Impact of Rescheduling Hydrocodone Combination Products Among Cancer Patients

Abstract

Many cancer patients experience significant pain requiring the use of an opioid pain medication such as hydrocodone. On October 6, 2014 the DEA rescheduled hydrocodone combination products from Schedule III to Schedule II of the Controlled Substances Act. Schedule II rules are closely enforced by the DEA and caregivers are fined for non-compliance. In addition, mid-level providers and residents are not able to write for schedule II drugs, so this limits the number of providers able to prescribe opioid pain medications. It has been hypothesized that such rescheduling will cause significant delays for patients who require such medications leading to uncontrolled pain, more emergency department visits and increased risk of readmission. The purpose of this study is to investigate what changes physicians and other healthcare providers have made to their prescribing practices as a result of this rescheduling. With IRB approval, prescription and pharmacy pick-up data for Tramadol, Hydrocodone-acetaminophen (Norco) and Tylenol 3 for all patients within a regional safety net health system were obtained. The time-frames in which data was collected were 6 months before the rescheduling date (April 5, 2014 – October 5, 2014) and 6 months after (October 6, 2014 – April 6, 2015). This dataset was then linked with the health system’s cancer database to identify all cancer patients receiving any one of these pain medications. P-values and confidence intervals were calculated using the N-1 chi square test. Total pills dispensed. Among all patients, considering these 3 pain medications, Norco dropped from 50% of the total pills dispensed before the rescheduling to 23.2% after while Tramadol saw a modest increase from 44.3% to 54.0% and Tylenol 3 saw a significant increase from 5.7% to 22.8%. Among cancer patients Norco dropped from 79.3% to 58.1% while Tramadol increased from 16.2% to 23.7% and Tylenol 3 increased from 4.5% to 18.2%. Total pills dispensed, overall saw a 28.5% decrease in all patients from before the rescheduling to after and in cancer patients there was a 24.5% decrease.Abstract 3252TramadolP-valueTylenol 3P-valueNorcoP-valueAll patientsApr 5 2014 – Oct 5 20141277116 (44.3%)163318 (5.7%)1443782 (50.0%)Oct 6 2014 – Apr 6 20141113033 (54.0%)470110 (22.8%)479003 (23.2%)Difference9.69% (CI: 9.61-9.79)<0.00117.13% (CI: 17.07-17.20)<0.00126.83% (CI: 26.75-26.91)<0.001Cancer patientsApr 5 2014 – Oct 5 201470301 (16.2%)19716 (4.5%)344290 (79.3%)Oct 6 2014 – Apr 6 201477859 (23.7%)59605 (18.2%)190570 (58.1%)Difference7.58% (CI: 7.37-7.73)<0.00113.63% (CI: 13.48-13.78)<0.00121.18% (CI: 20.97-21.39)<0.001 Open table in a new tab The rescheduling of hydrocodone products has dramatically changed prescriber patterns in our health system. Further research is warranted to understand the impact on pain scores.