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http://www.latimes.com/features/health/la-091001vicodin.story
Misuse of Pain Drug Linked to Hearing Loss
Doctors in L.A. and elsewhere have identified at least
48 cases of deafness tied to prolonged misuse of
Vicodin and other comparable prescription medicines.
By LINDA MARSA, TIMES HEALTH WRITER
A powerful and potentially addictive painkiller used
by millions of Americans is causing rapid hearing
loss, even deafness, in some patients who are misusing
the drug, according to hearing researchers in Los
Angeles and elsewhere.
So far, at least 48 patients have been identified by
doctors at the House Ear Institute in Los Angeles and
several other medical centers who have treated
patients with sudden hearing loss. The hearing
problems appear to be limited to people who abuse
Vicodin and other chemically comparable prescription
drugs by taking exceptionally high dosages for several
months or more, doctors said.
Vicodin, one of the most commonly prescribed
painkillers, is frequently used improperly.
"This has become such a popular drug of abuse," says
Dr. John W. House, president of the House Institute in
Los Angeles, one of the nation's leading centers of
hearing-related research.
Actress Melanie Griffith and Cindy McCain, wife of
U.S. Sen John McCain, have acknowledged their struggle
to overcome their addiction to Vicodin, which they
both were prescribed for severe back pain.
But it's not just notables who are getting hooked.
Christina Jaeger of Sherman Oaks was prescribed
Vicodin in 1993 after a back injury. Gradually, she
got addicted. She would wean herself off Vicodin for
brief periods, only to relapse when doctors continued
to prescribe the drug for her recurring pain.
Then, earlier this year, the 36-year-old model and
fitness trainer suddenly began to lose her hearing.
When her doctors couldn't explain what was happening,
she went to the House Institute, where specialists
concluded that Vicodin was to blame. Jaeger
immediately entered a treatment program to kick her
Vicodin habit. But it was too late. By the time she
completed the program, she was deaf.
"If I had only known, I would have tried anything to
stop," Jaeger said. "The lack of information is what
I'm most furious about. That, and the proclivity of
doctors to write prescriptions for Vicodin like it's
candy."
Some experts believe that doctors' willingness to
liberally prescribe potent narcotic painkillers may be
contributing to the rise in abuse.
A government survey found that more than 1.6 million
Americans began using painkillers like Vicodin in 1998
for nonmedical reasons, up from fewer than 500,000 in
1990. A new U.S. survey on drug use due out in a few
weeks will likely find "an upswing" in improper use of
prescription pain drugs, said Frank J. Vocci, director
of treatment research and development at the National
Institute on Drug Abuse.
Vicodin, a synthetic opiate that is a chemical cousin
of heroin and morphine, has long been known to doctors
as a potentially addictive medication. "As soon as
Vicodin hit the market, there was a steady stream of
addicts," said Dr. Drew Pinsky, medical director for
the chemical dependency program at Las Encinas
Hospital in Pasadena. "It's such a huge problem
already that I don't know how much bigger it could
be."
Researchers at the House Institute were among the
first to connect Vicodin use with sudden hearing loss.
They now have identified 29 people who heavily abused
the painkiller and who subsequently suffered a sudden
hearing loss; 16 of those were diagnosed in the last
two years. UCLA scientists said they have seen an
additional 14 patients with opiate-inducing hearing
loss, mostly from overuse of Vicodin, and other ear
experts around the country report seeing at least five
more of these cases.
Dr. Richard Wiet, a professor of otology at
Northwestern University, said he began noticing cases
of hearing loss tied to Vicodin use after learning of
the findings of House Institute researchers. "Then I
started watching for it and found two patients.
There's definitely something to this."
But researchers at a dozen other medical institutions
said in interviews that they were unaware of similar
cases. "It's an interesting observation, but there's
really no way to prove as yet that Vicodin caused this
problem," said Dr. Steven D. Rauch, an associate
professor of otolaryngology at Harvard Medical School
in Cambridge, Mass.
Doctors at the House Institute reported the hearing
loss incidents to the Food and Drug Administration in
1999, and then again last month. Last year, Knoll
Pharmaceutical Co., the firm that makes Vicodin, added
a warning about the potential for hearing loss to the
drug's label. But the label change appears to have
gone largely unnoticed, even among some top hearing
specialists. Knoll is now owned by Abbott
Laboratories.
Susan Cruzan, an FDA spokeswoman in Rockville, Md.,
said the agency worked with the manufacturer on the
wording of the label. No further action is planned,
Cruzan said, because the FDA considers the hearing
loss problem to be "a very rare side effect that is
associated with using the drug in an inappropriate
manner."
The 48 cases identified so far may seem small
considering that 36 million prescriptions for
Vicodin-type products were written in 2000, according
to IMS Health, a health information company in
Westport, Conn. (Vicodin is a combination of
acetaminophen and hydrocodone and is also sold under
the brand names Lorcet, Lortab and Hydrocet.)
But the hearing loss problem may be "much more
prevalent than we think," said Dr. Akira Ishiyama, an
assistant professor of otolaryngology at UCLA Medical
School who has treated nearly a dozen cases. Some
doctors, he said, may not have drawn a connection
between Vicodin use and sudden hearing loss in
patients because they "haven't been looking for it."
When doctors see isolated cases of sudden hearing
loss, they may believe it's just a chance occurrence.
At the same time, patients may not realize--or admit--
their addiction to painkillers. Vicodin is typically
prescribed for short-term use of two to three weeks at
most, with patients taking one pill every six hours.
But many of the patients who have suffered hearing
loss were taking 20 pills or more a day for at least
two months, doctors said.
"This seems to be a relatively new phenomenon," House
said. "Because we see thousands of hearing impaired
patients a year, we can spot trends faster than the
average ear, nose and throat doctor." The House
Institute pioneered the development of cochlear
implants, which are tiny electronic devices that aid
in processing sounds for people who are deaf.
Consequently, the research center sees a high number
of people with sudden hearing loss.
House Institute researchers believe they saw their
first patient with Vicodin-induced hearing loss in
1993, although they didn't realize then what caused
the patient's condition. Until then, there had been no
reports linking hearing deficits to this painkiller,
which has been on the market since 1982.
Generally, if an adult with normal hearing experiences
a sudden and rapidly progressing hearing loss, the
cause is either certain medications, like antibiotics
or diuretics, or the onset of an autoimmune disease.
Usually, when a patient stops taking the antibiotics
or diuretics, his or her hearing returns. Similarly,
people stricken with autoimmune-related hearing loss
respond to treatment with steroids.
That first patient at the House Institute, however,
didn't fit the usual pattern. He wasn't taking
antibiotics or diuretics, nor was he suffering from an
autoimmune disorder. He ran a successful construction
company in the west San Fernando Valley, owned a home
and had a wife and kids--but also a secret vice:
Vicodin.
He initially began taking the painkiller after two
knee surgeries. He developed a tolerance and the drug
lost its effect. Soon he was taking 20 to 30 pills a
day. "I didn't even realize I was addicted," he said.
"After all, this was a prescription drug. It took the
pain away, and I functioned normally."
His life changed, however, in November 1993, when he
started experiencing ringing in his ears. Then sounds
became muffled, first in one ear, then the other, like
an electrical short circuit in an amplifier. Alarmed,
he went to see his doctor, who referred him to the
House Institute. Doctors prescribed steroids, but the
drugs didn't help. Four weeks after his first
symptoms, he was completely deaf.
The construction manager blames his addiction and
deafness for the loss of his business and the demise
of his marriage. "I lost everything," he said. "All
because of a stinking little pill."
Soon, other patients with the same symptoms began
showing up at the House Institute. All admitted
abusing drugs containing the hydrocodone-acetaminophen
mix. Researchers began tracking these cases and, in
April 1999--after identifying 13 patients--shared
their findings with hearing specialists at a
professional meeting in Palm Springs. At the time,
House scientists considered the handful of cases an
anomaly. Soon, however, 16 more people showed up with
the same problem.
Hearing researchers are still trying to find out how
these painkillers cause deafness. They know the
delicate hair cells inside the inner ear are
permanently damaged in people with opiate-induced
hearing loss. These hair cells are like tiny
microphones, picking up sound vibrations and
transforming them into nerve impulses that are
transmitted to the brain. Once they're destroyed,
people lose the ability to sense sounds.
Researchers also suspect that the inner ear contains
opioid receptors, or nerve endings that are highly
sensitive to stimulation by drugs like morphine,
heroin or hydrocodone. They believe that there is a
connection between these two phenomena. "But we're
still unclear as to the exact mechanism of damage,"
said Dr. Robert W. Baloh, a professor of neurology and
head and neck surgery at UCLA Medical School.
It's unclear whether the damage can be reversed once
patients start experiencing symptoms. "Some patients
have retained some hearing if they stop using the
painkillers immediately," House said. "But for most,
the damage is already done. Once the process starts,
it seems irreversible."
#######
http://www.nydailynews.com/10-02-2003/front/story/122839p-110349c.html
Rush Limbaugh
in pill probe
Talk radio star had drug habit, maid sez
Excerpt:
"Limbaugh, 52, suffered from autoimmune ear disease, a
condition that left him deaf and had to be corrected
with cochlear implant surgery two years ago."
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