Rush, Deafness, Hillbilly Heroin and Opioids

A number of posters responded to my post suggesting that Rush Limbaugh should make amends by attacking the war on pain doctors with claims that opioid drugs like Oxycontin were responsible for Limbaugh's hearing problem.

But that connection is far from proven--and if some pain medications do cause hearing loss, it's far from clear whether the opioids in them are responsible for that problem.

The suggestion of a link between progressive hearing loss and opioids comes from case reports on two types of opioid medications: propoxyphene (Darvon, Darvocet) and hydrocodone/acetaminophen compounds like Vicodin. Oxycontin AKA "hillbilly heroin" itself has not been associated with deafness.

Although there is one case report of reversible hearing loss associated with heroin intoxication, this is in a literature spanning dozens of years and thousands of opioid addicts. Methadone, which is an opioid used in the treatment of heroin addiction, has not been associated with hearing loss.

There have, however, been at least four dozen cases reported of hearing loss in people who have taken high doses of Vicodin or similar drugs which combine acetaminophen (Tylenol) and hydrocodone. But 36 million prescriptions for that drug and generic substitutes were written in the year 2000 alone, making the problem, if it is connected, extremely rare. And it is impossible to know from this data if the hearing loss is associated with the opioid alone or the combination with acetaminophen and at what doses the risk becomes significant.

Acetaminophen itself is linked with serious liver toxicity--at doses not far higher than the effective painkilling dose. In fact, because tolerance develops to the opioid effect and opioids themselves are not damaging to the liver, Vicodin abusers who persist in taking high doses are at greater risk from the Tylenol in the product than they are from the opioid in terms of lasting physical damage. Tylenol and similar generics are the leading cause of acute liver failure in the U.S., in fact.

Propoxyphene is a mild opioid that is frequently prescribed in place of stronger medications--but actually may be more dangerous. The British government has withdrawn it from the market due to low efficacy and high rate of adverse effects--and Public Citizen has called for its removal from the U.S. market. Some case reports have also linked it to deafness.

In short, there is no case to be made for associating Oxycontin with deafness and an opioid/deafness link in general is far from proven. And in fact, far more people are killed by bleeding related to aspirin and other NSAID painkillers like ibuprofen (Advil) and the COX2-inhibitors like Celebrex than by opioids. About 16,500 deaths a year are attributable to GI bleeding associated with these drugs in pain patients--while only 8,000 deaths are attributed to drug overdoses (and not all of these involve opioids and most are found in drug misusers, not pain patients).