Chances are that about half of you who have prescriptions for Vicodin or Lorcet or Norco don’t receive a little bottle from the pharmacy with the brand name on it. Most likely it will use the generic name: Hydrocodone and Acetaminophen. Is there any difference between brand name and generic prescription painkillers? And more importantly, is either more or less addictive than the other?

In a word, no, on both counts. Generic versions of brand name prescription drugs are the exact same thing and of the same quality and therefore just as addictive. Their strength is the same as are their side effects and intended usage and administration. The U.S. Food and Drug Administration (FDA) makes sure of that with stringent requirements for the companies who make the generic version of your medication. In fact, the FDA estimates that about half of all generic drugs are made by brand name companies in the same facilities in which they make their brand name drugs.

So if you’ve heard rumors that the generic drugs are less potent than the brand name ones and therefore less addictive, you’ve heard wrong.

There are differences, however. Trademark laws require generic versions of the drug to look different than their brand name counterparts. They may be a different shape, color or, if liquid, a different flavor. They may even have different inactive ingredients. Again, inactive ingredients, so the efficacy of the drug is not affected. Oh, and brand name drugs are capitalized when their generic versions usually are not. But the active ingredients and their amounts must be the same in both versions of the drug, which means that they are equally addictive.

So what is the purpose of this and how does it happen? For one thing, generic forms are not available for all drugs; only after the patent is up can it be made generically. And the reason why the generic form is cheaper has nothing to do with the manufacturing but with the fact that the company did not have to invest in the original research, development and marketing. The price gets even cheaper when more than one company is approved by the FDA to produce a drug generically. 

So if your insurance company has anything to say about it, you’ll most likely be receiving the generic version for the duration, but don’t think for a second that they’re any less addictive. Opiates in any form are dangerous.

If you’d like to know more about Suboxone detox to break your addiction to opiates, check out the cache of articles at Meditox.

There seems to be a little confusion about the difference between the two “nal-xone” drugs, naltrexone and naloxone. Two very different drugs, the similar names are confusing but what makes it worse is the fact that both are related to the treatment of drug and alcohol abuse. Hopefully this will clear up the misconceptions.

Naltrexone

Naltrexone, like naloxone, is an antagonist that binds to opioid receptors and blocks the effects of opiates. However, naltrexone is used primarily in the treatment of alcohol addiction in an effort to reduce the craving to drink. Its generic name is naltrexone hydrochloride, but it’s sold under the brand names Revia and Depade. An extended release formula is also sold as Vivitrol.

After detox off of opiates or alcohol, naltrexone may be prescribed to help people stay off the sauce—in any form. It effectively blocks any opiates from binding to your opiate receptors so if you do try to get loaded while you’re taking it, it won’t work. You won’t get high at all. But for some reason, it’s rarely prescribed to people who suffer solely from opiate dependence but rather to those who need help fighting the urge to drink. With studies to back it up, it works well to prevent relapse and decrease the severity of relapse when it does occur. For those who need help with opiate addiction, a better medication is Suboxone, which combines buprenorphine and naloxone.

Naloxone

Sold under the brand name Narcan, naloxone is injected into a muscle when overdose on an opioid-based drug occurs. Whether you overdose on a prescription painkiller like Fentanyl, Vicodin, Dilaudid, Darvon or Darvocet, Norco or OxyContin or you overdose on a street drug like heroin or morphine, naloxone stops the overdose dead in its tracks (no pun intended).  It works by heading straight to the opiate receptors and knocking off any opiates that are there, which stops the respiratory depression they cause and the subsequent overdose. It doesn’t work for benzodiazepines like Valium, Xanax, Valium, or Klonopin, nor does it work for stimulants like methamphetamine and cocaine.

Naloxone stays active in the system, blocking opiates from binding to your opiate receptors for 30 minutes to 90 minutes. When it wears off, the opiates that caused the overdose are still in your system and their effects will kick in again and, possibly, slam you right back into an overdose. This brief reprieve, however, can be what you need to keep you from dying before you get emergency medical help.

A few things you should know:

- Naloxone won’t let you give a clean drug test.
- Naloxone is effective in fighting an overdose even if you hit a vein.
- Naloxone is ONLY meant to be delivered with a needle in the event that someone is dying.

Suboxone

If you are addicted to opiates and taking Suboxone to detox off of your drug of choice, then you are taking naloxone. Suboxone is a combination of buprenorphine and naloxone, and it comes in a pill that you take by dissolving it beneath your tongue. The naloxone remains dormant unless you should try to abuse the Suboxone by dissolving it in water and inject it. If you do this, the naloxone will kick in and prevent you from experiencing any of the relief that the buprenorphine provides for those trying to avoid withdrawal symptoms.

So hopefully that clears that up! Any questions?

Peggy Compton, RN, PhD, is an Associate Professor of Nursing at the UCLA School of Nursing, Los Angeles and recently published an article online at Pain-Topics.org, “Should Opioid Abusers Be Discharged From Opioid-Analgesic Therapy?” Basically, she says that those who are using prescription opiates are in a precarious situation and that abruptly stopping their medication is dangerous. A thorough exit plan is a necessity when doctors take on the responsibility of prescribing opioid-based medications like Vicodin, Norco, Fentanyl, OxyContin and others.

She is also a proponent of the idea that doctors and not their patients should be held accountable for any abuse of prescription painkillers. She says, “Any practitioner prescribing opioids for chronic use should be accountable for having a strategy in place if medication abuse or addiction occurs. Providing daily opioid pain relievers without suitable addiction expertise or support in place puts both the pain-management practitioner and patient at risk for poor outcomes.”

Simply dropping someone from an opiate treatment therapy when there are risks of addiction can not only hurt the patient but their family and community as well. Compton proposes that because the risks of an unaided exit from opioid-based medications extend so far into society that the harm should also rebound back onto the prescribing doctor. Rather than denying those who need them the relief that opiate painkillers can provide, Compton instead believes that the prescribing doctor should also take on the treatment of addiction as well. 

I agree with you, Ms. Compton! I believe that doctors who are licensed to prescribe opiates should also be required to become certified in the dispensation of buprenorphine. That way, the transition from high doses of painkillers back to reality can be smooth, a plan prepared for well ahead of time and discussed between doctor and patient.

Until that happens, however, we have Meditox, a stable of doctors who not only specialize in substance abuse treatment and addiction, but are also qualified to legally prescribe Suboxone to detox off of opiate pain medications. They’ll create a complete treatment plan, including your exit off of Suboxone so that you are not simply trading one addiction for another. If you find that you need more help with other aspects of addiction beyond the physical, your Meditox team are available to you any time of day or night. They can assist you with finding local support, therapists, doctors, and substance abuse specialists to help you make your way back to a drug-free life.