DEA puts tougher restrictions on hydrocodone drugs

Today, the DEA is making it harder for doctors to prescribe the nation’s most popular painkillers.

The agency is rescheduling all hydrocodone combination products (HCPs) from federal Schedule III to federal Schedule II, putting the drugs into a more restricted category and potentially lowering the number of prescriptions written. There were more than 130 million prescriptions for these drugs in 2013, making them the most frequently prescribed opioid in the United States.

According to the DEA, Schedule II drugs “have a high potential for abuse which may lead to severe psychological or physical dependence.” Despite all the public hand wringing over painkiller abuse, many painkiller products have remained in the lower-level Schedule III category. That made drugs such as Vicodin and Lortab easier to get access to than drugs such as Demerol and OxyContin.

The rule change takes effect today, October 6.

What do the new restrictions look like?

First, doctors will no longer be able to write prescriptions with automatic refills. To get a refill on one of these drugs, you will have to visit the doctor again and get a new prescription.

Second, doctors will no longer be able to call or fax in prescriptions for these drugs. Patients will have to bring a signed prescription note from the doctor to the pharmacy.

Third, doctors will have to upgrade their software in order to accurately report prescriptions of these drugs as Schedule II to the state.

Fourth, some doctors will not be able to prescribe these drugs at all. If a doctor has had a license restriction because of some past violation of state or federal rules that limited prescriptions to Schedules III and lower, that doctor will not be able to prescribe Vicodin and similar drugs.

Fifth, in some states, this will make stocking these drugs in the office a punishable offense. In the past, doctors could order drugs “for office use” and dispense them to patients at will. But the upgrade to Schedule II would make that illegal in some states. For example, West Virginia law says that prescribing a Schedule II drug for office use is cause for medical license revocation.

West Virginia has been particularly interested in this rule change. In 2013, the state had the highest per capita rate of prescription drug overdoses in the country. When the DEA first announced the rule change, West Virginia Attorney General Patrick Morrisey issued a statement of support:

We believe this will represent another small step in combating the prescription drug epidemic in our state. Rescheduling hydrocodone is one way to help prevent this drug from falling into the wrong hands and will ensure that these drugs are handled with the same precautions as other pain medications, such as oxycodone, hydromorphone, and fentanyl. Sadly, we’re painfully aware of the consequences of the drug epidemic in this state, and especially hydrocodone abuse.

While the overdose rates in California are not as high as in West Virginia, the drugs are extremely popular. During the last fiscal year, the state estimates that more than 1 billion doses of hydrocodone were dispensed in the state.

Reporters and patient advocates should pay close attention in the months and years to come to see if these restrictions have any effect on overprescribing and – perhaps just as importantly – to see if they lead to any meaningful improvements in the way we treat people who are suffering from different types of pain.

Cropped photo by Ryan Lackey via Flickr.