Hydrocodone Rescheduling: Did It Work?

Believe it or not, it has been a year since the Drug Enforcement Administration (DEA) reclassified all drugs containing the opioid hydrocodone as Schedule II controlled substances.

I guess time flies when you’re having fun, if by “fun” you mean double counting hydrocodone tablets, logging them into the perpetual inventory, ordering them through a DEA 222 form, and the various other prescription requirements that go along with a Schedule II product.

And let’s not forget the “fun” that legitimate pain patients are having, now that they have to visit their prescriber every month for a new prescription. Or the “fun” that prescribers are having when writing un-refillable prescriptions.

A year ago, many of us in the pharmacy profession were a bit skeptical about the benefit of hydrocodone rescheduling as a tool for addressing the opioid addiction problem in the United States.

We all acknowledge that our country has a drug addiction and overdose problem, with 16,000 related deaths per year. We all recognize that drug diversion, inappropriate prescribing, bogus prescriptions, and theft of narcotics are daily occurrences.

What many of us couldn’t understand is just how rescheduling hydrocodone would change the course of this so-called epidemic.

So, 1 year later, has it worked?

Certainly, rescheduling hydrocodone has probably made some forms of diversion more difficult.

I recall a case several years ago in which a pharmacy technician was secretly phoning in orders for Norco, and then conveniently stuffing the bottles in her pocketbook and shredding the invoices the next day. That would be more difficult to do now.

But I also finished reading the story of a young thug who jumped the counter at a Connecticut CVS and got away with a thousand tablets of Oxycontin. Apparently, he couldn’t be bothered with the hydrocodone, but if he wanted it, the rescheduling clearly wouldn’t have stopped him.

Has hydrocodone rescheduling really made a significant impact on public safety? Has it curbed our drug abuse problem? Are emergency rooms less crowded with overdosed patients? Do we have fewer families mourning the loss of a loved one who allowed their addiction to escalate to a fatal end?

These are the questions that need answers, but answers are harder to come by than you might think.

At the moment, it is too early to determine whether there has been any sort of shift in the opioid abuse problem. Even if the data show a decline in prescriptions written for hydrocodone-containing products, it will be hard to prove whether that decline actually caused fewer deaths.

At best, we can only speculate on whether hydrocodone rescheduling has had an overall positive impact.

Personally, I haven’t seen a big drop in the flow of hydrocodone prescriptions as a result of the rescheduling. Prescribers haven’t suddenly started writing for acetaminophen with codeine as a Schedule 3 alternative to avoid the hassle of a non-refillable Schedule 2 hydrocodone.

Perhaps there has been an increase in tramadol prescriptions, but overall, hydrocodone is still used heavily for the management of acute and chronic pain.

What about our problem with overdose deaths related to opioids? My impression is that the hydrocodone rescheduling has done nothing to slow this down.

I would even be willing to bet that it hasn’t prevented a single death, put a single drug dealer out of work, or put any unscrupulous health care professionals behind bars.

As a mechanism for tracking the legally manufactured and distributed supply of hydrocodone-containing products, the rescheduling may be modestly effective. But as a mechanism for improving patient lives, it has probably failed.

I would love to see some real progress in the form of fewer deaths and hospitalizations from drug overdoses, but the solution isn’t simple. Sadly, there aren’t enough options available for those who truly want to overcome their drug addiction.

To put it bluntly, the problem is just too big.

So, what can we do? For me, I do the things that I can do.

For instance, I inform my patients about the importance of securing their opioid medications and destroying whatever is left over when they are done. I want my patients who use these medications for legitimate purposes to do so safely and appropriately.

Like most other pharmacists out there, I also say “no” to inappropriate prescriptions and early fills. I regularly check the prescription drug monitoring program (PDMP) to identify problem patients and prescribers.

In my opinion, rescheduling hydrocodone simply didn’t work as a mechanism to curb our drug abuse problem, but that fact can’t keep pharmacists from doing their part.

Laws like this don’t change lives, but pharmacists and other health care professionals equipped with knowledge and compassion can make a difference every day.