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Tuesday, November 22, 2005

The Pusher Man

As you know, this time last week I was in recovery from dental surgery. Okay, an extraction. The dentist sent me home with two prescriptions: one for Amoxicillin, an antibiotic to cure the infection on one side of my mouth, and another for Vicodin, to ease the pain on the other. In both cases, he checked the "may substitute" box on the prescription.

I filled the scrips at CVS. This is not my usual drugstore, not that I have one, but if I did it would be the Walgreens down the street. But there's a newish CVS in my neighborhood, and so they've been sending out coupons. One offered a $25 gift card with a new prescription. How could I say no?

I should have known something was up when the first response of the pharmacist was, "These are some good meds." She clarified her statement by saying they weren't very expensive, but the cat had stuck its head out of the bag. I dithered about the store while she filled the prescription.

When I returned, another pharmacist – the actual pharmacist? – gave me the prescription, but also a tip. Instead of Vicodin, she had substituted Hydrocodone, which is Vicodin without the sharkskin suit. The prescription was for 8 pills. Since the instructions specified a dose of one tablet every 4 to 6 hours, this was 2 or 3 days' worth of treatment. Sufficient. But the pharmacist informed me that, as with many kinds of drugs, the more you buy, the cheaper they are. 8 pills were $10.99. But my scrip allowed for one refill, and 16 pills were also $10.99. Did I want the double dose?

When I originally went to my periodontist, I had some extensive work done. At the time, he prescribed some Vicodin, but told me that Advil would probably do the job just as well. He was right. He told me the same thing this time, and said I could choose whether or not I wanted to spend the money on Vicodin. He could have skipped the second prescription altogether, but pain is unpredictable.

The druggist was not making any more money by selling me twice as much opiate. Unless she was getting a kickback from the drug company for pushing their product. But it's a generic drug; there is no brand name. As for the sale, it was the same price. For twice as much. I understand the concept of bulk discounts. But it's never the same price for twice as much.

I appreciate her informing me of the savings possibility from a perspective of customer service. But did I need twice as much hydrocodone? Did I need half as much?

Between 1988 and 1998, the number of prescriptions per year for first-time users of Vicodin and similar painkillers grew from 500,000 to 1.6 million.

In animal studies in the 1930s, researchers discovered that hydrocodone, in addition to being an effective painkiller, "induced euphoria, and therefore there was danger of addiction." The drug produced "excitation indistinguishable from that produced by morphine in morphine-tolerant rats." Finally, "Its repeated administration to dogs and monkeys leads to the development of tolerance but more slowly than that of morphine or Dilaudid [a relative of morphine] and to the occurrence of abstinence syndromes that are less severe than with the other drugs." In other words, not only is it addictive, but you don't know you're getting addicted until you're really addicted.

I will not become addicted to hydrocodone. I don't have a doctor that will keep writing me prescriptions for the stuff. But I do have a pharmacist who will sell me twice as much as necessary for the same price. And in a world in which patients are told to ask their doctors about drugs X, Y and Z, and doctors write three times as many prescriptions for the stuff as they did 20 years ago, I am in a growing minority.


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