Is the Vicodin/Norco of today different than what it was 10 years ago?
August 8, 2017 12:05 PM   Subscribe

Has the "default" narcotics prescription changed in the last decade? I haven't required strong pain meds in a while, and my current experience is much different than it was in 2007-ish.

About a month ago, I decided to take advantage of a decent south swell and went surfing down at Venice Beach. Well, I ended up eating shit on a wave that broke too close to shore and I broke my clavicle in 4+ pieces and got an ambulance ride to UCLA Medical Center. It was bad enough that the Orthopedics surgeon had a "check out this craziness!" tone of voice when he showed my x-ray around to his colleagues in the ER. A week later, I went under the knife and got a plate and a bunch of screws to fix me up. I got a Norco prescription out of it (10mg Hydrocodone, 325mg Acetaminophen).

While the drugs have done the job for the most part, I can remember opiates really putting me on my ass when I had to take them after a root canal went bad, back in 2007.

When I was taking my current meds ever 4hrs, I had an occasional high (enough to have to take a nap when maybe I didn't want to). Now that I've eased of to one or two a day, I barely notice anything besides lack of pain.

But in 2007, I could barely get off the couch. Seems like sometimes I was high as shit, and other times had the sweats and became nauseous. I don't remember what the prescription was, but I would think it was whatever the default Vicodin dose is.

So, here's my question: Did the approach of how these drugs get doled out change in last decade? It would make sense because of the opiate crisis, but it figures that "screws drilled into your bone" would have gotten me the strong stuff.
posted by sideshow to Health & Fitness (12 answers total) 1 user marked this as a favorite
I don't know the dosage they gave me after fixing this in November of 2014, but it absolutely made me sweaty and nauseous. As I had no real experience with opiates before, I was simultaneously bummed (because no free high) and relieved (because I cannot conceive of enduring the nausea and sweatiness deliberately, it would appear I am not at risk of opiate addiction).

No idea how Dr House did it, honestly.
posted by uberchet at 12:15 PM on August 8, 2017

I was on that same mix for about 10 days after smashing my clavicle (slippery wooden MTB berm) and getting screws and a plate surgically implanted. I was over the nausea the first day, but it did take about 3 days for the bowels to work (and I was taking lots of laxatives). I did get a shot of dilaudid at the ER right after the accident which was far stronger than the scrip, obviously. But the Norco was enough post-op, and I tapered to every 6 hours before just quitting altogether within a week of surgery. After the surgery, when the bone was stabilized and my arm wouldn't just be hanging off my shoulder weirdly, the pain was dramatically less.
posted by Burhanistan at 12:34 PM on August 8, 2017

I think if you're really in a lot of pain they don't affect you as much maybe?
posted by fshgrl at 1:30 PM on August 8, 2017 [7 favorites]

Not sure about Norcos, specifically, but several years ago drug companies started reformulating some narcotics to be slower release as well as changing the tablets so that they couldn't be crushed and snorted/injected. While I would like to think the drug companies did this to help limit addiction, I think they had to do it because they were getting sued.
posted by homesickness at 1:40 PM on August 8, 2017 [1 favorite]

I got that same mix recently and noticed the same thing; helped the pain ok, but no couch-lock effect, and I noticed it was markedly different than what I got 10-15 years ago.
posted by The otter lady at 2:18 PM on August 8, 2017

I found I had a little bit of couch lock with the Norco, but mostly awake and uptime for the duration of each dose. I was fortunate enough to be on short-term disability so my demands were pretty low and didn't need to think that much:
posted by Burhanistan at 2:37 PM on August 8, 2017

Did the approach of how these drugs get doled out change in last decade?

Yes. 10 or 20 years ago there was a consensus in the medical community that pain was being under treated. In fact the commission responsible for credentialing hospitals began requiring a specific pain management protocol to be in place in order to pass their survey. Doctors began prescribing a lot more pain meds, including opiates. One of the biggest changes was in the treatment of long-term chronic pain. The drug companies began formulating extended-release narcotics (MS Contin, e.g.) and heavily marketed them to physicians. The result is that as a whole, Americans became over treated with opiates.

Over the last several years there has been a reappraisal in the use of opiates, both in acute and chronic conditions.
Physicians are now much more likely to prescribe non-opiate pain meds, or other treatments like physical therapy wherever possible. When opiates are used physicians now tend to prescribe them at lower strengths and in smaller quantities.

I know there are a few physicians on MF and they could give you more details on how and why they prescribe opiates, but as a simplified overview I think the above is accurate.

In your specific case Norco for post-surgical pain is completely appropriate (BTW a broken clavicle that had to be pinned - ouch. Sorry. Hope your recovery goes well). You didn't say how many Norco you were prescribed, but I'm willing to bet that 10 years ago you would have been prescribed a stronger opiate in a larger quantity.

Finally, the only change to a drug like Norco over the last decade is that the acetaminophen dose has been decreased from 500 mg to 325 mg. Why your reaction to Norco is different now than it was several years ago could be due to a bunch of things (are you sure that your dentist gave you hydrocodone, not oxycodone, e.g.). Also the change in effects with this specific course of Norco is due to building a tolerance to the hydrocodone. Acute tolerance to opiates occurs over just days, not months or years.

Source: I'm a pharmacist and I do this every single day.
posted by codex99 at 3:03 PM on August 8, 2017 [9 favorites]

In addition to what others have said above, your average human body can change a lot in ten years.
posted by The Underpants Monster at 3:18 PM on August 8, 2017 [1 favorite]

In my experience, the only time I've gotten a high from narcotic painkiller pills is when I didn't have tremendous pain. If I've been in terrible, unrelenting pain, there's no high at all. Only a decrease in pain.

The only possible exception has been when I've been hospitalized and received high-dose morphine via IV. That got me high and made the pain go away completely.
posted by quince at 3:31 PM on August 8, 2017 [3 favorites]

My anecdotal experiences lead me to suspect that the effect of Vicodin/hydrocodone/whatever they're calling it now is highly susceptible to type and strength of pain...
1998 - removal of four wisdom teeth - 1 pill knocked me totally out til the next day
2000 - spider bite, was in hospital - 2, every four hours like clockwork, worked marginally during part of the experience, did not even change pain level at ALL during the worst of it
2004 - wrist surgery - 1 reduced the pain and made me a little sleepy
2005 - 2010 - non-stop coughing and high cerebral-spinal fluid pressure from the flu - 1 knocked the coughing down enough that that I could at least get some sleep, did NOT knock me out - oh how I wished it had.
2005 - intracranial hypertension (for the major headache symptom) - 1 reduced the pain so I could handle it, didn't affect me otherwise.
2008 - root canal - 1 made it bearable
2010 - Again, non-stop coughing and high cerebral-spinal fluid pressure from the flu - 1 knocked me out, which solved the coughing and I slept
2012 - intracranial hypertension (yes, it came back) - 1 knocked the pain back a little, wasn't effective enough, made me loopier than S***, 2 knocked me out
2014 - stupid me skipped the flu shot again - got told in no uncertain terms not to let it - and 1 reduced the cough enough so I could function when awake, and sleep at night
2017 - very bad muscle strain - 1 knocked me out

Also, it doesn't help my fibro pain at all, but when that's the ONLY pain that's going on, half of one will knock me out even when the pain is bad enough to keep me awake.

I've decided that stuff is either bizarre, random, or my body has a really strange relationship with it. As a side note, the one time in all these years I was prescribed Oxycodone was by a dentist for my OTHER root canal, and I took it like twice - that stuff REALLY knocks me sideways and I did NOT like it.
posted by stormyteal at 8:49 PM on August 8, 2017

10 yrs ago you might have been rx'd tylenol 3, which was codeine rather than hydrocodone.
posted by OHenryPacey at 10:45 PM on August 8, 2017 [1 favorite]

Huh, sounds like other people have gone through the same thing, but there wasn't a "Pain meds will now be like this!" event sometime over the last decade.

I guess the most likely situation is that 25 year old me and 36 old me just handle the drugs differently.

Thanks everyone for the answers.
posted by sideshow at 11:43 AM on August 15, 2017

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