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Rezira: An Accident Waiting to Happen?

Rezira: An Accident Waiting to Happen?

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As a doctor I’ve been trained to recognize patterns, but that same skill can lead to prejudicial thinking. Maybe I’ll fail to recognize an old, disheveled man as the brilliant engineer he is, or the brilliant young physician as an alcoholic. I try to see beyond my own prejudices but one that’s hard to break is my suspicion of drug-seeking patients.

Prescription drug abuse has become a massive problem in the U.S.. Around 30,000 Americans die each year from the misuse of prescription drugs. Most of these deaths involve opioids such as oxycodone, or combinations of prescription drugs and alcohol. It’s a clinical conundrum. We want to treat severe pain, but the tools we have can be dangerous. It takes knowledge and vigilance to treat pain using opioids, given the risk of substance use disorders and their high street value.

Enter into this picture a new medication, Rezira, marketed as a syrup to treat cough and congestion. Presumably, this would be used for patients with the common cold, the usual cause of these symptoms.

This is an accident waiting to happen. The main ingredients are hydrocodone, the opioid present in vicodin, and pseudoephedrine, a decongestant and potential stimulant sometimes used in the manufacture of methamphetamine. When sold as vicodin, hydrocodone is mixed with tylenol, which if overused can cause liver failure. This drug removes that risk, perhaps protecting users from accidental tylenol doses. It offers a winning combination, a drug causing euphoria and central nervous system depression, plus a stimulant. Opioids and stimulants are a popular combination, for example when cocaine and heroin are mixed in “speedballing”.

This drug is a setup for diversion and abuse. It’s sure to develop a high street value. Given that the evidence for the use of opioids for cough is pretty meager, and the potential for misuse is high, I see no place for this drug in our pharmacopeia.

Originally posted on White Coat Underground October 7, 2012

Photo credit: Mattia Menestrin via Flickr


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i am a 45 yearold woman,i was suffering so bad from the bug that was going around, and coughing so hard ,it felt likesomeone really hit my chest really hard about 100 times,the cough was whole body cough,so bad couldnt catch my breath in a episode,i was prescribed rezira,and it was a god im sorry you prejudge all people,but this medicine really helped me so i didnt have to be in the hospital,and i could be home with my family, i feel sorry for your patients, and im glad your not my doctor,using a medicine that really helps when your sick,is a blessing.....

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As a doctor you well know that anybody who takes enough cough syrup to get "high" is usually putting themselves at serious risk to potentially dangerous side effects of the non-narcotic ingredient (in this case pseudoephedrine, or in the case of codeine/promethazine syr. the Phenergan can cause much much more nasty side effects than the codeine itself), though they may not care if they need a fix bad enough. Personally i'd need about 3-4ozs of this new Rezira to get anything near a "high", and I may be a dumbass, but I'm certainly not stupid enough to take 20 grains of Sudafed!!!

Unfortunatley, many many people are that stupid.

It would honestly be safer to use opioid-only preperations IME, because people will abuse drugs regardless of what else is in it besides the good stuff.
That being said, I also believe the amount of narcophobia employed by not only physicians, but by law enforcement, is only adding to the Rx drug abuse in America.

As a pain patient whose pain often goes undertreated due to the ever constricting narcotic laws, I would like to someday see Americans be able to see drugs(anything from LSD to cocaine to diamorphine), for what they are, which is medicine to improve lives.
As one of the most conservitave people in the country, I also believe Morphine should be sold OTC or with a pharmacists permission. No reason for people to live in pain due to junkies, and I truly believe that if we made opioids more available for everybody, the stupid "wanna get high" junkies will all kill themselves off through overdose and the like.
That would leave the people who see and respect opiates for what they are, The most crucial pain relief tools of all time.

nice article tho, don't do drugs kids, someday you will indeed NEED them,,,


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