One Year Later: The Impact of Hydrocodone Combination Product Rescheduling

 Impact of Hydrocodone Combination Product Rescheduling
Impact of Hydrocodone Combination Product Rescheduling

Hydrocodone combination analgesic prescriptions have dropped by 22% since the U.S. Drug Enforcement Administration (DEA) reclassified the products from schedule III to schedule II of the Controlled Substances Act. Matching the drop in prescriptions, the number of dispensed hydrocodone combination product tablets also declined by 16%. Those figures are based on the amount of prescriptions and products dispensed 12 months after the DEA's rescheduling occurred. They are part of a new study published in JAMA Internal Medicine, to examine the implications of the rescheduling. The authors analyzed a national sample that covered nearly 80% of all dispensed retail prescriptions.

RELATED: DEA Makes Official Change for Hydrocodone Combination Products

The decision to reschedule these drugs became effective in October 2014, and came in the wake of growing hydrocodone combination product-related abuse incidents. In 2011, emergency departments across the U.S. registered almost 100,000 visits due to abuse of hydrocodone combination products. Prescription opioid abuse has long been identified as a major public health problem in the U.S.

The authors assessed the level of prescribing before and after the rescheduling. They found that the number of hydrocodone combination prescriptions had slowly declined by 8.4% in the 3 years before rescheduling occurred, and the number of dispensed tablets declined by 6%. However, the plunge of 22% in prescriptions and 16% in actual tablets, in the 12 months after rescheduling; represents a dramatic change.

The reason for the dip can be mostly attributed to the tighter refill controls that schedule II drugs have. Whereas physicians were able to prescribe several refills at a time when hydrocodone combinations products were under schedule III, patients were required to return to the physician for each refill. In total, refills accounted for 73.7% of the decline, and they were eliminated by March 2015.

Interestingly, in the 12 months after the rescheduling, non-hydrocodone combination analgesics increased by 4.9%, though this is not considered to have significantly affected the total number of opioid analgesics dispensed. Using a model of linear regression analysis the study's authors assert that the reductions in dispensed hydrocodone combination product prescriptions and tablets were substantially greater than would have been predicted in the absence of rescheduling. Bearing in mind how the numbers had already been on a slow decline, the author of the study deduced that the rescheduling resulted in an overall reduction of 14,360,378 (95% CI, 14,037,780–14,682,876) opioid prescriptions, and 750,095,774 (95% CI, 733,245,286–766,946,262) opioid tablets dispensed in the 12 months after rescheduling.

The numbers on record show a total of 26.3 million actual fewer prescriptions and 1.1 billion fewer tablets dispensed, in the 12 months after rescheduling. The only healthcare specialists who increased prescriptions during this period were pain specialists. Surgeons and primary care physicians showed the biggest decrease in allotted prescriptions, at 38.4% and 22.9% less, respectively.

The numbers on record show a total of 26.3 million actual fewer prescriptions and 1.1 billion fewer tablets dispensed, in the 12 months after rescheduling. The only healthcare specialists who increased prescriptions during this period were pain specialists. Surgeons and primary care physicians showed the biggest decrease in allotted prescriptions, at 38.4% and 22.9% less, respectively.

The figures for decreases and increases for tablets dispensed are similar. The only specialty associated with an increase in the number of hydrocodone combination tablets dispensed was pain specialists, at an increase of 8.9%. The lowest decrease, at 2%, was dentists, and the most drastic decrease was among surgeons at 30.8% less tablets.

The researchers note the numerous actions that have been taken to address the opioid epidemic in recent years. They point to the ‘abrupt change' in dispensing these products as an indication that rescheduling from III to II played a primary role. The findings are conclusive in the realm of lowering the number of prescriptions and tablets dispensed. However, the authors call for further research to assess whether these changes have had “an effect on access for patients, and are associated with the desired goals of reduced abuse, addiction, and overdose.”

For more information visit JAMA.

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