All of the robots in this company are stocked full of the three most common hydrocodone/APAP strengths, 5/500, 7.5/500, and 10/500. Occasionally you'll see a script for Vicodin ES, but it is mainly those three strengths.
Until recently that is.
Six months ago we started having to add the 10/325mg strength to the robots. It wasn't that uncommon to see someone switch from #240 of 10/500mg to #360 of 10/325mg. On some days, the 10/325mg flavor was the most used.
Weird.
Now we've had a rush of scrips for the 5/325mg flavor in the past month. Some docs have exclusively switched from 5/500mg to 5/325mg. We were debating on Thursday whether or not we need to start adding this to the robots as well.
Yesterday someone handed me the first script for 7.5/325mg that I have seen in five years.
What in the hell is going on? What is with the massive change in the past year? I mean I see why they could be going that route as they were previously limited to eight tablets a day so their liver didn't explode. Now they can enjoy upwards of 120mg of hydrocodone daily.
Where is the logic in this? The people who are bringing these in are those who are on narc contracts or are known abusers. Isn't this just catering to their problem?
Is this happening anywhere else or is isolated to the small area here? Is there some therapeutic benefit that we're not aware of or have I figured out the method to this madness? I hope to God I'm wrong because, if so, I'll have even less faith in prescribers than I do already.
8 comments:
Yep, it's that whole Tylenol overdose thing. If we can't get them off the habit-forming narcotic we can at least take comfort that we're not giving 'em too much of that deadly Tylenol.....
Frantic is right. Becasue of the FDA "Tylenol" scare I've been switching to the lower APAP forms of the combo narcs.
I agree it's somewhat silly, but it's more to cover ourselves from the hassle of families, patients, and lawyers grilling us on the potential for APAP OD.
I think its more than a little silly, it's down right stupid. All it's going to do is give the addict another way to get more hydrocodone because of the 'liver' risk. I say fuck that.
I don't personally think anything of it. Lets be quite honest, for people taking that amount of hydrocodone daily, the tylenol isn't used for anything other than to keep the from overdosing. If the mds are changing the dose so the patient can actively take more, then that's one thing, but is there really a difference between 10/500 1-2 q 4 to 6 h prn and 10/325 1-2 q 4 to 6 h prn? I know the prior is tylenol overdosing, but it's also the amount of hydrocodone that the patient was instructed to take (not by the pharmacist, of course).
Granted, I may just be jaded from local docs still trying to write for the 10/660s under the same directions with no regard to my pleas.
The thing is, they're not keeping the same directions but upping to the max quantity of the 325mg tablets so they end up being in the same boat but with more hydrocodone.
agreed...its's the tylenol. But I've been begging docs to switch for years. And as a side note....most docs in my area with chronic pain patients are requiring narc contracts. It doesn't imply the patient is a seeker or abuser. The docs are requiring them for ALL pain patients to comply with DEA scrutiny and state board regs. I've seen the contract patients are not abusers and very compliant with their doses. And believe me, I'm very jaded. I still see the seekers and abusers every day and refuse their rxs.
I think a little bit of it is this part of the country - It's all Lortab, Lortab, Lortab here, but where I used to work, I was far more likely to see Vicodin, Vicoden, Vicodan (sad when the docs can't spell the brand name of the most prescribed drug...) and quite a few Norco rxs as well. Come to think of it though, I have seen quite a few more /325s than previously...
Giant Academic Medical Center here in town took 5/500 off formulary about two years ago in favor of 5/325. The reason was to reduce the amount of tylenol and maximize the amount of hydrocodone. It's not new here. Maybe the rest of the country is catching on? If hydrocodone was available as a single-entity product, I don't think norco/vicodin/lortab would even be prescribed.
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