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Posted: 12/3/2007 4:15:19 PM EDT
So my grandfather helps with the drug/addiction recovery group that our church started, and he said one of the ladies that came in was taking FORTY Vicodin pills A DAY. I said he had to be insane and that wasn't possible, he swore he was telling the truth. I could see 40mg, 4 pills, 14 pills even if you've built up a big tolerance, but FORTY?!?!?
So, ARFCOM docs, is it possible?
Link Posted: 12/3/2007 4:26:42 PM EDT
btt
Link Posted: 12/3/2007 4:29:42 PM EDT
Oh yeah, it's possible. A good friend of mine is a rehab councellor, you might be SHOCKED at how much junk the body can take into itself.
Link Posted: 12/3/2007 4:29:44 PM EDT
Not a doc, but IIRC people build up remarkable tolerances to opiates. I know that someone with chronic pain who's being treated with opiates can take a dose that would literally kill you or me, and pronounce that his pain has subsided to a bearable level (but not been eradicated), and speak & think clearly.
Link Posted: 12/3/2007 4:31:29 PM EDT
Wow, that's absurd! I mean... 40 pills, say you're awake for 16 hrs, that's 2.5 pills per HOUR!
Link Posted: 12/3/2007 4:34:36 PM EDT
40 vicodin is equivalent to the hydrocodone in 20 lortabs. That is ten mg of hydrocodone per tablet. Take two tablets at a time, every four hours, and you get a normal, high end perscribed dose of hydrocodone to be 12 lortabs in a 24 hour day. So, if you don't care about your acetaminaphen intake, thats equal to 24 vicodin in a day as a PERSCRIBED dose. The truth is, with vicodin and lortab, it is the acetaminophen that is the limiting drug in those two medications, not the hydrocodone. She's destroying her liver with acetaminophen, but really hasn't increased the codiene level that significantly. She would have done better to step up to a more effective codiene family drug, but she did what she could get, obviously. It's just a shame that she could actually get a hold of that much stuff.

Anyway, I'm sure that people end up on more than 40 a day of these things. I mean, I take four ms contin and 12 percocet every day and it doesn't really kill the pain, but I don't want to escalate it until I'm completely immobile again and require yet another surgery. Chronic pain sucks, but at least I have a valid reason for using this stuff.

Cam
Link Posted: 12/3/2007 4:36:35 PM EDT

Originally Posted By Camberlyn:
40 vicodin is equivalent to the hydrocodone in 20 lortabs. That is ten mg of hydrocodone per tablet. Take two tablets at a time, every four hours, and you get a normal, high end perscribed dose of hydrocodone to be 12 lortabs in a 24 hour day. So, if you don't care about your acetaminaphen intake, thats equal to 24 vicodin in a day as a PERSCRIBED dose. The truth is, with vicodin and lortab, it is the acetaminophen that is the limiting drug in those two medications, not the hydrocodone. She's destroying her liver with acetaminophen, but really hasn't increased the codiene level that significantly. She would have done better to step up to a more effective codiene family drug, but she did what she could get, obviously. It's just a shame that she could actually get a hold of that much stuff.

Anyway, I'm sure that people end up on more than 40 a day of these things. I mean, I take four ms contin and 12 percocet every day and it doesn't really kill the pain, but I don't want to escalate it until I'm completely immobile again and require yet another surgery. Chronic pain sucks, but at least I have a valid reason for using this stuff.

Cam


Apparently she stole like $20K from her parents or soemthing to buy all this shit... people are insane...
Link Posted: 12/3/2007 6:07:05 PM EDT
The problem with Vicodin is that there's Acetaminophen in it. While you can build a truly massive tolerance for opiates (the narcotic portion of Vicodin) the Acetaminophen can cause real problems. (In fact, Vicodin is Schedule III because it has Acetaminophen in it, and it tends to cause liver and kidney problems in large doses. The opiate narcotic in Vicodin, Hydrocodone, is Schedule II by itself but Schedule III when added with a Aspirin or Acetaminophen. The DEA has this crazy idea that a drug that has habit forming properties is "less addictive" if it starts to cause liver damage when you take a lot of it when compared to the same drug without Acetaminophen, but the same opiate).

This is why the 40 pills a day part is one of those "things that make you go Hmmmmm."

The lowest dose from Vicodin would be 5/500. 5mg of Hydrocodone and 500mg of Acetaminophen. Hydrocodone, being an opiate, really doesn't have a general toxic level. Fatalities with less than 15 grams of Hydrocodone are rare. 10 grams is when you start to do renal damage. That's thousands of pills. (There's only .05 grams per pill in Vicodin).

However, Acetaminophen is a different story. It's toxicity starts around 150mg/kg. In a 120 pound adult you are looking at around 8 grams for the first toxic effects. Since there is half a gram per pill 16 pills gets you to 8 grams. 40 pills per day is 20 grams. That is really dangerous and could easily be causing very severe liver damage, and that dose should typically be fatal if taken in a single go.

You don't develop tolerance to Acetaminophen either. Some people who have been using Opiates for a long time can take 5x - 10x the amount that would put a opiate naive person down for the count and barely get an effect. Acetaminophen isn't like that.

I highly doubt anyone is popping 40 Vicodin per day without SERIOUS ill effects. It is also a VERY unpleasent way to go. The usual cause of death is liver failure and it can take weeks to die.

The general course of an acute overdose looks about like this:

Phase 1 (0-24 h)
Asymptomatic
Anorexia
Nausea or vomiting
Malaise
Subclinical rise in serum transaminases levels begins at about 12 hours postingestion

Phase 2 (18-72 h)
Right upper quadrant abdominal pain, anorexia, nausea, vomiting
Continued rise in serum transaminases levels

Phase 3 (72-96 h)
Centrilobular hepatic necrosis with continued abdominal pain
Jaundice
Coagulopathy
Hepatic encephalopathy
Nausea and vomiting
Renal failure
Fatality

Phase 4 (4 d to 3 wk)
Complete resolution of symptoms
Complete resolution of organ failure

But who knows. The human body can take a lot of abuse, as long as it is spread out.
Link Posted: 12/3/2007 6:09:14 PM EDT
[Last Edit: 12/3/2007 6:19:49 PM EDT by Austrian]
Double tap.
Link Posted: 12/3/2007 6:16:55 PM EDT
height=8
Originally Posted By Austrian:
The problem with Vicodin is that there's Acetaminophen in it. While you can build a truly massive tolerance for opiates (the narcotic portion of Vicodin) the Acetaminophen can cause real problems. (In fact, Vicodin is Schedule III because it has Acetaminophen in it, and it tends to cause liver and kidney problems in large doses. The opiate narcotic in Vicodin, Hydrocodone, is Schedule II by itself but Schedule III when added with a Aspirin or Acetaminophen. The DEA has this crazy idea that a drug that has habit forming properties is "less addictive" if it starts to cause liver damage when you take a lot of it when compared to the same drug without Acetaminophen, but the same opiate).

This is why the 40 pills a day part is one of those "things that make you go Hmmmmm."

The lowest dose from Vicodin would be 5/500. 5mg of Hydrocodone and 500mg of Acetaminophen. Hydrocodone, being an opiate, really doesn't have a general toxic level. Fatalities with less than 15 grams of Hydrocodone are rare. 10 grams is when you start to do renal damage. That's thousands of pills. (There's only .05 grams per pill in Vicodin).

However, Acetaminophen is a different story. It's toxicity starts around 150mg/kg. In a 120 pound adult you are looking at around 8 grams for the first toxic effects. Since there is half a gram per pill 16 pills gets you to 8 grams. 40 pills per day is 20 grams. That is really dangerous and could easily be causing very severe liver damage, and that dose should typically be fatal if taken in a single go.

You don't develop tolerance to Acetaminophen either. Some people who have been using Opiates for a long time can take 5x - 10x the amount that would put a opiate naive person down for the count and barely get an effect. Acetaminophen isn't like that.

I highly doubt anyone is popping 40 Vicodin per day without SERIOUS ill effects. It is also a VERY unpleasent way to go. The usual cause of death is liver failure and it can take weeks to die.

The general course of an acute overdose looks about like this:

Phase 1 (0-24 h)
Asymptomatic
Anorexia
Nausea or vomiting
Malaise
Subclinical rise in serum transaminases levels begins at about 12 hours postingestion

Phase 2 (18-72 h)
Right upper quadrant abdominal pain, anorexia, nausea, vomiting
Continued rise in serum transaminases levels

Phase 3 (72-96 h)
Centrilobular hepatic necrosis with continued abdominal pain
Jaundice
Coagulopathy
Hepatic encephalopathy
Nausea and vomiting
Renal failure
Fatality

Phase 4 (4 d to 3 wk)
Complete resolution of symptoms
Complete resolution of organ failure

But who knows. The human body can take a lot of abuse, as long as it is spread out.


+1 if she is really taking 40 pills a day, i give her less than a week to live following liver failure.
Link Posted: 12/3/2007 6:22:39 PM EDT
Every time I open a medical thread the original question has already been answered.

As far as the Schedule II vs. III, I think the DEA has a hard-on for any injectable drug. Since it would be a considerable challenge for the average drug addict to separate the hydrocodone from the acetaminophen, the DEA thinks hydrocodone alone is more desirable and hence more 'addictive'. That's the DEA for ya.
Link Posted: 12/3/2007 6:23:06 PM EDT
Sounds like BS, but I am no doctor either.
Link Posted: 12/3/2007 6:24:16 PM EDT

Originally Posted By Camberlyn:
Anyway, I'm sure that people end up on more than 40 a day of these things. I mean, I take four ms contin and 12 percocet every day and it doesn't really kill the pain, but I don't want to escalate it until I'm completely immobile again and require yet another surgery. Chronic pain sucks, but at least I have a valid reason for using this stuff.

Cam


I'm not sure what dose of Percocet you are taking but be careful with 12 a day. if you are taking 5/500s then you are at 6 grams of Acetaminophen. That's a lot.
Link Posted: 12/3/2007 6:26:41 PM EDT

Originally Posted By C-4:
Every time I open a medical thread the original question has already been answered.

As far as the Schedule II vs. III, I think the DEA has a hard-on for any injectable drug. Since it would be a considerable challenge for the average drug addict to separate the hydrocodone from the acetaminophen, the DEA thinks hydrocodone alone is more desirable and hence more 'addictive'. That's the DEA for ya.


I never considered this, but I suspect you are correct.

That makes me wonder after the big issue with IV use, but I suppose you get more "bang for the buck" with what you can IV and therefore it might expand the dependency problem if you have a drug with that route available.

Hmmm!
Link Posted: 12/3/2007 6:30:39 PM EDT

Originally Posted By sdman11890:
So my grandfather helps with the drug/addiction recovery group that our church started, and he said one of the ladies that came in was taking FORTY Vicodin pills A DAY. I said he had to be insane and that wasn't possible, he swore he was telling the truth. I could see 40mg, 4 pills, 14 pills even if you've built up a big tolerance, but FORTY?!?!?
So, ARFCOM docs, is it possible?


Here's the other thing that occurs to me. Vicodin is a specific formulation. (5/500 of hydrocodone and acetaminophen or 7.5/750). But many people mistakenly call any of the many opiate pain killer pills with less Acetaminophen "Vicodin." It's possible she was taking another opiate painkiller with similar amounts of the narcotic but less Acetaminophen and mistakenly calling it "Vicodin" There are several pills with reduced Acetaminophen. (Lorcet, Norco, etc.)

So the person referred to by the original poster might not be lying, just mistaken.
Link Posted: 12/3/2007 6:39:32 PM EDT

Originally Posted By Austrian:

Originally Posted By C-4:
Every time I open a medical thread the original question has already been answered.

As far as the Schedule II vs. III, I think the DEA has a hard-on for any injectable drug. Since it would be a considerable challenge for the average drug addict to separate the hydrocodone from the acetaminophen, the DEA thinks hydrocodone alone is more desirable and hence more 'addictive'. That's the DEA for ya.


I never considered this, but I suspect you are correct.

That makes me wonder after the big issue with IV use, but I suppose you get more "bang for the buck" with what you can IV and therefore it might expand the dependency problem if you have a drug with that route available.

Hmmm!


On a slightly related topic, Oxycontin abusers commonly break apart the tablet to find the 'mini' tablet at the core. They then dissolve and inject it. An ingenious little trick the manufacturers want to use is to mix a narcotic antagonist in with the oxycontin. The narcotic antagonist would have a protective layer that does not dissolve in the GI tract. So if a cancer patient took the tablet, the oxycontin would get absorbed but the narcotic antagonist would not.

If a drug addict crushed the tablet for injection, then the protective layer around the narcotic antagonist (naloxone) would be broken and they would inject both the oxycontin and the naloxone, thereby preventing a 'high'.

I don't know if oxycontin has been reformulated yet, but this was what they were talking about doing.
Link Posted: 12/3/2007 6:41:52 PM EDT
Damn hope there isnt ACE in those, that sounds deadly.....
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