Fast becoming one of (if not) the most contentious questions in the medical/pharmaceutical field is the challenge doctors and pharmacists will face striking a harmonious chord between effective pain management and curbing opioid addiction and/or abuse. This is likely due to drug abuse treatment for prescription abuse has climbed a stunning 403 percent in the past decade.

A number of pain management doctors, advocates and patients cite the phenomenon of “opiophobia” among doctors in response to the huge quantity of press given painkiller abuse and addiction as contributing to under-medication. However, looking into the raw numbers of this issue, a Stanford study found that at least 50 percent of chronic pain sufferers were under-medicated, as were more than 50 percent of cancer patients. Furthermore, according to Reuters Health, fewer than 5% of chronic pain sufferers prescribed opiates become addicted. So what has sparked this concern?

The emergence of a new opioid analgesic formulation of hydrocodone from the Zogenix pharmaceutical corporation, called “Zohydro ER”, has recently undammed a fresh tributary of debate in an already controversy-flooded topic. Zohydro is an extended-release hydrocodone capsule and the first version of the drug offered without an accompanying over the counter (OTC) pain reliever included- most commonly, acetaminophen (APAP).

After the OxyContin abuse and addiction nightmare that tore through North America from the mid-90s to 2010 (and still continues to a lesser degree), much of the pharmaceutical industry, as well as abuse and addiction treatment communities are understandably concerned. It’s an understandable concern- even in its immediate release hydrocodone is the second most commonly abused prescription drug- right behind oxycodone. Releasing a hydrocodone capsule with 10 times the potency of the drug’s lowest current 5 mg version, has definitely opened the floor for debate.

Considering the OxyContin abuse debacle and the accompanying $634 million lawsuit one would think that any new narcotic analgesic, particularly “ER” formulations, wouldn’t even be released without incorporated abuse-deterrents. However, the FDA doesn’t yet require abuse-resistance for any new medication and many of the pharmaceutical corporations (including Zogenix and the producer of OxyContin, Purdue) argue that abuse-deterrents hurt a medication’s efficiency.

But is it fair to block a drug from release (as the FDA’s review panel suggested they do) because of hypothetical abuse potential? Even more trickily, prohibition of opioid pharmaceuticals may cause more harm than good. According to a study published in the New England Journal of Medicine, in 2010 when Purdue switched exclusively to crush-and-abuse-resistant ER oxycodone production, the percentage of addicts citing oxycodone as their drug of choice dropped more than 17 percent. Unfortunately opiate abuse remained virtually unchanged. A shocking proportion of abusers and addicts simply switched to heroin (The use of street heroin doubled between 2010 and 2012). Others sought out Opana ER, an extended-release oxymorphone formula, or other powerful narcotic painkillers such as fentanyl and hydromorphone.

Moreover, most narcotic painkillers do relatively little damage to a user’s system when used appropriately. The health risks accompanying opiate addiction are generally those incurred by the deprivations and hardships of an addict’s lifestyle. Including but not limited to dangerous adulterants, poor nutrition and medical care, overdose due to purity fluctuations or a chemical (like fentanyl) “cut”, and blood-borne illnesses. Even long term opiate use does little systemic harm. The chief danger of hydrocodone abuse and chronic use right now isn’t the hydrocodone itself, but acetaminophen toxicity.

As such, Zogenix’s supporters argue that even if Zohydro were abused, “pure” hydrocodone is very likely considerably less detrimental than the APAP and ibuprofen combinations now available. Obviously there’s no simple solution or easy answer. For patients suffering from chronic or acute pain and/or requiring longer term pain control, an extended-release painkiller less powerful than oxycodone and not requiring daily dosing of APAP could be a godsend. Although addicts and abusers might very well find it a godsend as well. Like any other disputed or controversial medical ethics conundrum, progress toward a solution necessitates cooperation and an open dialogue between doctors, health science officials, pharmacists and patients.

Knowing the dangers of Zohydro is quickly becoming as essential as knowing how to recognize the symptoms of heart attacks or the ability to deliver CPR. Make sure that you’re in-the-know