Lemongrass,

There is a three-fold reason for the common combination of narcotic and non-narcotic analgesics in a single medication. The first is therapeutic. Many types of pain respond better to treatments of multiple mechanisms, for example, blocking the pain impulses at the brain, at the site they or occur, and/or systemically en-route, usually in the spinal area. It is an exponential increase in efficacy, not just cumulative. The second is that many conditions that result in pain also have accompanying symptoms that an NSAID or other analgesic treats better, including fever for infections (abscesses), anti-inflammitory properties for swelling, etc. The third is that it reduces the abuse potential for the medication by not only making it more effective and abating (at least theoretically) the need to further increase opiate/opiod use, but the side-effects, including potential toxicity of the the other additive is preceived to mitigate abuse. For example, Hydrocodone itself is a Schedule II Controlled Substance, but when delivered with a specific proportion of APAP, it becomes Schedule III.

There are many dosage forms of simply the opiate component of pain medications, including OxyIR (Immediate Release Oxycodone) and OxyContin (Sustained Release Oxycodone), Roxicodone (Roxane Labs' Brand Version of Oxycodone), as opposed to Percocet and Roxicet, which are both Oxycodone/APAP combinations. All of these are Schedule II. As C-II's are the most regulated of the legal controlled substances, almost all products can be or are available in their pure form as a C-II. Those that aren't typically aren't sufficiently strong enough to warrant their usage in the pursest form in lieu of a different or more potent product. Morphine, Hydromorphone (Dilaudid), Fentanyl, are all C-II and compound-free.

There are no branded products containing Hydrocodone without some sort of additive like APAP, an antihistimine, or atropine, each of which have unpleasant or unhealthy side-effects if taken in sufficiently large or prolonged doses. Some compounding pharmacies, however, will make special preparations of Hydrocodone/APAP products with much lower APAP content, but at a substantial cost for their service.

The process does not just apply to opiates. Butalbital, a barbituate and primary component of the migraine treatment medications Fioricet and Fiorinal are combined with caffiene (for vascular constriction and to speed delivery) and APAP (Fioricet) or Aspirin (Fiorinal). While Aspirin can eventually do a number on the GI tract, it does not pose a comparable risk to large APAP doses, which is why Fioricet is not a federally controlled substance, but Fiorinal is. Go figure.

There actually is a method to the madness that is born out of efficacy and some fashion of logic intended to better serve patients.

I hope this is helpful.