On June 30, 2009, a . Food and Drug Administration (FDA) advisory panel voted by a narrow margin to advise the FDA to remove Vicodin and another opioid, Percocet , from the market because of "a high likelihood of overdose from prescription narcotics and acetaminophen products".  The panel also cited concerns of liver damage from their acetaminophen component, which is also the main ingredient in commonly used nonprescription drugs such as Tylenol.  Each year, acetaminophen overdose is linked to about 400 deaths and 42,000 hospitalizations. 
In response to my own post – a clarification. The cut off for morphine in urine drug screens is supposed to read 2,000ng/ml and not 20000ng/ml. Still this is a huge difference than the 100ng/ml to detect therapeutic use of synthetic and semi-synthetic opiates at 100ng/ml for the oxycodones and 300ng/ml for hydrocodones. Ironically if the test has a cut off of 100ng/ml it would, in theory, catch all of the opiates
while the higher cutoff of 2000ng/ml is calibrated to catch the “natural” opiates and reduce the risk of false positives. This could have the unintended consequence of failing to catch illegal users of oxycodone and hydrocodone and even giving them a prescription for those drugs in emergency rooms or primary care when they are doctor shopping. If the urine tests negative it would seem they aren’t using. Also since abusers tend to be intermittent users of high doses rather than routine users of therapeutic doses, the likelihood of catching them on a urine drug screen is lower. So, the urine drug screen may well give a negative for a legitimate pain patient who uses the medications with some regularity if not ordered and interpreted correctly. That same negative result may allow a drug abuser to leave a doctor’s office with a legal prescription for their preferred drug of abuse. There are many nuances to using a urine drug screen properly. One of the first hurdlers to overcome is finding a lab with an acceptable quality profile for drug testing. Also doctors and office staff need to be apprised of the proper way to collect and store urine prior to delivery to the lab. My former doctor’s office did not seal the bottles to make them tamper resistant. They did not refrigerate the specimens. Rather they were dropped into a bin hanging on a wall to be picked up twice daily by a lab courier. The lab that the specimens went to had seen a substantial increase in numbers of urine drug screens since HB1 took effect. That lab, which was owned by the hospital that employed the doctor, was not equipped to test for individual drugs accurately, nor were they quality certified to a minimum standard of accuracy. There are many mistakes that can be made in urine drug testing and when a doctor does not question a unexpected result and acts as if a lab test is always definitive we have a set up for disaster. I was once again a medical train wreck. The cars of my health care just kept derailing one after another and my pleas for help were drowned out by attitudes of “the labs are always correct”, “you must have been doing something wrong or your doctor would not have sent you here” My doctor did admit that he knew I was using my medication and not diverting when he saw me in withdraw. But that did not stop him from sending me to “detox” because he had those negative lab tests. When I reminded him that doctors are supposed to treat patients and not their labs his reply was “what was I supposed to think when more than one was negative?” My reply “you might have at least asked yourself why the test was negative when your patient was insistent about using the medication and further went into withdraw” It only took me a few minutes online after I got a copy of my drug screen to find out why it was negative. There is a huge difference between 100ng/ml and 2000ng/ml. My point is that when we criminalize a medical treatment and mandate screening tests we should have an obligation to make sure those tests are as accurate as possible and have procedures in place to verify any unexpected results.