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November 3, 2013

FDA should rethink

NORMAN — The United States consumes 99 percent of the hydrocodone used in the world. Opioids are over-prescribed and frequently abused. Overdoses from narcotic painkillers have quadrupled in the last decade.

This epidemic of abuse and addiction is why we think the U.S. Food and Drug Administration made a good decision last week to recommend tighter controls on narcotic painkillers such as Vicodin.

It’s also why we cannot fathom an FDA decision announced the very next day to approve a new high-dose narcotic painkiller without a formula to limit abuse and using a testing method that critics say biases the test in favor of approval.

Zohydro ER was approved even after the FDA’s own advisers recommended against it. It will be the first hydrocodone-only opioid and will be available in doses containing as much as five to 10 times more of the narcotic than other hydrocodone products on the market such as Vicodin, which also contains acetaminophen.

The narcotic in Zohydro ER is designed to be released over 12 hours, but it’s easy to see how it might be abused by people who could crush it, chew it or mix it with alcohol to get high.

“If the FDA was really interested in protecting the public, they would have said, ‘No thanks...we have too many people dying of opioids in this country to justify approving Zohydro,’” David Juurlink, a physician and director of pharmacology and toxicology at the University of Toronto, told John Fauber of the Journal Sentinel and Kristina Fiore of MedPage Today, who collaborated on an article about the FDA decision.

“Minus the pesky acetaminophen, plus the crushability, it’s a disaster in the making.”

We fear that Juurlink might be right — and so did FDA staff. Fauber and Fiore reported that a November 2012 memo from FDA staff predicted that the drug would be abused more than traditional hydrocodone products. The new drug will come in doses as high as 50 mg.

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