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Hydrocodone 10/325mg cannot be bought online with home-focused express solutions as a Schedule II controlled substance requiring a valid prescription from a DEA-registered US healthcare provider for moderate-to-severe acute pain unresponsive to non-opioid therapies; prescription-free platforms constitute federal felony distribution under 21 U.S.C. § 841 with mandatory minimum 5-year imprisonment penalties.

Immediate-release hydrocodone bitartrate 10mg/acetaminophen 325mg every 4-6 hours PRN (maximum 6 tablets/day hydrocodone 60mg, acetaminophen 4g/day) demands Numeric Rating Scale ≥7/10 after NSAID/acetaminophen/gabapentin failure ≥72 hours under 2025 CDC guidelines, synchronous HIPAA video PDMP clearance through telemedicine flexibilities expiring December 31, 2025—post-flex mandates in-person initiation, EPCS two-factor authentication prohibiting refills nationwide with 50 states enforcing 3-7 day acute limits typically #15-30 tablets.

Semi-Synthetic Mu-Opioid Agonist plus Hepatotoxic Analgesic Synergy

High-affinity MOR full agonist (Ki 12nM) combined acetaminophen central/peripheral antinociception, Tmax 1.3 hours, t½ 3.8 hours hydrocodone CYP2D6 polymorphic to hydromorphone active metabolite; FDA black box warnings specify respiratory depression OR18 benzodiazepine synergy, acetaminophen hepatotoxicity >4g/day ALT >3x ULN 1-2%, physical dependence 8-12% >7 days—CDC taper 25-50% daily over 7-10 days; contraindications: paralytic ileus, severe hepatic Child-Pugh C (acetaminophen clearance -70%), acute asthma, concurrent MAOIs.

Ryan Haight Schedule II Compliance (Through 12/31/2025)

1. Pain Threshold: NRS ≥7/10 + ADL impairment ≥30% post-ibuprofen 600mg TID + acetaminophen 1g q6h + gabapentin 300mg TID ≥72h failure.

2. Video Assessment: Multi-state PDMP clean, ORT <8, STOP-BANG <3, RR >12/min, naloxone consent.

3. EPCS Limits: #15-30 tabs 10/325mg zero refills 3-7 days pharmacy-direct.

4. Delivery: Signature USPS Priority tamper-evident USP <1116>.

5. Day 3: ≥30% NRS reduction or taper/non-opioid escalation.

Adverse Event Matrix

Home-focused express solutions violates Ryan Haight/CSA Schedule II—federal felony 5-40 years.