Relatively worse

Over the past two weeks, FDA has addressed potential alcohol interaction problems associated with three oral extended-release opioid products. Yet while Purdue Pharma L.P. was asked to pull its Palladone hydromorphone off the market, Ligand Pharmaceuticals Inc. and Alpharma Inc. were only asked to strengthen the existing warnings for their respective morphine sulfates, Avinza and Kadian. None of the companies would discuss why only Palladone was taken off the market, and the FDA isn't talking, but an educated guess is that it has to do with the different half-life of the drugs and/or the different controlled-release technologies.

The dangers of mixing neurological depressants, such as alcohol and opioids, are well documented and labels generally carry warnings against combining the two. In addition to their additive effects, recent studies suggest that alcohol also is capable of breaking down the extended-release characteristics built into these opioid products to reduce their abusability...