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Zohydro ban unlikely in N.H., as doctors and pharmacists voluntarily postpone using it

It appears unlikely the state will launch a moratorium against the new pain medication Zohydro, but the drug still promises to be difficult to find in the state as doctors and pharmacists voluntarily reject it.

Medical professionals and hospital officials across the state have come out against using the drug, which is five times as powerful as similar prescription pills and doesn’t have the same anti-abuse mechanisms to make it difficult to crush and snort or inject.

Their voluntary moves against the drug are “encouraging,” said Sen. Andy Sanborn, a Bedford Republican and chairman of the Commerce Committee, who sponsored the moratorium idea.

“We’re close to where I want to be,” Sanborn said Friday. “The ability to have a nonlegislative solution is within sight, and if we can do that, it’s the best solution.”

The nonlegislative solution Sanborn said he hoped for relies on public pressure on the company to introduce a tamper-resistent version, including opposition from New Hampshire Attorney General Joe Foster and nearly 30 other state attorneys general.

Representatives of the state’s doctors and pharmacists said at a hearing Tuesday that they don’t support a moratorium, but don’t plan to distribute the drug, at least until the manufacturer makes it harder to misuse.

“This drug is going to be extremely dangerous. Opiate addicts are going to want it. They’re going to want it bad, and they’re going to do whatever it takes to get it,” Ed McGee, president and executive director of the New Hampshire Independent Pharmacy Association and a registered pharmacist in Enfield, said at a committee hearing last week.

Still, McGee is against the proposed moratorium. The drug was reviewed and approved by the federal Food and Drug Administration, and “I don’t think you, as a legislative body, have either the scientific knowledge or the right to say to the FDA they don’t know what they’re doing,” he told the committee.

“I really don’t want to see this drug in my state, I don’t want to see it in my pharmacy. . . . I agree with you, but this is not the right way to go about it.”

In addition to having greater potency, Zohydro doesn’t contain acetaminophen, which until now was always mixed with its main ingredient, hydrocodone.

Acetaminophen in high doses can cause liver damage. Pain treatment specialists have long wondered when a pharmaceutical manufacturer would give them access to hydrocodone without acetaminophen, said Seddon Savage, director of the Dartmouth Center on Addiction, Recovery and Education, and an expert in pain treatment.

“The more tools we have for pain management, the better we can treat patients. Clinically, it’s not critical, but it might be helpful for some people,” Savage said.

Supporters of a moratorium – voluntary or legislated – said they fear the drug’s lack of an abuse deterrent will worsen the state’s growing problem with opiate addiction.

Savage said she doesn’t see that happening.

“It’s not clear to me how having the medication out there will create a whole new generation of addicted persons or people who are overdosing. Heroin is cheaper,” she said.

Despite her support for a broader arsenal of treatment for pain, she said she was pleased to see Dartmouth-Hitchcock Medical Center announce earlier this month it would not stock or prescribe the drug.

Those decisions belong with the medical community, doctors and hospital officials said.

The New Hampshire Medical Society adopted a resolution “opposing the introduction of new long-acting opioids that do not include abuse deterrence protections,” Deputy Executive Vice President Janet Monahan said at the hearing Tuesday.

McGee said at least one of the three pharmacists who work in his Enfield facility has said the practice should not sell the drug, so it won’t.

Wentworth-Douglass Hospital, Portsmouth Regional Hospital, York Hospital, Lakes Region General Hospital and Pain Care in Somersworth have all said they do not prescribe Zohydro.

Fletcher Allen Health Care and Rutland Regional Medical Center, both in Vermont, told the Associated Press earlier this month that they will not be stocking the drug either.

Zohydro is not on the formulary or in the electronic prescribing system at Concord Hospital, “and it’s unlikely it ever will be,” said Chief Medical Officer David Green.

“It isn’t as though any drug that comes out automatically comes up for any consideration,” he said.

If a physician at the hospital requested access, the request would go before an administrative committee. No such requests have been made, Green said.

A similar committee will review the drug next month at LRGHealthcare, which oversees Lakes Region General Hospital in Laconia and Franklin General Hospital.

Until then, it is not in the formulary for the hospital and many physicians in the external practices have said they won’t be using it, said Marge Kerns, vice president of clinical support services.

Kerns put the drug on the committee agenda herself, after reading about Dartmouth-Hitchcock’s decision to ban it. She expects the committee will not recommend adding it to the formulary.

“It’s efficacious if used correctly, and if used correctly, it’s safe,” she said. “But I don’t see anyone looking at this and saying, ‘Wow, this is a wonder drug we have to have.’ There are alternatives.”

This article has been updated to correctly reflect the decision by physicians in LRGHealthcare external practices not to use Zohydro.

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

Legacy Comments1

It's hard to know where to begin. All hydrocodone is equally potent. Mixing acetaminophen with hydrocodone does not make it less potent, which you seem to suggest. There is only one medication that the FDA recognizes as "abuse deterrent," and it does not have hydrocodone. There is no similar medication that fits your description. Vicodin is schedule three, and Zohydro is schedule two with no abuse deterrence, so they are no terribly similar. You seem to be making stuff up.

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