As a doctor I've been trained to recognize patterns, but that same skill can lead to prejudicial thinking. Maybe I'll fail to recognize an old, disheveled man as the brilliant engineer he is, or the brilliant young physician as an alcoholic. I try to see beyond my own prejudices but one that's hard to break is my suspicion of drug-seeking patients.
Prescription drug abuse has become a massive problem in the U.S. Around 30,000 Americans die each year from the misuse of prescription drugs. Most of these deaths involve opioids such as oxycodone, or combinations of prescription drugs and alcohol. It's a clinical conundrum. We want to treat severe pain, but the tools we have can be dangerous. It takes knowledge and vigilance to treat pain using opioids, given the risk of substance use disorders and their high street value.
Enter into this picture a new medication, Rezira, marketed as a syrup to treat cough and congestion. Presumably, this would be used for patients with the common cold, the usual cause of these symptoms.
This is an accident waiting to happen. The main ingredients are hydrocodone, the opioid present in vicodin, and pseudoephedrine, a decongestant and potential stimulant sometimes used in the manufacture of methamphetamine. When sold as vicodin, hydrocodone is mixed with Tylenol, which if overused can cause liver failure. This drug removes that risk, perhaps protecting users from accidental Tylenol doses. It offers a winning combination, a drug causing euphoria and central nervous system depression, plus a stimulant. Opioids and stimulants are a popular combination, for example when cocaine and heroin are mixed in "speedballing."
This drug is a setup for diversion and abuse. It's sure to develop a high street value. Given that the evidence for the use of opioids for cough is pretty meager, and the potential for misuse is high, I see no place for this drug in our pharmacopeia.
Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.