More Restrictive DEA Scheduling of Hydrocodone Combination Products Substantially Reduced the Number of Prescriptions and Tablets Dispensed

Hydrocodone combined with non-opioid analgesics (e.g., acetaminophen) have been among the most commonly prescribed medications and were involved in over 100,000 substance-related US emergency department visits in 2011. When the Drug Enforcement Agency shifted hydrocodone products from Schedule III to II in 2014, prescription refills were no longer permitted. Researchers used prescription dispensing in a large national pharmacy database and prescriber specialty data to determine how dispensing of hydrocodone products changed when the more restrictive scheduling went into effect.

• The number of hydrocodone combination prescriptions declined by 22% and tablets dispensed declined by 16% in the 12 months after rescheduling compared with the 12 months before rescheduling,
• The number of non-hydrocodone opioid-containing pain combination prescriptions increased by 4.9% and tablets dispensed increased by 1.2% in the 12 months after rescheduling compared with the 12 months before rescheduling,
• Primary care physicians and surgeons accounted for the largest decreases in hydrocodone prescriptions and tablets dispensed.

Comments:

More restrictive rules on prescribing hydrocodone combination products resulted in fewer prescriptions and tablets dispensed. While increases in non-hydrocodone opioid combination products did occur, these did not fully offset the hydrocodone reductions. This study does not report whether these reductions are offset by opioids that are not combined with other analgesics, are sustained beyond 12 months, or are associated with changes in pain treatment, addiction risk, or overdose in patients.

Alexander Y. Walley, MD, MSc

Reference:

Jones CM, Lurie PG, Throckmorton DC. Effect of US Drug Enforcement Administration’s rescheduling of hydrocodone combination analgesic products on opioid analgesic prescribing. JAMA Intern Med. 2016;176:399–402.