The Great Hydrocodone Rescheduling Debate

Author: Daniel Weiss, Senior Editor

In October 2013, the FDA announced that it would recommend tighter restrictions on commonly prescribed painkillers that include hydrocodone in combination with other drugs such as acetaminophen or aspirin. The announcement called for reclassifying hydrocodone combination products such as Vicodin and Lortab as Schedule II drugs from their status as Schedule III drugs.
 
A session at the American Society of Health-System Pharmacists (ASHP) 2013 Midyear Clinical Meeting in Orlando included a debate on whether hydrocodone combination products should be rescheduled. Mary Lynn McPherson, PharmD, professor and vice chair at the University of Maryland School of Pharmacy, argued in favor of rescheduling, and Jeff Fudin, PharmD, FCCP, adjunct associate professor at the Albany College of Pharmacy and adjunct assistant professor at the UCONN School of Pharmacy, argued against it. (Drs. McPherson and Fudin were assigned to take these positions, and their arguments do not necessarily reflect their personal positions on the issue.)

At the ASHP Midyear Clinical Meeting, we interviewed Drs. McPherson and Fudin about the key points of their respective arguments. Here are all 12 of the video clips from these interviews.

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Increased Opioid Usage
Dr. McPherson discusses the dramatic increase in use of opioids in the United States.



Evidence for Rescheduling Hydrocodone Combination Products?
Dr. Fudin argues that there is no evidence to support categorizing hydrocodone combination products as Schedule II drugs rather than Schedule III drugs.



Potential for Abuse of Hydrocodone Combination Products
Dr. McPherson discusses the appeal of hydrocodone combination products to drug abusers.



Will Rescheduling Hydrocodone Combination Products Actually Reduce Abuse?
Dr. Fudin argues that categorizing hydrocodone combination products as Schedule II drugs is unlikely to reduce abuse of the medications.



Rationale for Categorizing Hydrocodone Combination Products as Schedule III
Dr. McPherson discusses why hydrocodone combination products were categorized as Schedule III drugs in the first place.



Abuse Liability of Hydrocodone Combination Products
Dr. Fudin argues that studies comparing the abuse liability of hydrocodone combination products with that of other opioids have produced conflicting results.



How Rescheduling Hydrocodone Combination Products Will Reduce Abuse
Dr. McPherson explains how rescheduling hydrocodone combination products as Schedule II drugs will help reduce levels of abuse.



Codeine and Rescheduling Hydrocodone Combination Products
Dr. Fudin argues that categorizing hydrocodone combination products as Schedule II drugs could lead to increased prescription of codeine, a much “sloppier” drug that could create problems for patients.



Rescheduling Hydrocodone Combination Products Will Lead to More Responsible Use
Dr. McPherson argues that rescheduling hydrocodone combination products as Schedule II drugs will introduce limitations that will lead to more responsible prescribing of the drugs and monitoring of their use.



Rescheduling Hydrocodone Combination Products: Lessons from New York State
Dr. Fudin discusses the effect of making hydrocodone combination products Schedule II drugs in New York State on prescription of other opioids, including oxycodone.



Why Should Hydrocodone Combination Products Be Categorized as CII Drugs?
Dr. McPherson explains why hydrocodone combination products should no longer be categorized as Schedule III drugs.



Hydrocodone Combination Product Rescheduling: The Bigger Picture
Dr. Fudin argues that categorizing hydrocodone combination products as Schedule II drugs will not make the medications safer for patients. Instead, he argues, there should be more education for those who prescribe the medications and pharmacists who dispense them.