No longer able to get refills for hydrocodone, patients are forced to see a doctor each time they need more of the pain killer. It’s a process that appears to have cut hydrocodone abuse, but that’s only part of the story.
It’s been more than a year since the federal Drug Enforcement Administration (DEA) reclassified hydrocodone from a schedule III to a schedule II drug.
The change has had the desired effect; doctors are writing fewer prescriptions for this powerful opioid.
Hydrocodone combination products (Vicodin, Lorcet, etc.) are used to treat pain or relieve coughs. It’s a narcotic that affects how the central nervous system perceives pain.
The drug is an effective pain reliever, but can also create feelings of euphoria and become addictive.
In 2011, hydrocodone combination products were involved in almost 100,000 U.S. emergency room visits. That’s twice the 2004 rate.
The DEA, in an effort to cut down on abuse, reclassified the drug in October 2014. The effect of this change is detailed in JAMA Internal Medicine.
In addition, the FDA today unveiled what it called a “far reaching action plan” to combat the “opioid abuse epidemic.”
The study published in JAMA was led by Christopher M. Jones, Pharm.D. He and his researchers used data from the IMS Health National Prescription Audit.
They compared prescriptions dispensed in the 12 months prior to the change with those dispensed in the 12 months following the change.
The number of prescriptions for hydrocodone combination products declined by 22 percent. There was a 16 percent decrease in the number of prescriptions for hydrocodone tablets.
Doctors wrote 26 million fewer prescriptions for hydrocodone combination products in the year after reclassification. That same year, 1.1 billion fewer hydrocodone combination product tablets were dispensed.
Meanwhile, prescriptions for non-hydrocodone opioids rose a bit. Dispensed prescriptions for non-hydrocodone opioids grew by almost 5 percent. Dispensed tablets increased by 1.2 percent.
According to the DEA, schedule III drugs have a moderate to low potential for physical and psychological dependence.
Schedule II drugs have a high potential for abuse due to their potential for severe psychological or physical dependence.
What does the change mean for doctors and patients?
Doctors can no longer write or call in prescriptions for refills. If a patient wants more, it means a trip to the doctor for a new prescription.
More than 73 percent of the decline could be attributed to this key factor, researchers said.
The study found that primary care physicians and surgeons wrote far fewer prescriptions than they used to. Pain specialists wrote slightly more.
Researchers said they don’t yet know the long-term effects of the changes.
Study authors stated that “future research should examine whether these changes are sustained, have had an effect on access for patients, and are associated with the desired goals of reduced abuse, addition, and overdose.”
For people who were already addicted, reclassification didn’t solve the problem.
Constance Scharff, Ph.D., director of addiction research at Southern California’s Cliffside Malibu Treatment Center, told Healthline that the damage has already been done.
“The medication was too widely prescribed for a long period,” Scharff said. “Now, those who were using hydrocodone are switching to heroin, which is cheaper and more readily available.
In the future, we must be more careful about recognizing the real dangers associated with medications and be diligent in monitoring their use as well as being vigilant in reacting to unintended outcomes.”
Dr. Damon Raskin, medical director at Cliffside Malibu, told Healthline it’s somewhat unusual for the DEA to reclassify a drug.
“But because of the opioid epidemic raging across this country, they decided they had to reclassify these drugs to make it more difficult for patients to obtain these medications,” he said.
The steps required to obtain a prescription act as a deterrent for both doctor and patient.
“It emphasizes the fact that this is a serious drug that requires full evaluation by a doctor to determine if the patient really needs the drug,” Raskin said.
The DEA’s action is helpful, but according to Raskin, it’s not enough.
“There are many layers of work needed to fix this problem,” he said, “including doctors’ education on handling pain management as well as reigning in pharmaceutical companies from promoting these drugs unnecessarily.”
Raskin believes it would be helpful to reclassify a few other dangerous drugs, specifically benzodiazepines (Valium, Xanax, etc.).
Caren Ragan was taking hydrocodone to treat neck pain that lingers even after surgery.
The Florida resident told Healthline the process has been time-consuming and expensive, involving a lot of back and forth with her health insurer. She ultimately had to leave her long-term doctor to see a pain specialist.
She needed pain relief, but Ragan hated getting her prescription filled.
“The pharmacist looked at me like I was a drug addict,” she said. “The law is a Band-Aid to stop some addicts while adding an additional burden to people who are in pain.”
Without pain medication, Ragan doesn’t think she could continue to work.
Her doctor tried a handful of other medications to no avail. She finally found some relief with the Butrans (buprenorphine) skin patch, a schedule III controlled substance.
“The problem is, it’s expensive,” Ragan said. “If my insurance changes I’m not sure if I could afford to pay for this out of pocket.”