Promoted from the Ricochet Member Feed by Editors Created with Sketch. Week of Cough Misery by DEA Schedule Change

 

keep-calm-and-swig-the-tussionex“That drug is [expletive],” muttered my usually genteel personal doctor this morning, as he wrote me a new prescription for the opioid narcotic Tussionex to ease the hacking cough that has wreaked havoc in my lungs and life for the last week. I had explained my confusion of that name for the non-narcotic Tessalon the Med Check nurse practitioner had prescribed five days before. My diagnosis was a bronchial virus and only its symptoms are treatable. That Saturday morning, desperate for more cough relief and sleep than provided by over-the-counter Mucinex, I had suggested Tussionex to the NP. I recalled the great effect that a drug close to that name had had on my cough symptoms several years ago. She wrote me up for Tessalon and suggested I keep dosing with Mucinex and add cough drops to my regimen. This morning, seven days, four bottles of cough syrup, and a hundred cough drops later, I dosed myself with Tussionex. I slept for four blissful hours. I awoke wanting answers.

Just after midnight, two days ago, I was wrenched from sleep to cough. Awaking to that violent urge, I could not at first even inhale enough air to cough! This was out of control. I dressed and drove to the ER. I was prodded and X-rayed and the physician assistant said there was nothing more they could do. Keep taking the Tessalon, Mucinex, and cough drops. Add in an Albuterol inhaler. Drink lots of fluids. The attending nurse mentioned Tessalon’s cough suppressant effects were hit-or-miss in her experience. I replied that I thought I had taken something called Tussionex before. She did not reply. She did not say that might be just what I needed.

Rising a few minutes ago from my hours-long nap, I searched and found that my delayed relief was likely due to a 2014 drug reclassification that made Tussionex and other hydrocodone-containing drugs more difficult to prescribe. Perhaps difficult even to mention.

In August 2014, the DEA reclassified hydrocodone up to a Schedule II drug from a Schedule III. Hydrocodone-combination drugs are one of the most prescribed drug categories – a wonder drug for pain management. However, citing increasing drug abuse and poisoning with such drugs, the DEA changed its classification. Briefly aside, it is a bit ironic that marijuana, a Schedule Class I drug most places, has been prescribed to treat pain, and is now off the Schedule and legal in several states for casual, non-medicinal use.

Car and drug deaths“Drug overdoses caused more deaths in 2011 than traffic fatalities,” parroted Forbes and other publications in 2014, while also pausing to consider hydrocodone’s positive benefits. Good copy that, and a great storyline, DEA. It was based on a CDC comparison study showing 20 years of steadily declining traffic deaths and rising fatal poisonings. Yet, a recent CDC finding indicates death due to opioids to be a smallish portion of drug poisonings overall.

Drug poisoning, opioids as part

A side-effect of Tussionex is drowsiness, and I feel like a nap. I have coughed only five times in the three hours it took to research and write this. Without Tussionex, I would have been coughing continuously for that time, could not have written anything, and would be ruing life in general.

I want to thank my doctor for his personal care despite his now higher profile within the DEA. I’m looking forward to accessing and reading Professor Stephen Ziegler’s oft-cited scholarly article, “Pain and the Politics of Hydrocodone.” Thanks to Tussionex for helping me write this. A caring friend wondered if there might be a homeopathic cure I could have sought. Hmm, Cannabis oil can cure cancer … There’s internet hits on cough benefits … Who knows if hydrocodone will even be available next time? Who knows how much longer general practitioners will be able to personally care for their patients?

Recommendation: Best cough drops? Fishermen’s Friend, by far.

Get your flu shot (it’s an untreatable virus, too)!

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  1. jmelvin Member

    Interesting article there indymb. Thanks for taking the time to write it. I too like your suggestion for Fishermen’s Friend cough drops. I’ve used them since I was a youngster on an as needed basis and they have worked far better than the typical Hall’s type drops.

    • #1
    • November 4, 2015, at 3:50 PM PST
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  2. John Walker Contributor

    A country gone completely mad. And I have been chastised for saying it is no longer serious. Now they treat you like a criminal in the U.S. if you want to buy Sudafed because it’s possible to extract crystal meth from huge quantities of this previously over the counter drug.

    • #2
    • November 4, 2015, at 4:08 PM PST
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  3. HeartofFLA Inactive

    A cough serious enough that you cannot sleep for a couple of days requires a serious dose of Hydrocodone. I know because I have been there and used Tussenex in the past. I even kept the bottle so I know what to reference/ask for in the future. Much better than those pearl-like things they pass for cough medicine that never work. Hope you get better.

    • #3
    • November 4, 2015, at 4:33 PM PST
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  4. John Walker Contributor

    Meanwhile Just Everybody But has opposed prescribing slow-release pain relief drugs to children because “pain is a part of life”. I guess he’s moved beyond “compassionate conservatism”.

    • #4
    • November 4, 2015, at 4:37 PM PST
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  5. Ned Walton Inactive

    I had a similar affliction about twenty years ago that lasted for six months until I was sent to the right doctor. He described the condition as viral burns on the esophagus and prescribed a steroid inhaler, unfortunately I can’t remember the name of it, but he said the cough would be gone within ten days and it was. The only side effect was that the twenty-five pounds I had lost with the coughing came back.

    • #5
    • November 4, 2015, at 5:11 PM PST
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  6. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    Wait a minute.

    It’s the DEA that classifies the legality of prescription drugs, and not the FDA?

    That’s … just … wrong.

    • #6
    • November 4, 2015, at 6:10 PM PST
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  7. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    John Walker:A country gone completely mad. And I have been chastised for saying it is no longer serious. Now they treat you like a criminal in the U.S. if you want to buy Sudafed because it’s possible to extract crystal meth from huge quantities of this previously over the counter drug.

    Speaking of which: Any cold medicine that doesn’t contain pseudoephedrine does absolutely nothing.

    A study published in the Journal of Allergy and Clinical Immunology: In Practice in September examined phenylephrine, the decongestant that appears in many over the counter cold medicines found on store shelves, from Tylenol Sinus to Sudafed PE to Advil Sinus Congestion & Pain. Phenylephrine worked no better than a placebo at reducing nasal congestion in people suffering from seasonal allergies — even at doses four times higher than is typical in cold or sinus medicines.

    • #7
    • November 4, 2015, at 6:14 PM PST
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  8. Midget Faded Rattlesnake Contributor

    Ned Walton: I had a similar affliction about twenty years ago that lasted for six months until I was sent to the right doctor. He described the condition as viral burns on the esophagus and prescribed a steroid inhaler, unfortunately I can’t remember the name of it…

    Steroid inhalers are awesome! But corticosteroids work by suppressing immune response, so using them to tame the symptoms of a current viral infection is not risk-free. If a doctor thought the risk of worsening the infection outweighed the benefits of treating the symptoms, I can understand why he’d avoid steroid treatment.

    If you felt like using yourself as a guinea pig, taking several times the OTC dose of dextromethorphan (an OTC cough suppressant) could increase its cough suppressant power. People take massive doses of this stuff for fun and usually manage to avoid super-horrible things happening to them. While that doesn’t sound like my idea of fun, if I needed to not-cough bad enough and felt short of other options…

    • #8
    • November 4, 2015, at 7:51 PM PST
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  9. Joseph Eagar Member
    Joseph Eagar Joined in the first year of Ricochet Ricochet Charter Member

    Eek. Cold medications. I can’t stand the things. They usually make me feel worse. Except for ibuprofen: that does work, but I avoid it like the plague. Nasty stuff if you have any sort of chronic health condition, because it will make you feel better. . .while worsening the underlying condition.

    I’m not a fan of over the counter medications.

    • #9
    • November 4, 2015, at 8:45 PM PST
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  10. EHerring Coolidge

    There is a nasty thing going around. I just finished keeping my twin 2 yr old grandsons so I could do the albuterol inhaler several times a day. It is a helpless feeling watching a toddler cough and practically choke. They are better….back at their daycare but now I have the 4 yr old granddaughter. I guess I will be able to personally diagnose what this virus does to you in a day or two. I hate that it is so difficult getting the right meds OTC.

    • #10
    • November 4, 2015, at 8:52 PM PST
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  11. Casey Taylor Inactive

    What’s never mentioned about opioid prescription poisonings is that it is rarely the opioid that poisons. Rather, continuous ingestion or overdose of the acetaminophen that is paired with modern opiate medicines – such as in hydrocodone, Oxycontin/codone – kills via liver toxicity and/or renal failure. The FDA issued a serious of advisory recommendations somewhat addressing this, but as far as I know Dr. Carl Hart is the only public figure in addiction studies to stress the connection between the two.

    • #11
    • November 4, 2015, at 9:27 PM PST
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  12. P̄om tā lôn (I am Bald Gram… Inactive

    It wasn’t very long ago that the Joint Commission maintained that analgesia was grossly inadequate in the ER (some truth to that, I think), but now wants to make it harder to prescribe opiates. Every time I write for hydrocodone (not to mention oxycodone or hydromorphone), I feel like I’m coming under the microscope.

    • #12
    • November 4, 2015, at 9:30 PM PST
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  13. OmegaPaladin Moderator

    Well, of course Hydrocodone is more powerful than a non-narcotic cough suppressant! And Tussionex includes an antihistamine as well, which will make this even more sedating. Codeine is used as much for cough suppression as pain relief.

    Misthiocracy – The DEA regulates drugs of abuse / controlled substances. The FDA determines if the drug is safe and effective. Marijuana is usually Schedule I, but the active ingredient is sold as Dronabinol at Schedule IV. Cocaine, morphine, oxycodone, and now hydrocodone are Schedule II, which means prescriptions cannot be refilled.

    As far as Pseudoephedrine goes, I prefer it for the duration of action. I know the Phenylephrine has worked for some colds – perhaps it is just useless with allergies. In Illinois, there is more detailed verification required if you want to buy sudafed than if you want to vote.

    Ms. Rattlesnake – I’d be cautious about taking large doses of dextromethorphan. High doses stop acting like a weak opiate and start behaving like ecstasy / MDMA. I’d ask a pharmacist or your doctor for the maximum dose available – this site says 30mg, but I am not able to provide medical advice.

    • #13
    • November 4, 2015, at 10:40 PM PST
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  14. I Walton Member

    Has anyone added up the deaths and ruined lives from the war on Drugs? It would dwarf overdoses, poisonings or even addictions.

    • #14
    • November 5, 2015, at 2:56 AM PST
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  15. She Reagan
    She Joined in the first year of Ricochet Ricochet Charter Member

    John Walker:A country gone completely mad. And I have been chastised for saying it is no longer serious. Now they treat you like a criminal in the U.S. if you want to buy Sudafed because it’s possible to extract crystal meth from huge quantities of this previously over the counter drug.

    Oh, it’s not only over here. The last few times I’ve traveled to the UK, I’ve made sure I have a full tube of 1% hydrocortisone ointment ($2 or so at Walmart) in my checked baggage, for the inevitable bites and stings. Because here’s what Boots’ website says about it:

    This Medicine is sold by BOOTS UK LIMITED at the professional discretion of a Boots pharmacist.

    Unfortunately, next day home delivery is unavailable for this product.

    Please note that you must be in to sign for this delivery.

    We need to ensure that this medicine is suitable for the person it is intended for. Therefore a Boots pharmacist may be required to contact you by phone to find out some additional information. If they are unable to speak to you when required your order may be delayed or the pharmacy medicine part of your order cancelled.

    Walking into a Boots and trying to buy a tube of the stuff causes one to be subjected to an interrogation of the third degree, starting with whether you’ve seen a doctor, or why you haven’t brought a doctor’s prescription with you.

    And, just try finding an over-the-counter Neosporin equivalent in the UK. To my knowledge, there isn’t anything close.

    As things have developed (or not) with health care in the US, I’ve come to view my 25-year career in healthcare IT as a great stroke of luck, because along the way I’ve formed firm friendships with a number of physicians.

    And although I, or they, would never skirt the rules just for me, I know I can get an informed, honest, attentive medical opinion anytime I need one (in return, they ask me about their computers). To borrow from the Mastercard commercial: Priceless.

    Knowing what I know now, if I were just starting out, I’d probably think a career with some sort of healthcare involvement, in any field, was a good idea.

    • #15
    • November 5, 2015, at 4:07 AM PST
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  16. Son of Spengler Contributor

    In CT, there’s a new government database of pain medication prescriptions that every prescriber is now required to check before writing a new scrip. Besides the fact that this database is liable to be compromised and result in privacy breaches, it adds time to patient visits, leaving less time for care (and/or lowering provider reimbursement per hour).

    The focus on addiction at the expense of legitimate pain relief is to our shame. Modern medicine should alleviate pain. This is one more example of how regulators and politicians deny things globally to the rest of us in response to a small minority of bad cases.

    • #16
    • November 5, 2015, at 4:34 AM PST
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  17. Son of Spengler Contributor

    Separately, I understand there are places you can go on the Web to find recipes for synthesizing hard-to-find Sudafed from easily obtained crystal meth.

    • #17
    • November 5, 2015, at 4:37 AM PST
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  18. Nick Stuart Inactive

    Neither Jeb!, Barack Obama, Bill Bennett, their families, nor the whole pantheon of drug warriors will ever lack for efficacious pain medication. Neither will medical professionals who’ll keep the good stuff for themselves.

    • #18
    • November 5, 2015, at 5:31 AM PST
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  19. Blondie Thatcher

    John Walker:Meanwhile Just Everybody But has opposed prescribing slow-release pain relief drugs to children because “pain is a part of life”. I guess he’s moved beyond “compassionate conservatism”.

    As if I need another reason……

    • #19
    • November 5, 2015, at 6:03 AM PST
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  20. John Walker Contributor

    She: The last few times I’ve traveled to the UK, I’ve made sure I have a full tube of 1% hydrocortisone ointment ($2 or so at Walmart) in my checked baggage, for the inevitable bites and stings.

    In Switzerland, you can buy up to 5% hydrocortisone ointment at any pharmacy without a prescription, questions, or record-keeping. They don’t stock it on the open shelves, but all you have to do is ask. (This is also the case with many non-prescription items such as Vitamin C.)

    I wonder if the rest of the Anglosphere is also on the cutting edge of busybody regulation in this regard.

    In Egypt you can buy Valium over the counter.

    • #20
    • November 5, 2015, at 6:09 AM PST
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  21. Idahoklahoman Member

    John Walker:In Egypt you can buy Valium over the counter.

    You can probably buy Valium over the counter at any number of Egyptian-run pharmacies in Florida …

    • #21
    • November 5, 2015, at 6:50 AM PST
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  22. Songwriter Member
    Songwriter Joined in the first year of Ricochet Ricochet Charter Member

    indymb – You have my sincerest empathy. You describe symptoms that strike me every other year or so. When I get these symptoms, my cough is very violent. After a couple of days, my entire torso is sore from the coughing. Left untreated, my bronchitis nearly became pneumonia on one occasion.

    • #22
    • November 5, 2015, at 7:19 AM PST
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  23. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    OmegaPaladin: Misthiocracy – The DEA regulates drugs of abuse / controlled substances. The FDA determines if the drug is safe and effective. Marijuana is usually Schedule I, but the active ingredient is sold as Dronabinol at Schedule IV. Cocaine, morphine, oxycodone, and now hydrocodone are Schedule II, which means prescriptions cannot be refilled.

    I understand that, but determining which schedule a drug is on is supposed to be based on medical criteria. It’s all about the “likelihood for abuse” and “legitimate medical application” of the drug.

    It seems to me that determining the legitimate medical uses for a drug should be the purvue of the FDA (if it must be the job of the federal government at all). They’re the scientists.

    • #23
    • November 5, 2015, at 7:49 AM PST
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  24. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    Idahoklahoman:

    John Walker:In Egypt you can buy Valium over the counter.

    You can probably buy Valium over the counter at any number of Egyptian-run pharmacies in Florida …

    Or at least a reasonable, hand-drawn facsimile of it.

    ;-)

    • #24
    • November 5, 2015, at 7:50 AM PST
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  25. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    John Walker: In Switzerland, you can buy up to 5% hydrocortisone ointment at any pharmacy without a prescription, questions, or record-keeping. They don’t stock it on the open shelves, but all you have to do is ask. (This is also the case with many non-prescription items such as Vitamin C.)

    < devil’s advocate mode = on >

    To be fair, the very concept of buying anything on open shelves is relatively new. In the good olde days one had to ask for pretty much everything from the clerk behind the counter. In many places this was still the usual way of doing business right up until the 1950s.

    I find it somewhat amusing that the idea that having to ask a clerk for something has come to be seen as a hardship. I understand why this has come to be so, but still it’s amusing.

    < devil’s advocate mode = off >

    • #25
    • November 5, 2015, at 7:55 AM PST
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  26. Midget Faded Rattlesnake Contributor

    OmegaPaladin:Ms. Rattlesnake – I’d be cautious about taking large doses of dextromethorphan. High doses stop acting like a weak opiate and start behaving like ecstasy / MDMA. I’d ask a pharmacist or your doctor for the maximum dose available – this site says 30mg, but I am not able to provide medical advice.

    Oh, I’d definitely be cautious about taking large doses of it. And if I ever did have to go that route, I’d ask a doctor, nurse, or pharmacist how much above the recommended OTC dose they’d estimate was still safe.

    Mainly, I was being sarcastic about recommending a robotrip to treat a cough – there is grim humor in imagining someone getting high off OTC cough syrup because he could not get Tussinex.

    • #26
    • November 5, 2015, at 1:59 PM PST
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  27. She Reagan
    She Joined in the first year of Ricochet Ricochet Charter Member

    Misthiocracy:

    John Walker: In Switzerland, you can buy up to 5% hydrocortisone ointment at any pharmacy without a prescription, questions, or record-keeping. They don’t stock it on the open shelves, but all you have to do is ask. (This is also the case with many non-prescription items such as Vitamin C.)

    < devil’s advocate mode = on >

    To be fair, the very concept of buying anything on open shelves is relatively new. In the good olde days one had to ask for pretty much everything from the clerk behind the counter. In many places this was still the usual way of doing business right up until the 1950s.

    I find it somewhat amusing that the idea that having to ask a clerk for something has come to be seen as a hardship. I understand why this has come to be so, but still it’s amusing.

    < devil’s advocate mode = off >

    Asking a clerk to hand something to you, that’s on a shelf behind the counter, that you can’t reach, is very different from subjecting yourself to an interrogation as to why you want it and if you’re ALLOWED to have it.

    • #27
    • November 5, 2015, at 2:36 PM PST
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  28. She Reagan
    She Joined in the first year of Ricochet Ricochet Charter Member

    John Walker:

    She: The last few times I’ve traveled to the UK, I’ve made sure I have a full tube of 1% hydrocortisone ointment ($2 or so at Walmart) in my checked baggage, for the inevitable bites and stings.

    In Switzerland, you can buy up to 5% hydrocortisone ointment at any pharmacy without a prescription, questions, or record-keeping. They don’t stock it on the open shelves, but all you have to do is ask. (This is also the case with many non-prescription items such as Vitamin C.)

    I wonder if the rest of the Anglosphere is also on the cutting edge of busybody regulation in this regard.

    . . .

    The Anglosphere excels in busybodies. And regulations.

    I know of no country that surpasses the mothership in its desire to comply with what are always called “the authorities.”

    92-year-old Aunt Pat never ceases to display her frustration about the Common Market European Union and the way in which other member countries flout the same regulations that the Brits tie themselves in knots over, while trying to comply and show the flag.

    Unfortunately, 92-year-old Aunt Pat is part of a vanishingly small minority who remembers a life that was possible before nanny-state and micromanagement control. The rest of them “love” Big Brother. And it breaks my heart.

    • #28
    • November 5, 2015, at 2:44 PM PST
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  29. Misthiocracy held his nose and Member
    Misthiocracy held his nose and Joined in the first year of Ricochet Ricochet Charter Member

    She: 92-year-old Aunt Pat never ceases to display her frustration about the Common Market European Union and the way in which other member countries flout the same regulations that the Brits tie themselves in knots over, while trying to comply and show the flag.

    I met a British MP who lamented how the British culture of “fair play” works against the country in its dealings with the EU. The British might not like the regulations, but they’ll always comply because that’s what you do with regulations.

    The continental culture, on the other hand, is to impose and then ignore as many regulations as possible.

    • #29
    • November 5, 2015, at 4:55 PM PST
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  30. She Reagan
    She Joined in the first year of Ricochet Ricochet Charter Member

    Misthiocracy:

    She: 92-year-old Aunt Pat never ceases to display her frustration about the Common Market European Union and the way in which other member countries flout the same regulations that the Brits tie themselves in knots over, while trying to comply and show the flag.

    I met a British MP who lamented how the British culture of “fair play” works against the country in its dealings with the EU. The British might not like the regulations, but they’ll always comply because that’s what you do with regulations.

    The continental culture, on the other hand, is to impose and then ignore as many regulations as possible.

    Misthiocracy:

    She: 92-year-old Aunt Pat never ceases to display her frustration about the Common Market European Union and the way in which other member countries flout the same regulations that the Brits tie themselves in knots over, while trying to comply and show the flag.

    I met a British MP who lamented how the British culture of “fair play” works against the country in its dealings with the EU. The British might not like the regulations, but they’ll always comply because that’s what you do with regulations.

    Exactly. “The Authorities.”

    • #30
    • November 5, 2015, at 5:42 PM PST
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