"I stop treating them, without doubt."
Lt. Chad Napier, Metro Drug Unit commander, said hydrocodone usually draws a lower price than oxycodone on the street.
Oxycodone is a "schedule two" drug in West Virginia, meaning patients must get an appointment with their doctor to obtain a prescription, and generally are not eligible for refills. Hydrocodone is a "schedule three" drug, which means doctors can phone in prescriptions for patients, and the prescriptions can be refilled without another doctor's visit.
"It's a little easier for them to get hydrocodone, so they sell a little cheaper," Napier said.
He said police typically see hydrocodone abuse in more impoverished areas and in communities where oxycodone is generally out of reach.
"They're still abusing, but they just can't afford the oxycodone as much, so they're abusing hydrocodone. It's second string," he said.
But Mike O'Neal, a professor of drug diversion, substance abuse and pain management at Knoxville South College School of Pharmacy in Tennessee, said hydrocodone is every bit as addictive and prone to abuse as oxycodone.
It is more widely available than oxycodone because the acetaminophen can cause severe damage to the liver and kidneys if it is abused.
"The thought was, people won't abuse that as much because the acetaminophen would hurt their kidneys. That's a reasonable thought, but that's not true. In the face of drug addiction, all appropriate rationale and safety goes away," he said.
Loratab is the No. 1 most abused prescription drug in the country, O'Neal said. And while prescription drug addiction is a major issue in West Virginia and throughout the United States, O'Neal said it is very unlikely for patients who follow their doctors' directives to become addicted to the drugs.
"There is very little data that says if you take the drug, exactly the way you are prescribed it, you don't take an extra dose, you don't take one from your spouse or anyone else . . . there's little data that says you'll become addicted," he said.
O'Neal said patients who take their drugs exactly as prescribed have a less than 2 percent chance of becoming addicted.
But Derakhshan said some patients still have become fearful of narcotics, even though they need them.
"I think, in my personal opinion, we are living an era of prohibition about narcotics just like we were a century or less ago with alcohol prohibition. People don't realize that pain is a major issue and they are all scared of getting addicted. They would prefer to die rather than get addictions. However, the fact is, if you use pain medication for pain you almost never get addicted," he said.
Simvastatin, a drug used to treat high cholesterol and triglyceride levels, was the second-most popular medicine among Medicare patients in West Virginia in 2010, with 323,923 prescriptions. The prescriptions cost Medicare $5.6 million.
Lisinopril was third, with 293,291 prescriptions to Medicare patients costing $2.8 million. Levothyroxine Sodium, used to treat thyroid disorders, was fourth with 277,868 prescriptions at $2.4 million.
Omeprazole, an acid reflux medication better known by brand names like Prilosec, rounded out the state's top five with 257,283 prescriptions. It cost Medicare $8 million.
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