Monday, July 25, 2005

Stupid drug warrior tricks ...

... or, "just because you're paranoid, it doesn't mean they're not out to get you."

I confess: I'm blogging this particular bit of trivia not only because I find it interesting and instructive, but because I want to cover my own ass. I've been performing some ... interesting ... web searches, and when I say "interesting," I mean "the kind of searches that I'm afraid might make me a 'person of interest' if Uncle Sugar really does eavesdrop on Internet activities." If a bunch of masked thugs with guns and "DEA" on their shirts show up at my house, I want to have things on the record beforehand.

So, it goes like this: My significant other received a prescription awhile back for hydrocodone, an opiate-based painkiller (the original brand of this stuff was Vicodin).

Being the mordbid type, and also preferring to know just what is in our medicine cabinet in case the kids get into it or something, I noted the prescription and decided to find out just how bad this stuff is. Specifically, how much does it take to kill you? So, I headed on over to Google and punched in "hydrcodone LD50." LD50 is an acronym for "Lethal Dose 50," and refers to how much of a particular chemical it takes to kill 50% of the people who ingest that amount. It's a good thing to know, if you know what I mean. It lets me know, for example, what to do if one of the kids manages to climb high enough to get into the medicine cabinet (which they can both do no matter how high that medicine cabinet is), and if they manage to pick the "wrong" drug (which, in a given amount, could be any of them from aspirin on up), and if they manage to get off the childproof cap (you're kidding, right? When I have a problem opening a medicine bottle, I yell for the six-year-old). Should I should be racing to the ER with them or just raising the roof with them about how one never takes a pill without Mommy or Daddy knowing?

I was relieved to find that the LD50 of hydrocodone is huge -- as best I can tell, something on the order of 375 milligrams of the drug for every kilogram of body weight. For a 40 pound kid, that would mean almost seven grams of the stuff. The prescription was for 20 tablets, each containing a whopping five milligrams of hydrocodone. In other words, if I had four bottles of it, I could reasonably expect to have half a chance of killing a 2.2 pound premature baby.

Yeah, I know -- I worry too much. So sue me. But there's more ...

When I looked at the bottle, I realized that this was not a bottle of five milligram hydrocodone tablets, but a bottle of "five milligram hydrocodone/500mg APAP" tablets. So, uh, what the hell is this APAP stuff? Back to Google.

APAP is acetaminophen (the stuff in Tylenol, a non-prescription analgesic) -- and the search results made it pretty clear why the stuff is combined in pill form with hydrocodone. There are numerous web pages dedicated to performing what's called a "water extraction" to separate the hydrocodone from the acetaminophen so that one can get high on the former without the latter causing one's liver to go berserk. No, I'm not going to duplicate those instructions. If you want to be a junkie, you'll have to do the legwork to be a healthy (or at least surviving) junkie yourself.

The LD50 of acetaminophen is pretty high, too -- I came across a bunch of conflicting estimates, but it looks like somewhere in the neighborhood of 800 milligrams per kilogram of body weight ... but far smaller doses, especially if repeated, can cause severe liver damage.

This is the FUBAR logic of the drug warriors: "We regard recreational drug use as harmful to people, and we don't want people to hurt themselves. So, if they engage in behavior that might hurt themselves, why, we'll just make damn sure that, uh, they really hurt themselves."

The DEA's "schedules" -- drug classifications -- make hydrocodone more easily available as the accompanying acetaminophen content goes up, and less easily available as it goes down. I read a few contentions that the mixture was for "effectiveness ..." but surely physicians would prefer flexibility to prescribe X milligrams of one drug and Y milligrams of another, instead of having a pre-determined ratio forced on them in the manufacturing process. No, this is about deterring junkies.

It doesn't work, of course -- recreational users just perform their "water extractions" and go about the business of getting high. All it does is add an additional layer of risk for non-recreational users who may need the relief that hydrocodone offers, but who may already have (or could develop) liver function problems and most manifestly do not need acetaminophen in their diet.

I do my best to keep medicines well out of reach of my kids and to teach them to never put pills in their mouths unless they've been told to by the doctor/Mommy/Daddy. But with this particular prescription, the drug thugs have changed a potential case of "don't you feel awful and dopey and don't ever do that again" to a potential case of "Jesus, I hope we can get this kid to the ER before he dies and before his liver is so far gone that he requires a transplant."


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