough suppressant, users build up a tolerance very slowly, inducing them to become addicted.

Acetaminophen is introduced to the U.S., under the name Tylenol. It’s prescription-only, in a child’s liquid dose. The adult version arrives six years later.

Pure hydrocodone joins the Schedule II list of narcotics, along with opium and morphine, with passage of the Controlled Substances Act. But in combination with other drugs, it’s considered a less stringently regulated Schedule III drug.

Knoll introduces Vicodin, five milligrams of hydrocodone with 500 milligrams of acetaminophen, in the U.S.

Generic Vicodin available.

Emergency-room reports involving hydrocodone increase 500 percent since 1990. That same year, the FDA recommends tighter warnings on drugs containing acetaminophen over liver-damage fears.

Americans are written 130 million prescriptions for drugs containing hydrocodone.

Abbott plans to sell a controlled-release version of Vicodin—but fails to gain FDA approval. A few months later, Abbott lays off 200 sales reps who were expected to be marketing the product.

On June 30, a federal advisory panel votes to recommend the FDA ban Vicodin.

Why Is It Prescribed So Much?
“Originally it was a Schedule III opioid, as opposed to Schedule II. So it could be called in to the pharmacy and refilled. That led to development of a great amount of product loyalty—to physician practice patterns that are very Vicodin-based. It’s also effective. As a combination analgesic, it targets two pain mechanisms simultaneously.” —Dr. Chris Gharibo, Director of Pain Medicine at the NYU Hospital for Joint Diseases

Maximum Safe Daily Dose of Acetaminophen: 4 grams

Approximate Number of Vicodin to Get You There: 8

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Life Without Vicodin?