Hydrocodone Prescriptions Research Articles

Opioids prescribing restrictions and homelessness: Evidence from hydrocodone rescheduling

This paper examines the effect of restricting opioid prescription on homelessness. We assess this relationship by exploiting plausible exogenous variation in prescribed opioid supply derived from an opioid restriction policy: the hydrocodone (i.e., Vicodin, not oxycodone products like Oxycontin) rescheduling. We identified the causal effect of this decrease in the supply of hydrocodone, the most prescribed opioid in the U.S. and comprising 55% of overall use opioid prescription dispensing, by comparing the number of homeless individuals in geographies with higher exposure to Hydrocodone against those in areas with lower exposure, before and after the enactment of the policy. We find that in the quarter following hydrocodone upscheduling, the rate of people experiencing homelessness decreased by almost 56 per 100,000 inhabitants (a 25.4% reduction relative to the pre-policy mean). In addition, results show that hydrocodone prescriptions, drug related deaths, unemployment, and divorce rates decrease following the upscheduling. Taken together, our results suggest that during our study period (2007–2017) the hydrocodone rescheduling reduced homelessness by preventing some household crises.

Changes in Hydrocodone Misuse Exposures Reported to U.S. Poison Centers Following Rescheduling in 2014

Background In 2014, the Drug Enforcement Administration rescheduled hydrocodone combination products to Schedule II to reduce nonmedical use and diversion. Methods The impact of rescheduling was assessed using quarterly data from 2011 through 2019 from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System Poison Center Program and IQVIATM Longitudinal Prescription Data. Trends and immediate changes in prescriptions dispensed and misuse exposures before and after rescheduling involving hydrocodone, oxycodone, and other Schedule II opioid analgesics were calculated using segmented regression. Results Hydrocodone prescriptions were stable pre-rescheduling, decreased by 2.7% (95% CI: −3.6%, −1.8%, p < 0.0001) per quarter post-rescheduling. Misuse exposures involving hydrocodone were decreasing by 3.2% (95% CI: −3.9%, −2.4%, p < 0.0001) per quarter pre-rescheduling and decreased by 4.9% (95% CI: −5.5%, −4.2%, p < 0.0001) post-rescheduling. Immediate decreases in hydrocodone prescriptions and misuse exposure rates in 2014Q4 compared to 2014Q3 were significant and different from oxycodone or other Schedule II opioids. Schedule II opioid analgesics prescriptions in aggregate were stable prior to rescheduling, decreased by 10.8% (95%CI: −14.0%, −7.6%, p < 0.0001) immediately after the rescheduling, and decreased by 2.3% per quarter (95% CI: −3.1%, −1.5%, p < 0.0001) subsequently. Misuse exposures involving these opioids were decreasing by 3.3% (95% CI: −4.1%, −2.5%, p < 0.0001) prior to rescheduling then by 2.8%, (95% CI: −3.4%, −2.2%, p < 0.0001) after rescheduling. The immediate change in misuse was not significant. Conclusions Rescheduling corresponded with changes in hydrocodone prescribing and misuse not offset by increases in other Schedule II opioid analgesics. Misuse exposures for hydrocodone and comparators were decreasing prior to rescheduling with little change post-intervention.

Sustained reduction of discharge opioid prescriptions in an enhanced recovery after thoracic surgery program: A multilevel generalized linear model

BackgroundEnhanced Recovery After Surgery programs have been shown to effectively reduce opioid prescriptions at discharge after their implementation in several institutions, but little is known regarding the sustainability of this effect. Understanding opioid prescribing patterns after long-term implementation of Enhanced Recovery After Surgery initiatives may help guide further opioid prescription reduction and improvements. Our group aimed to determine whether reductions in opioid prescriptions at discharge are sustained in an Enhanced Recovery After Surgery program for thoracic surgery. MethodsThis retrospective cohort included 2,081 patients undergoing thoracic surgery within a 4-year Enhanced Recovery After Surgery program from March 2016 through April 2020. Our Enhanced Recovery After Surgery protocol included a standardized multimodal analgesic regimen (ie, preoperative gabapentin, tramadol, intercostal nerve block with liposomal bupivacaine, and intraoperative acetaminophen, and ketorolac) and the rest of the interventions recommended by the Enhanced Recovery After Surgery society guidelines. Our primary outcomes were the presence of opioid prescriptions at discharge (hydrocodone, hydromorphone, and oxycodone) and the total opioid amount prescribed (morphine equivalent daily dose). Multilevel generalized linear models were used to account for surgeon variabilities and types of thoracic resection. ResultsOver the study period, the rate of opioid prescriptions at discharge reduced from 35% (Mar 2016) to 25% (Apr 2020), and the amount of opioid prescribed declined from 184 ± 321 morphine equivalent daily dose to 94 ± 251 morphine equivalent daily dose. In multilevel generalized linear models, there was a sustained downward trend in opioid prescriptions over the study period (β -11.8 morphine equivalent daily dose per year, P = .048), which was also directly correlated with the use of minimally invasive surgery (β -84.9 morphine equivalent daily dose for video-assisted thoracoscopic surgery, P < .001; β -139.2 morphine equivalent daily dose for robotic-assisted thoracic surgery, P < .001), intraoperative opioid administration (β -1.4 morphine equivalent daily dose per 1 morphine equivalent dose, P = .026), and the amount of postoperative acetaminophen (β -18.2 morphine equivalent daily dose per 1 g, P = .026). The sustained reduction of opioid prescriptions at discharge did not impact hospital readmission rates within 30 days (odds ratio 1.17, 95% confidence interval 0.86–1.59, P = .306). Subgroup analysis showed a significant, sustained decrease in hydromorphone (β -10.9 morphine equivalent daily dose per year, P = .004), but not for hydrocodone prescriptions (β -5.7 morphine equivalent daily dose per year, P = .168) or oxycodone (β +4.78 morphine equivalent daily dose per year, P = .183). ConclusionOur Enhanced Recovery After Surgery program for thoracic surgery contributed to a sustained reduction of opioid prescriptions at discharge, which positively correlated with the duration of its implementation and the use of minimally invasive surgical techniques but was negatively impacted by the amount of intraoperative opioid administration.

Rates of Opioid Prescriptions Obtained After Mohs Surgery

To curtail the opioid epidemic, physicians have been advised to limit opioid prescriptions. To characterize the frequency and changes over time (2009-2020) of opioid prescriptions following Mohs micrographic surgery. This cross-sectional study using Optum Clinformatics DataMart (Optum CDM), a nationally representative insurance claims database, included patients aged 18 years and older who had Mohs micrographic surgery insurance claims in the Optum CDM database from 2009 to 2020. Data were analyzed from November 11, 2020, to March 30, 2021. Opioid prescription following Mohs surgery. The primary outcome was the proportion of patients who underwent Mohs surgery and obtained an opioid prescription within 2 days of surgery. Secondary outcomes included type and opioid quantity prescribed. Among 358 012 patients with Mohs micrographic surgery claims (mean [SD] age, 69 [13] years; 205 609 [57.4%] were men), the proportion of patients obtaining an opioid prescription after Mohs micrographic surgery increased from 2009 (34.6%) to 2011 (39.6%). This proportion then declined each year, reaching a low of 11.7% in 2020 (27.9% absolute decrease from 2011 to 2020). Hydrocodone, codeine, oxycodone, and tramadol were the 4 most commonly prescribed opioids. By 2020, hydrocodone was obtained less (2009: 47.5%; 2011: 67.1%; 2020: 45.4%; 21.7% absolute decrease from 2011 to 2020) and tramadol was obtained more (2009: 1.6%; 2020: 27.9%; 26.3% absolute increase from 2009 to 2020). In this cross-sectional study of Mohs micrographic surgery claims, patients obtained fewer postsurgery opioid prescriptions over the study period, suggesting responsiveness of patients and dermatologic surgeons to public health concerns regarding the opioid epidemic. During this decline, prescriptions for hydrocodone decreased and tramadol increased.

California court defers to Board of Pharmacy expertise

Pharmacists sometimes get caught in the middle between prescribers who insist that their opioid prescriptions be honored, and regulations that require pharmacists to decline suspicious opioid prescriptions. Disputes between pharmacists and prescribers may lead to litigation based on alternative interpretations of pharmacy laws. A court in California recently ruled that the State Board of Pharmacy has primary jurisdiction to consider any such dispute prior to resolution of the dispute in a court of law. A pain management physician sued a pharmacy that declined to honor the physician's hydrocodone prescriptions. The physician's lawsuit sought an injunction that would force the pharmacy to honor his prescriptions. The physician based his legal argument on a state pharmacy law that says “a licensee shall not obstruct a patient in obtaining a prescription drug or device that has been legally prescribed or ordered for that patient.” The pharmacy opposed the injunction, citing another state law that recognizes a “pharmacist's responsibility to ensure that prescriptions for controlled substances are issued only for a legitimate medical purpose.” The trial court explained that a judicial order requiring the pharmacy to honor particular prescriptions “would involve judgments concerning the statutory obligations of pharmacists that the Board is both expected and equipped to resolve.” The trial court ruled that the physician should first take his complaint to the Board before pursuing his claim in court. The physician appealed this ruling. The appellate court first noted that the Board has the “background to evaluate the specific facts that are relevant to these issues.” The physician contended that the doses he prescribes “are not excessive,” and that “hydrocodone is the lowest potency pure µ-receptor opiate agonist available.” The court concluded that “the Board is better equipped than the courts to evaluate how such technical claims affect a pharmacy's statutory corresponding responsibility.” The appellate court then referred to “the context of a national opioid problem,” agreeing with the trial judge that “the Board has more experience in evaluating a pharmaceutical licensee's responsibilities in this context.” The court also noted the need for “regulatory uniformity” since pharmacy opioid prescription screening programs are likely to affect many prescribers. The court said, the “Board is well positioned to adopt a uniform approach to determining whether such programs—and implementation of them—are consistent with pharmacists’ professional obligations.” The court applied the “doctrine of primary jurisdiction” to the case. Under this doctrine, the issue is not whether courts are capable of adjudicating claims based on state laws, but whether those claims require the “resolution of issues which, under a regulatory scheme, have been placed within the special competence of an administrative body.” The court explained that referral of the physician's case to the Board will not have any effect on the physician's right to eventually proceed with his case in a court of law, but “a ruling from the Board will provide a benefit to the court in ruling on issues that are reserved for its decision.” The physician was instructed to file a complaint with the State Board of Pharmacy prior to proceeding with his court case against the pharmacy. Judicial restraint has not been frequently exercised in the numerous legal cases brought against pharmacists and/or pharmacies based on allegations that opioid prescriptions were unlawfully honored when they should have been declined, or that opioid prescriptions were declined when they should have been honored. The California case is a very sensible and welcome exception. State Boards of Pharmacy are well positioned and well qualified to review claims of illegal conduct by the pharmacists or pharmacies that are licensed by them. Under the doctrine of primary jurisdiction, the determination of a Board of Pharmacy is not binding on a court of law, yet it can be useful and persuasive. Justice is best served when legal claims are examined by knowledgeable reviewers.

Calculating prescription rates and addiction probabilities for the four most commonly prescribed opioids and evaluating their impact on addiction using compartment modelling.

In 2016, more than 11 million Americans abused prescription opioids. The National Institute on Drug Abuse considers the opioid crisis a national addiction epidemic, as an increasing number of people are affected each year. Using the framework developed in mathematical modelling of infectious diseases, we create and analyse a compartmental opioid-abuse model consisting of a system of ordinary differential equations. Since $40\%$ of opioid overdoses are caused by prescription opioids, our model includes prescription compartments for the four most commonly prescribed opioids, as well as for the susceptible, addicted and recovered populations. While existing research has focused on drug abuse models in general and opioid models with one prescription compartment, no previous work has been done comparing the roles that the most commonly prescribed opioids have had on the crisis. By combining data from the Substance Abuse and Mental Health Services Administration (which tracked the proportion of people who used or misused one of the four individual opioids) with data from the Centers of Disease Control and Prevention (which counted the total number of prescriptions), we estimate prescription rates and probabilities of addiction for the four most commonly prescribed opioids. Additionally, we perform a sensitivity analysis and reallocate prescriptions to determine which opioid has the largest impact on the epidemic. Our results indicate that oxycodone prescriptions are both the most likely to lead to addiction and have the largest impact on the size of the epidemic, while hydrocodone prescriptions had the smallest impact.

Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention’s Opioid Prescribing Guidelines

It is not known whether decreases in Schedule II (high abuse potential) vs Schedule IV (lower abuse potential) opioid prescriptions overall and among high-risk patients followed publication of the Centers for Disease Control and Prevention (CDC) opioid prescribing guideline on March 15, 2016. To compare the odds of new Schedule II opioid (codeine, hydrocodone, oxycodone) prescriptions vs Schedule IV opioid (tramadol) prescriptions in the 18-month periods before and after the CDC guideline release to determine whether new prescriptions for Schedule II opioids decreased relative to new prescriptions for tramadol and to assess whether patients with benzodiazepine prescriptions or those with depression, anxiety, or substance use disorders had a greater decrease in receipt of Schedule II vs Schedule IV opioids. Cross-sectional study of Optum's deidentified Integrated Claims-Clinical data set for 5 million US adults 18 months before and 18 months after March 15, 2016. Eligible patients were 18 years or older, free of HIV and cancer diagnoses, and had a noncancer painful condition. Patients received new prescriptions for codeine, hydrocodone, oxycodone, or tramadol. Data were analyzed from September 5, 2014, to September 14, 2017. The CDC opioid prescribing guideline published on March 15, 2016. The odds of prescriptions for each Schedule II opioid vs tramadol after guideline publication. Data from 279 435 patients were included in the study. The mean (SD) age of patients was 52.9 (16.5) years; 61% were female and 79.4% were White. The prevalence of new prescriptions for each drug before and after guideline publication was as follows: codeine, 7.1% vs 7.0%; hydrocodone, 47.4% vs 45.6%; oxycodone, 22.4% vs 24.0%; and tramadol, 23.0% vs 23.4%. Overall, the odds of being prescribed hydrocodone or oxycodone vs tramadol significantly decreased after guideline publication (odds ratios, 0.95; 95% CI, 0.91-0.98 and 0.86; 95% CI, 0.82-0.90, respectively). Odds of being prescribed a Schedule II opioid vs tramadol after vs before guideline publication were similar in patients with and without benzodiazepine comedication or psychiatric disorders. In the 18 months after compared with the 18 months before publication of the CDC prescribing guideline, a 14% decrease in oxycodone prescriptions was observed relative to tramadol. Little change in prescriptions of other Schedule II opioids was observed. Schedule II opioids continue to be prescribed to high-risk patients 18 months after publication of the CDC guideline.

Leveraging Prescription Drug Monitoring Programs to Evaluate Opioid Policy Interventions

Research ObjectiveA variety of state and federal policies have been enacted to curtail prescription opioid overdoses, including implementation of statewide opioid prescribing guidelines and rescheduling of hydrocodone from DEA Schedule III to Schedule II. We aimed to use data from the Ohio Prescription Drug Monitoring Program (PDMP) to evaluate the effects of these policies.Study DesignRetrospective study of all opioid prescriptions dispensed in the state of Ohio from 2010 to 2017. We first determined the number and characteristics of opioid prescriptions stratified by specialty. We then used an interrupted time series analysis to determine the effect on opioid prescribing after (a) the release of statewide opioid prescribing guidelines in 2012 and (b) the federal rescheduling of hydrocodone in 2014.Population StudiedThe state of Ohio. Prescriptions for the nine most common pill form opioid pain relievers dispensed in Ohio were included. The PDMP includes all prescriptions dispensed to individuals in the state, regardless of payer.Principal FindingsThe number and characteristics of opioid prescriptions and trends over time varied greatly between different prescriber specialties. The mean number of pills/prescription and morphine content of the prescriptions were highest for physical medicine/rehabilitation (91.2 pills, 1532 mg, n = 1 680 579), anesthesiology/pain (89.3 pills, 1484 mg, n = 3 261 449), hematology/oncology (88.2 pills, 1534 mg, n = 516,596), and neurology (84.4 pills, 1230 mg, n = 573 389). Overall, family medicine (21.8%) and internal medicine (17.6%) prescribed the most opioids. The implementation of emergency department opioid prescribing guidelines was associated with a 12% decrease (95% CI −17.7% to −6.3%) in the level of statewide total prescriptions/month and an additional decrease of 0.9% (95% CI −1.1% to −0.7%) relative to the trend before the guidelines. Rescheduling of hydrocodone was associated with a level change of −26 358 (95% CI −36 700 to −16 016) prescriptions (−5.8%) and an additional decrease of −1568 (95% CI −2296 to −839) prescriptions/month. Rescheduling was associated with a temporary substitution effect (increase) of codeine and with a decrease in the prescribing of tramadol.ConclusionsThe characteristics of opioid prescriptions vary widely by specialty and suggest the need for specialty‐specific guidance. Opioid guidelines targeting the emergency department were associated with a decrease in prescribing beyond the secular trend. The rescheduling of hydrocodone was associated with a decrease in hydrocodone prescriptions beyond the secular trend, but also appeared to affect the prescribing of other opioids as well.Implications for Policy or PracticePDMPs are state‐based prescribing databases that can be used to influence prescriber decision‐making at the point of care. However, their powerful data can also be used to describe prescribing behaviors overall and evaluate the effectiveness of implemented opioid‐related policies.

How Do Local Government Finances Respond to the Opioid Epidemics? Evidence From Hydrocodone Rescheduling

The opioid epidemic has dramatically impacted communities across the United States. According to the Center for Disease Control statistics, more than 72,000 people died from an overdose in 2017, of which two-thirds were opioid-related. In this study, I address the effects of such an epidemic directly on the finances of local governments. Specifically, I use the exposure to hydrocodone prescriptions and the rescheduling among regulated substances by the DEA as a source of exogenous variation and compare results in three settings: standard difference-in-difference, and counterfactual created using nearest neighbors regression and generalized random forests. I find that the rescheduling led to an increase in health expenditures driven mainly by localities that are still, as of 2016, suffering the epidemics. This is consistent for the standard difference-in-difference as well as for the nearest neighbor regressions. A similar finding is obtained using generalized random forests with noisier estimates, however, heterogeneity is determined by race, education, and prevalence of rural population instead of overdose rates.

Opioid Prescribing Among Adults With Disabilities in the United States After the 2014 Federal Hydrocodone Rescheduling Regulation.

Deaths from prescription opioid overdoses have reached an epidemic level in the United States, particularly among persons with disabilities. The 2014 federal rescheduling regulation is associated with reduced opioid prescribing in the general US population; however, to date, no data have been published on this regulation's effect on persons with disabilities. We examined whether the 2014 hydrocodone rescheduling change was associated with reduced opioid prescribing among adult Medicare beneficiaries with disabilities. We identified 680 876 Medicare beneficiaries with disabilities aged 21-64 in 2013 and 657 687 in 2015 from a 20% national sample. We examined changes in the monthly opioid-prescribing rates from January 1, 2013, through December 31, 2015. We also compared opioid-prescribing rates in 2013 with rates in 2015. In 2014, the percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased by 0.154% per month (95% confidence interval [CI], -0.186 to -0.121, P < .001). The percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased from 32.2% in 2013 to 27.7% in 2015, whereas rates of any opioid prescribing, prolonged prescribing (≥90-day supply), and high-dose prescribing (≥100 morphine milligram equivalents per day for >30 days) decreased only modestly, from 50.2% to 49.0%, from 27.4% to 26.5%, and from 7.5% to 7.0%, respectively. The 2014 federal rescheduling of hydrocodone was associated with only minor changes in overall and potentially high-risk opioid-prescribing rates. Neither state variation in long-term prescribing nor beneficiary characteristics explained the changes in persistently high opioid-prescribing rates among adults with disabilities after the 2014 regulation. Future studies should examine patient and provider characteristics underlying the persistent high-risk prescribing patterns in this population.

Opioid prescribing rates from the emergency department: Down but not out

IntroductionTo examine opioid prescribing rates following emergency department (ED) discharge stratified by patient’s clinical and demographic characteristics over an 11-year period. Material and methodsWe used 3.9 million ED visits from commercially insured enrollees and 15.2 million ED visits from Medicaid enrollees aged 12 to 64 over 2005–2016 from the IBM® MarketScan® Research Databases. We calculated rates of opioid prescribing at discharge from the ED and the average number of pills per opioid prescription filled. ResultsApproximately 15–20% of ED visits resulted in opioid prescriptions filled. Rates increased from 2005 into late 2009 and 2010 and then declined steadily through 2016. Prescribing rates were similar for commercially insured and Medicaid enrollees. Being aged 25–54 years was associated with the highest rates of opioid prescriptions being filled. Hydrocodone was the most commonly prescribed opioid, but rates for hydrocodone prescription filling also fell the most. Rates for oxycodone were stable, and rates for tramadol increased. The average number of pills dispensed from prescriptions filled remained steady over the study period at 18–20. DiscussionOpioid prescribing rates from the ED have declined steadily since 2010 in reversal of earlier trends; however, about 15% of ED patients still received opioid prescriptions in 2016 amidst a national opioid crisis. ConclusionsEfforts to reduce opioid prescribing could consider focusing on the pain types, age groups, and regions with high prescription rates identified in this study.

Effects of Rescheduling Hydrocodone on Opioid Prescribing in Ohio.

We quantified opioid prescribing after the 2014 rescheduling of hydrocodone from schedule III to II in the United States using a state-wide prescription database and studied trends three years before and after the policy change, focusing on certain specialties. We used Ohio's state prescription drug monitoring program database, which includes all filled schedule II and III prescriptions regardless of payer or pharmacy, to conduct an interrupted time series analysis of the nine most prescribed opioids: hydrocodone, oxycodone, tramadol, codeine, and others. We analyzed hydrocodone prescribing trends for the physician specialties of internal medicine, anesthesiology, and emergency medicine. We evaluated trends 37 months before and after the rescheduling change. Rescheduling was associated with a hydrocodone level change of -26,358 (95% confidence interval [CI] = -36,700 to -16,016) prescriptions (-5.8%) and an additional decrease in prescriptions of -1,568 (95% CI = -2,296 to -839) per month (-0.8%). Codeine prescribing temporarily increased, at a level change of 6,304 (95% CI = 3,003 to 9,606) prescriptions (18.5%), indicating a substitution effect. Hydrocodone prescriptions by specialty were associated with a level change of -805 (95% CI = -1,280 to -330) prescriptions (-8.5%) for anesthesiologists and a level change of -14,619 (95% CI = -23,710 to -5,528) prescriptions (-10.2%) for internists. There was no effect on prescriptions by emergency physicians. The 2014 federal rescheduling of hydrocodone was associated with declines in hydrocodone prescriptions in Ohio beyond what had already been occurring, and hydrocodone may have been briefly substituted with codeine. These results indicate that rescheduling did have a lasting effect but affected prescribing specialties variably.

Factors associated with potentially problematic opioid prescriptions among individuals with private insurance and medicaid

If opioid analgesics are prescribed and used inappropriately, they can lead to addiction and other adverse effects. In this study, we (1) examine factors associated with potentially problematic opioid prescriptions and (2) quantify the link between potentially problematic prescriptions and the development of opioid use disorder. We found that older age; female sex; having back pain, arthritis, or migraine; hydrocodone prescription; previous pharmacotherapy for opioid use disorder; and frequent emergency department use were associated with problematic prescriptions among individuals with Medicaid and private insurance. Patients with commercial insurance and Medicaid who had potentially problematic opioid prescriptions were eight and three times more likely, respectively, to develop an opioid use disorder than patients without potentially problematic opioid prescriptions. Our findings help identify factors associated with problematic prescriptions and underscore the importance of targeted public health interventions.

Descriptive, observational study of pharmaceutical and non-pharmaceutical arrests, use, and overdoses in Maine

ObjectivesThe Maine Diversion Alert Program grants healthcare providers access to law enforcement data on drug charges. The objectives of this report were to analyse variations in drug charges by demographics...

The opioid epidemic and patient satisfaction: a review of one institution’s experience

Background: The opioid crisis caused the Drug Enforcement Administration (DEA) to reschedule hydrocodone to schedule II from III. Other narcotics (i.e. codeine) were not reclassified, becoming the narcotic medications for many surgeons. We wanted to review how this rescheduling of hydrocodone influenced prescribing practices and Press Ganey scores. Methods: A retrospective review from April 6, 2014, to April 5, 2015, was conducted on all orthopaedic trauma patients at a level I trauma center. Patient charts were abstracted for the type and amount of narcotic prescribed. Press Ganey scores for the surgeons were collected during the same period. The data were used to determine the percentage of hydrocodone prescription before and after reclassification as well as the effect on Press Ganey Scores. Results: Surgeons significantly decreased the percentage of hydrocodone prescriptions, 70% versus 44% (P &lt; 0.001), after reclassification. Two surgeons, A (76% vs. 11%) and B (69% vs. 30%), had a significant decrease in the percentage of hydrocodone (P &lt; 0.0001), surgeon C’s percentage (67% vs. 67%) did not change (P =0.96), and surgeon D significantly increased (67% vs. 86%) (P =0.009). No significant changes were seen for overall Press Ganey scores for the group aggregate or individual providers, 91 versus 91 (P =0.993) after reclassification. Conclusions: The results show that the percentage of hydrocodone to all narcotic prescriptions decreased after rescheduling hydrocodone. This did vary by individual surgeon, with one surgeon’s percentage being significantly increased. Press Ganey scores did not appear to be influenced by rescheduling hydrocodone.

Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study.

To qualitatively assess prescribers) perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings. This was a cross-sectional study. Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016. Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling. Prescribers) perceptions regarding hydrocodone rescheduling. Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred. The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians) hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients) satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.

Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery

In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood. To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone. An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion. The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use. Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female; P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg). There were no significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55), but there was a significant decrease in the refill rate (β = -5.2% [1.3%]; P < .001). Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.

Postoperative opioid prescribing practices and the impact of the hydrocodone schedule change

BackgroundIn 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be “called in” to a pharmacy. We analyzed current postoperative opioid prescribing patterns and the impact of the schedule change on the type and amount prescribed. MethodsOpioid prescriptions for common surgeries at 1 medical center from 2013 to 2016 were analyzed retrospectively. Milligram morphine equivalents prescribed before and after the schedule change were compared by t tests, and interrupted time series models and drug frequencies were compared by χ2 and Fisher exact tests. ResultsData from 7,046 patients (7,361 prescriptions) after 29 different operations were analyzed. Milligram morphine equivalents prescribed for minor open procedures ranged from 211 to 342 milligram morphine equivalents, from 323 to 1297 for major open procedures, from 238 to 359 for basic laparoscopic procedures, and from 221 to 868 for complex laparoscopic procedures. Mean milligram morphine equivalents prescribed were not affected for most procedures, but over the entire population, milligram morphine equivalents prescribed began decreasing after the rule change. The percentage of hydrocodone prescriptions decreased after the rule change (from 33.8% down to 27.0%) and oxycodone and tramadol prescriptions increased. ConclusionBefore versus after the rule change, hydrocodone prescriptions decreased and oxycodone and tramadol prescriptions increased. Milligram morphine equivalents prescribed varied considerably across and within classes of procedures, but the schedule change did not affect mean milligram morphine equivalents prescribed for most procedures.

Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products.

To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States. Retrospective cohort study. United States. A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year) MEASUREMENTS: From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015. From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio=0.93, 95% confidence interval (CI)=0.93-0.94). Medicare enrollees with an original entitlement because ofdisability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio=1.24, 95% CI=1.03-1.50). The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use.

The Impact of the U.S. Drug Enforcement Agency Schedule Changes for Hydrocodone and Tramadol on California Prescriptions Patterns

The Impact of the U.S. Drug Enforcement Agency Schedule Changes for Hydrocodone and Tramadol on California Prescriptions Patterns