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Misuse
of Pain Drug Linked to Hearing Loss Deafness:
Doctors in L.A. and elsewhere have identified at least 48 cases 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." |
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