Small Change in Opioid Prescribing May Have Big Impact

Gregory A. Hood, MD

Disclosures

October 22, 2014

A Change in Opioid Prescribing

In the latest change to controlled substance prescribing, hydrocodone has moved to Schedule II among controlled substances. In recognition of well-publicized reports that 99% of the worldwide supply of hydrocodone in 2007 was consumed in the United States,[1] the US Drug Enforcement Administration (DEA) enacted the Final Rule on October 6, 2014.

This change, roughly a decade after it was first recommended, moved the hydrocodone combination products to Schedule II, joining pure hydrocodone products, among others. Given that hydrocodone's proclivities for abuse, diversion, and overdose are not dependent upon combination with other products, this change made administrative sense.

The labeling change is likely to generate a slow decline in the prevalence of hydrocodone-containing prescriptions. The change reinforces the message from physicians that this is not a trivial medication. It also brightens the red light in the minds of those patients who, even when the medication is appropriate, are leery of receiving a prescription. The added attention that this labeling change has generated is an opportunity to enhance the necessary education and understanding among both prescribers and the general public as to the dangers, and hopefully the limitations and untoward long-term effects, of these medications.

Some disruptions have been minimized, even though, according to the DEA, hydrocodone combination prescriptions issued prior to October 6, 2014, with refills may be dispensed as long as such dispensing occurs before April 8, 2015. Many pharmacies do not have software that allows them to dually track prescription rules. As a result, those pharmacies have already begun requiring new prescriptions. Regardless, hydrocodone combination prescriptions written after October 5, 2014, cannot be refilled.

On the heels of changes to state law and medical board regulations in the past 2-plus years, some of the changes reinforce and simplify rules for prescribing. Schedule II controlled prescriptions cannot be faxed or called in under most circumstances. Patients on call cannot request courtesy refills. As has been the case for Kentucky practices at least since 2012—if not before, based on office protocols—patients who make such requests on call cannot have them fulfilled.

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