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Zohydro: Why this new painkiller could spark another addiction epidemic

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 (Zogenix)

A new, highly potent painkiller is out on the market – and many health experts want it gone.

The controversial drug is Zohydro, an extended-release painkiller containing the already widely used opioid, hydrocodone.  Designed to release painkilling medication into the body slowly over a 12-hour period, Zohydro is available in doses as high as 50 milligrams – five times the amount found in similar immediate-release hydrocodone pills.

According to Zohydro’s manufacturer Zogenix Inc., the drug’s hallmark is its simplicity.  Zohydro is the first painkiller to contain only hydrocodone, while other comparable drugs, such as Vicodin and Lortab, contain hydrocodone plus acetaminophen.   The company claims that acetaminophen overdose is the leading cause of acute liver failure in the United States, and 63 percent of these cases are caused by hydrocodone-acetaminophen combination drugs.  Zohydro is meant to provide pain relief without this threat of liver toxicity.

"A lot of these kids wouldn’t be addicted if [opioids] weren’t so readily available."

- Dr. Dana Jane Saltzman, addiction specialist

But addiction experts claim this argument isn’t enough to outweigh the potential dangers posed by the painkiller.  Because of its extremely high dosage and lack of abuse deterrents, many believe Zohydro could easily ignite another addiction epidemic – as well as a new wave of overdose deaths.

“I treat addiction, and see countless young people come in – a lot of guys in their late 20s, early 30s – who had a sports injury and were given an opiate.  I’m seeing them years later, and it’s devastated their lives,” Dr. Dana Jane Saltzman, a licensed acupuncturist and addiction specialist in New York City, told FoxNews.com. “...It’s really a lifelong struggle, and a lot of these kids wouldn’t be addicted if [opioids] weren’t so readily available.”

Opioids and the brain

Derived from the opium poppy plant, opioids work by binding to receptor sights in the brain called opioid receptors.  Normally, when the body experiences pain, naturally occurring peptides, such as endorphins and other chemicals, will bind to these receptor sites in order to reduce discomfort.  

Opioids, on the other hand, greatly enhance this process.  Not only do they help to diminish pain, but they also stimulate the brain’s reward pathways, increasing the activity of the neurotransmitter dopamine.

This causes an overall sense of euphoria – which ultimately gets users hooked.

“When the brain receives a reward message that feels good, we tend to want to do it again,” Ray Isackila, a licensed professional counselor and team lead of addiction recovery services at UH Case Medical Center in Cleveland, Ohio, told FoxNews.com. “…And when the brain receives a message over and over from these opiate medications, the brain changes to adapt to that reward and that drug.  So the first change in the brain is tolerance.”

For individuals who start using opioids day after day, it may take only a few weeks before their brains build up a tolerance to the medication.  This means users will need higher and higher doses to get the desired euphoric effect – and as they take more pills, their bodies begin to develop a physical dependence on the drug.  Then, if they are ever deprived of medication, the withdrawal period can be very intense.

And most frightening of all, as users continue to increase their opioid dosage, they run the risk of overdosing and suffering complete respiratory failure.

“[Opioids] suppress the part of the brain responsible for keeping you breathing … and when that is suppressed, you really just stop breathing completely,” Saltzman said. “Another cause is mixing it with other things like alcohol, which is an incredibly strong synergistic suppression of breathing.”

Why Zohydro is so concerning

Experts have long known about the addiction risks associated with opioids.  When OxyContin – a drug containing the opioid oxycodone – was launched in 1996, reports soon surfaced that the medication was being misappropriated and abused.  Like Zohydro, OxyContin is designed to release medication over a slow period of time, but addicted individuals soon realized that by crushing up and snorting the tablets, they could receive the entire dosage all at once.

After this discovery, manufacturer Purdue Pharma L.P. reformulated OxyContin so that it was more difficult to manipulate for purposes of misuse.  However, the new drug Zohydro does not come equipped with this abuse deterrent technology, and since it is available in such high dosages, thrifty drug users could potentially get quite a bit of hydrocodone all at once.

“What clinicians are concerned about is that we suspect people might be able to snort it like they used to do with OxyContin,” Isackila said. “That makes the drug very abusable.  My understanding is there’s no check in place to prevent people from doing that.”

Zogenix officials say they are currently researching ways to make Zohydro non-crushable, but in the meantime, they are offering the pills in bottles with combination locks. 

The company says that Zohydro is meant to be prescribed “for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment, and for which alternate treatment options are inadequate.”  Officials claim that Zohydro would be beneficial for patients with malignant cancer pain or those needing proper end-of-life care.

But Saltzman argues that there are already so many other painkiller options available for these purposes, and only 2 percent of opioid painkillers are actually being given to people with malignant pain.  Additionally, despite how the drug is marketed, doctors can prescribe Zohydro for any patient they believe needs the medication.

“There are many doctors practicing that don’t know anything about chronic pain―or pain in general—and they’re not very aware of alternative treatments,” Saltzman said, “which can include something like acupuncture, exercise, physical therapy, or a non-narcotic pain reliever.  That’s one huge part of the problem.”

Both Saltzman and Isackila agree that given the amount of opioid abuse over the past few decades, the availability of a much more potent painkiller is just going to add to the growing problem.  Saltzman argues that with no immediate need for Zohydro, the drug is just another byproduct of a painkiller-hungry society.

“We give out 84 percent of all the painkillers in the world, and 99 percent of the hydrocodone in the whole world,” Saltzman said.  “How they can justify that, and how our children are having their lives ruined?”