Big change to make it harder for patients to get pain killers like Vicodin

[McCamy Taylor]

73. Untreated sleep apnea makes your body fight the effects of hydrocodone and opiates.

One in ten people over 40 has OSA (obstructive sleep apnea) (at least) in this country. 80% of them do not know it. If you look just at people with "chronic pain" the percentage with sleep disorders is much, much higher, but the percentage who do not know that they have a sleep disorder is still sky high because doctors are so extremely bad at spotting sleep disorders.

They did a study in which they exposed people to painful stimulus after giving them enough codeine to block their sensation of the pain. They then sleep deprived the subjects and gave them the same painful stimulus. It took more codeine to block the sensation of the pain in the same people. Conclusion---sleep deprivation makes your body resist the pain relieving effects of opiates. This makes sense from an evolutionary standpoint. If you are sleep deprived, your body wants you to be alert before all else, and so it tells you to shut off your natural endorphin system so that you are prepared to run from a tiger etc. Opiates like hydrocodone work on the endorphin system.

People with untreated OSA are like sponges. They can absorb enormous amounts of opiates and still be awake and still be in pain. In my experience, they are not addicted. Once their underlying sleep disorder is diagnosed and treated---i.e. as soon as some doctor thinks to ask "Do you snore at night? Do you stop breathing? Does anyone in your family have sleep apnea? Do you sleep flat on your back? Do you get up at night to urinate? Do you wake up with a dry mouth, a headache and elevated blood pressure?"---they stop demanding increasing doses of pain medications. Usually they cut back on their own. The number one way you can tell them from addicts is their primary concern is "I want to go back to the way I was before." I.e. back to the way they were in the days when they could sleep. They think pain is the reason they can not work because they have never heard of OSA and their doctors are not trained to recognize their OSA.

Also---this may not apply to everyone---if you have chronic pain issues and you think an undiagnosed or untreated sleep disorder may be part of the problem, while you are trying to get the sleep addressed, consider alternative medications that target other parts of the body's pain response like tramadol or lyrica. A real addict will tell you "Tramadol" does nothing for me. They want the opiate buzz. Someone with untreated with OSA will often say "Yeah, if I take tramadol between doses of hydrocodone, it helps a lot."

As for the schedule 2 change, consider Tylenol Number 4 (codeine). It is equivalent to hydrocodone 5 and as far as I know will stay non-triplicate.