Q: I have chronic back pain, and I've been taking Vicodin for about a year. Why are the rules changing about how it is prescribed and how often I have to see the doctor? — Henry G., Evanston, Ill.
A: Let us explain. Vicodin, a combination of the powerful opioid pain reliever hydrocodone bitartrate and acetaminophen, is being reclassified as “possibly” highly addictive and prone to abuse, and will now be considered a schedule II drug. The current rash of abuse of prescription drugs has made it important to establish more control over how Vicodin is dispensed. Drug-related overdoses are now the leading cause of accidental death for Americans ages 25 to 64 (60 percent of drug overdoses in 2010 were from prescription drugs). In 2010, Vicodin was the most prescribed medication in the U.S.; 131 million prescriptions were filled.
So, instead of allowing your doc to call the pharmacy to renew your prescription every six months, these changes mean you'll have to see your doc in person for a new written prescription, and you'll hand deliver it to the pharmacy every three months. For people with legitimate health issues — like you, Henry — this should make little difference. You'll continue to get the medication you need to control pain (true, with a little more effort). But seeing your doc every three months when you are taking a potentially addictive drug and have a chronic condition is better health care anyway.
It's hoped that many people with chronic back pain will try physical therapy again, so they can relearn or retry core muscle strengthening. That way, this new regulation may help some people, maybe many, to get rid of part or all of their chronic back pain and its limitations on their life.
So we see no problem with tightening the Vicodin reins a bit and making prescribing doctors more hands-on. Good doctors won't mind. And you shouldn't mind the slight inconvenience, either. Chances are you'll wind up with better treatment.
Q: I'm ambivalent about signing an organ donation card. What do you think about the practice? — Katrina D., Springfield, Va.
A: Organ donations happen about 13,000 times a year (6,600 come from cadavers and around 6,000 from live donors), and in 2009 they accounted for around 23,000 organ transplants. But there's a waiting list of more than 120,000 people looking for a new kidney, heart, liver or other organ. And around 6,570 people will die this year waiting for a transplant.
Fortunately, changes in the way of classifying and cross-matching kidneys (there are 93,000 people in the U.S. waiting for a new one) will now let more people get transplants. Researchers discovered more than 85 percent of so-called high-risk transplanted kidneys were still functioning after 2.4 years. So the Centers for Disease Control and Prevention has decided that the “high risk” designation may not apply to as many potential donor organs as was thought. That should make more organs available.
Even though lists are getting shorter, you can still help. Live donors can give a kidney, a partial liver, a lobe of a lung, (rarely) part of the pancreas and bone marrow. The National Living Donor Assistance Center can provide funds for travel and basic expenses, especially to people who otherwise could not afford the costs of live donation. Or, if you're one of the 90 percent of Americans who say they support organ donation but haven't done anything about it, you can check off the box on your driver's license that identifies you as an organ donor for when you no longer need them.
Eventually we're hoping organ regeneration will be what's used in place of transplants to repair a heart and even restore brain cells or neural circuits. A windpipe has already been successfully “grown” and implanted. Researchers in Japan recently used stem cells to produce a tiny version of a human liver that they successfully implanted in a mouse. But until then? We should all contribute to organ donation as we can or want.