FORT WORTH -- Rick Elliott said his pain became more intense and he began suffering from insomnia last month after his supply of prescription painkillers was cut by two-thirds.
Elliott, a patient at the JPS Health Network's Diamond Hill clinic, said he would normally receive an allotment of 180 pain pills that would last him a month, but all they would give him during his last visit on July 10 was 60 tablets, a 10-day supply.
Elliott said he took his last pill at 3 a.m. on July 22 and withdrawal symptoms from his lack of medication set in soon after. He ultimately got more - but not until July 28.
"They've always treated me very well up to now," Elliott said. "It's the only medication I'm taking. I've been on this drug for more than six years and I don't know what I'm going to do."
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Elliott, who plays and teaches drumming for a living, gets his medications from JPS, which is experiencing a shortage of hydrocodone-acetaminophen-based medications.
JPS Health Network pharmacies are voluntarily limiting the amounts of hydrocodone-acetaminophen-based medications that it will dispense. Acute pain sufferers receive 30 tablets and chronic pain sufferers receive 60 tablets, said Gary Floyd, JPS medical director. Floyd said it is difficult to know how many patients may have been or will be affected by this supply bottleneck.
"When this first hit we were running out of tablets by noon," Floyd said. "We see a lot of patients here with pain. We will try to be proactive in doling out the medication so that no one gets turned away."
The situation may be inconvenient for some patients and force them to come back to the pharmacy to get their full prescription, but no one will be refused needed medication, Floyd said. The staff will provide doctors with notices so that they can inform their patients of the situation and also provide pharmacy customers with information that will be placed in their medication bags.
Perhaps hundreds of JPS patients use hydrocodone-acetaminophen-based medications, a synthetic narcotic, for pain control, officials said. Some, like dental or post-operative patients have acute pain symptoms and others have chronic pain issues, Floyd said. Sometimes it is difficult to find substitutes for the medication, but that is a patient-physician discussion, Floyd said.
"We do not know when the supply might get back up to speed," Floyd said.
The drugs in short supply are Vicodin, Lortab and Norco, according to a JPS official.
The cause of the shortage dates back to 2011 when the U.S. Food and Drug Administration asked manufacturers to limit the amount of acetaminophen to no more than 325 milligrams in each tablet or capsule of combination acetaminophen products. Acetaminophen, which is widely used as a pain reliever and fever reducer, is also widely used in combination with other drugs, such as codeine, oxycodone or hydrocodone. Since JPS is no longer dispensing medications with high acetaminophen contents its allocation in this drug class has been limited, Floyd said.
FDA officials were seeing an increased incidence of liver disease occurring in patients that took acetaminophen that was combined with other drugs and who also took over-the-counter acetaminophen products, the letter stated. The FDA strategy called for an elimination of the higher dose acetaminophen combinations during a three-year period and the addition of a label on combination prescription medications containing acetaminophen that warned about the risk of liver injury.
Over-the-counter medications containing acetaminophen were not affected by the changes and the changes should not have caused any shortages, according to the FDA. The changes were designed to make prescription medications containing acetaminophen safer, the letter stated. Most of the cases of severe liver injury occurred in patients who took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period, took more than one acetaminophen-containing product at the same time or drank alcohol while taking acetaminophen products, the letter stated.
"Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the United States; many of which result in liver transplant or death," Sandra Kewler, deputy director of the Office of New Drugs, said in a press release.
Abbott Laboratories has reported to the FDA that it has discontinued manufacture and distribution of its current formulations of Vicodin, Erica Jefferson, FDA spokeswoman, said in an e-mail. Abbott plans to introduce new formulations of Vicodin with reduced acetaminophen content in the third quarter of 2012, the e-mail said.
Elliott said he has been diagnosed with arthritis and has pain from an automobile accident in 2006. The medication cuts have made it impossible for Elliott to continue to work playing or teaching drumming, he said. Elliott said he was able to get 120 tablets of his painkiller with three refills prescribed to him on Saturday through the JPS Urgent Care Center.
"I'm an old beat-up drummer," said Elliott.
"Since the car wreck, I haven't gigged that much ... If I don't have the meds, it's really hard for me to work."
Mitch Mitchell, 817-390-7752