KILLING THE PAIN -- AND HEARING, TOO

Misuse Of Powerful, Widely Prescribed Vicodin Linked To Rapid Hearing Loss,
Even Deafness

LOS ANGELES: 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," said 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 Sen. John McCain, have
acknowledged their struggles to overcome Vicodin addiction, which they both
were prescribed for severe back pain.

It's not just notables, though, who are getting hooked.

Christina Jaeger of Los Angeles 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."

Prescriptions Too Easy

Some experts believe that doctors' willingness to liberally prescribe
potent narcotic painkillers may be contributing to the rise in 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, Calif. "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."

No Proven Link

Researchers at a dozen other medical institutions, however, said 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 in August. 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."

New Phenomenon

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."

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 in the
morphine, heroin or hydrocodone families. 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."