The Great Hydrocodone Rescheduling Debate
An expert debate on whether hydrocodone combination products should be made Schedule II drugs, as the FDA has recommended.
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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Dr. McPherson discusses the dramatic increase in use of opioids in the United States.
Dr. Fudin argues that there is no evidence to support categorizing hydrocodone combination products as Schedule II drugs rather than Schedule III drugs.
Dr. McPherson discusses the appeal of hydrocodone combination products to drug abusers.
Dr. Fudin argues that categorizing hydrocodone combination products as Schedule II drugs is unlikely to reduce abuse of the medications.
Dr. McPherson discusses why hydrocodone combination products were categorized as Schedule III drugs in the first place.
Dr. Fudin argues that studies comparing the abuse liability of hydrocodone combination products with that of other opioids have produced conflicting results.
Dr. McPherson explains how rescheduling hydrocodone combination products as Schedule II drugs will help reduce levels of abuse.
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.
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.
Dr. Fudin discusses the effect of making hydrocodone combination products Schedule II drugs in New York State on prescription of other opioids, including oxycodone.
Dr. McPherson explains why hydrocodone combination products should no longer be categorized as Schedule III drugs.
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.