Pain Killers

It is Nancy is a 25 years old single accountant with no previous drug problems. It is her first night home from the hospital after undergoing a major tests to find out she has Lupus. She wakes up early the next morning with constant pain throughout her body. "No big deal," she thinks. "I will just call the doctor and get a painkiller." The doctor hears her problem and prescribes 65mg of Darvocet to be taken twice daily. She picks up the prescription and immediately throws away the drug information. After two days of medication, Nancy still has a continuous pain in her back. She contemplates calling the doctor, but instead she decides to prescribe herself a double dose of Darvocet. But what she does not know it she is really prescribing herself a prescription for trouble.

Darvocet, a brand name for mild narcotic analgesic drug, is manufactured and distributed by Eli Lilly and Company (6). This prescription painkiller was put on the United States market in 1957 and was promoted as a safe, non addicting substitute for codeine. For decades it was near the top of the list of most-prescribed medications. Then things began to sour. It all started when Darvocet was cited for around 600 overdose deaths in 23 cities U.S. cities. People began demanding for the removal of the drug from the US market and calling it "the deadliest prescription drug in the United states (2)." Although, people knew about its deadliness, they still were not aware of what that deadliness really consisted of. Darvocet is made-up of two properties, propoxyphene and acetaminophen. Propoxyphene is related to codeine by changing the way the body feels pain (9). However, propoxyphene breaks down during metabolism, producing norpropoxyphene (NPX), "which is particularly dangerous as it is 2.5 times more potent than its parent compound (12)." Acetaminophen, the same active drug as in TylenolÐ'®, is a less potent pain reliever that increases the effects of propoxyphene (9). The more people learned, "the less Darvocet looked like a safe, non-addicting substitute for anything (2)." None the less, doctors still continue to over prescribe this painkiller even though they know about its dangers effects.

To solve this problem, The Federal Drug Administration tried educating people about the drug, hoping this would lower the rate of accidental overdose deaths. To educate people required manufactures of Darvocet "to revise the drug's labeling and conduct a mailed and person to person educational campaign," telling physician, patients, and pharmacists to "not prescribe propoxyphene to high risk groups (suicidal, abuse-prone, or addiction prone patients); and do not combine alcohol, tranquilizers, or sedative hypnotics with propoxyphene (13)." Drug information pages were made to update people on side effects. Propoxyphene is said to have adverse reactions such as "lightheadedness, dizziness, sedation, nausea, and vomiting." Where as, acetaminophen, when used correctly, side effects are believed to be rare (11). People were also told that, "when used properly, these drugs can mean the difference between incapacitating pain and normal functioning (2)." Studies, to show Darvocets effectiveness, were performed by Medical Universities in Rhode Island and Massachusetts stating that, "Darvocet N-100 is the preferred narcotic for joint replacement rehabilitation" over Vicodin, Tylenol #3, and Percocet (15). All of this information is used to persuade the public about the safety and effectiveness of Darvocet, and to ensure the public of lower overdoes rates.

Conversely, a study of the use of Darvocet and other propoxyphene drugs, "during the period of government and commercial warning did not depart from a pre-existing downward trend of about eight percent per year. In fact, this trend stabilized in the post warning period." This study shows that just educating about the drug is not the answer to the dangerous problems with Darvocet. Also people were not informed that a "physical or psychological dependence may occur, and withdrawal effects are possible" if medication is stopped. Darvocet has interactions with other drugs, "such as antidepressants, alcohol, antihistamines, sedatives, other pain relievers, anxiety medicines, and muscle relaxants. Together, these medicines may cause dangerous sedation, possibly resulting in unconsciousness or death (9)." "In fact more than ninety-three of all propoxyphene-related deaths in 1995 were the result of interactions with other drugs (2)." Large doses of Darvocet also can damage the liver and kidneys, because of the amount of acetaminophen in the drug. However, the major downfall of Darvocet is overdose problems. Some Darvocet users, when the relief does not appear "fast or forthcoming", it is necessary to self-prescribe a double dose. This is writing themselves a prescription for trouble. "For one thing, the gap between a therapeutic dose and an overdose is small." Slight overdoses cause a "dangerous slowing of breathing and heart rate." A step higher

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