Scrutiny and Praise for the FDA on Painkillers

Last week was a big news week for the FDA who has gained both scrutiny and praise for its decisions regarding prescription painkillers.

The FDA finally recommended that hydrocodone containing drugs are reclassified from a Schedule III drug to a Schedule II drug, which imposes greater restrictions on prescribing and access to this class of drugs. By changing the classification they will be restricted in the same way oxycodone and morphine are.

Given that hydrocodone drugs are the most widely prescribed in the US and the highly addictive, this has been long awaited. In 2011 alone, there were 131 million prescriptions written for hydrocodone and according to the DEA it ranks as the first or second most-abused medicine in the U.S. alongside oxycodone. The abuse of these drugs has resulted in an estimated 100,000 accidental overdoses in the US over the last decade. A huge proponent of this measure, Democratic Sen. Joe Manchin stated this was a "tremendous step forward in fighting the prescription drug abuse epidemic that has ravaged West Virginia and our country," and "Rescheduling hydrocodone from a Schedule III to a Schedule II drug will help prevent these highly addictive drugs from getting into the wrong hands and devastating families and communities.”

Just as the praise was soaring for the FDA, they announced their approval of a new painkiller that is a stronger version of hydrocodone called Zohydro ER. The drug is stronger for those that require around the clock pain management that requires pure hydrocodone rather than the current versions that combine hydrocodone with non-narcotics like acetaminophen. The approval reportedly came as surprise since a panel of pain specialists gave it a negative review last year - saying the US didn’t need another form of widely abused prescription drugs.

Patient safety advocates like Avi Israel, who lost her son who committed suicide while struggling with painkiller addiction, asserted, "We're just going to kill more kids and then the FDA is going to come back and say, 'oh, we made a mistake.’” Lawmakers in Washington who have been working hard to deter prescription abuse in their states were especially critical of the fact that the pills have no abuse deterrents (so they can’t be crushed or snorted) like the new forms of OxyContin do; “FDA not only approves this dangerous drug, but does so without requiring any abuse-deterrent features. This is outrageous,” said Rep. Bill Keating, D-Mass.

Here at Harmony Foundation we continue to see the trend of opioid painkiller abuse in our prescription drug treatment program in Colorado - among young adults and adults alike. While the new reclassification measure is notable, we share the sentiment of Keating and Israel that there does not need to be yet another prescription drug with potential for abuse on the market.

JFK's Community Mental Health Act Turns 50

Vice President Joe Biden will be in Boston today speaking at the John F Kennedy Presidential Library hosting The Kennedy Forum on community mental health. The Forum is a two-day event falling around the 50th anniversary of the signing of the Community Mental Health Act by President John F. Kennedy.

This was the last legislation signed by JFK before his assassination and provided funding for community mental health treatment centers with the goal of deinstitutionalizing those with mental illness. Instead of being held in state facilities with reputations for neglect and poor treatment, the mentally ill were encouraged to seek treatment at local community facilities. The intent was that people could get treatment while living and working at home.

In 1963 the typical stay at a mental institution was 11 years for someone with schizophrenia. The legislation to build 1500 centers intended to reduce the 500,000 people living in mental institutions by 50%. However, only half of the centers were ever built or funded while 90% of the beds in mental institutions were cut. This translated into many without a place to go - often ending up homeless or in prison.

JFK’s nephew, former U.S. Rep. Patrick Kennedy, who leads the Kennedy Forum on community mental health explains, “The goals of deinstitutionalization were perverted. People who did need institutional care got thrown out, and there weren’t the programs in place to keep them supported.” To improve this, Patrick Kennedy has gathered advocates like Joe Biden, Chelsea Clinton, MSNBC’s Chris Matthews and Chicago Bears wide receiver Brandon Marshall for the Forum to come up with an agenda for improving mental health care.

Is Addiction Inherited?

Robert Downey Jr. has been in the news recently, not because of Iron Man or his past drug problems, but because of his son - 20-year-old Indigo - who is reportedly in rehab.

Robert Downey Jr. had a very public battle with addiction when he was in and out of jails and institutions while trying to salvage his career. People watched as the extremely talented actor struggled with addiction to heroin, alcohol and cocaine and now praise him as a hero - not only because he is Iron Man, but for having overcome his powerful addiction to drugs and alcohol - he has been sober since 2003.

His son apparently went to treatment for trouble with prescription pills. His mother - Downey’s ex wife Deborah Falconer reportedly said, "He was never addicted. He was taking one pill a day" and now  “He's doing great. He'll be back playing music and going better soon."

Indigo, who plays in a band called The Seems (who just got a record deal with Warner Brothers) seems to have inherited creativity from his father, is it possible he inherited addictive tendencies as well? Robert Downey said that he was influenced by his own father’s drug use and began using marijuana at 6 years old after seeing his dad use it.

In the field of addiction treatment there are arguments for both nature and nurture when determining whether or not addiction can be inherited. To date, there is not one specific “addiction gene” but biological characteristics that make people either more or less vulnerable to addictive substances. For example, genes play a role in people having difficulty quitting once they start or experiencing greater withdrawal symptoms from substances once they stop. But scientists say that someone’s genetic makeup will not inevitably doom them to a life of addiction.

What do you think? Is it nurture or nature that puts one at greater risk for addiction?