Hydrocodone Combination Product Rescheduling Has Effect on Pain Patients
Based on preliminary analysis of a new survey conducted by the National Fibromyalgia & Chronic Pain Association, chronic pain patients are finding it harder to access hydrocodone combination products (HCP) after the Drug Enforcement Administration (DEA) rescheduling, resulting in greater expenses for patients and strained doctor-patient relationships.
The research was presented at the 31st Annual Meeting of the American Academy of Pain Medicine.
The DEA had issued its final rule rescheduling HCPs as Controlled Substance Schedule II, effective Oct. 6, 2014. The change in schedule meant HCP prescriptions would need to be written on hard copy, original prescriptions, or electronically transmitted where e-prescribing of C-IIs was allowed. HCP prescriptions could no longer be faxed or called into a pharmacy and no refills could be issued unless the prescription had been given before October 6, 2014.
Key findings from the survey, which included over 3000 responders (mostly female), were the following:
- Approximately two-thirds of survey responders reported inability to access HCPs. Patients prescribed the same medication at the same dose for many years reported that they were told their doctors would no longer prescribe hydrocodone medications for them.
- More than 15% of the responders reported negative impacts on doctor-patient relationships.
- Survey respondents cited higher expenses from more frequent doctor's visits, higher medication co-pays, greater transportation expenses for extra doctor's visits and travel to multiple pharmacies, and lost income related to inability to work due to pain.
- More than a quarter of respondents (27%) reported suicidal thoughts due to being denied their hydrocodone prescriptions.
From these findings it can be inferred that DEA rescheduling has negatively impacted chronic pain patients, however the authors note the survey had been conducted online through patient advocacy websites which may have resulted in bias.
The DEA had proposed rescheduling last year based on study analysis showing high abuse potential with HCPs, which may lead to severe psychological or physical dependence. An increasing trend in emergency department visits, addiction treatment center admissions, and deaths were demonstrated to be the result of HCP abuse. Also, the total prescriptions of HCPs exceeded that of any other opioid analgesic, which further compounded the abuse potential and risk. Several epidemiological surveys and a retrospective review of medical records of addiction treatment populations showed that HCPs were among the most abused opioids in prescription opioid-dependent patients in the country.
While this may be the first report to be issued regarding the impact of HCP rescheduling on chronic pain patients, more research will need to be conducted, particularly in male patients since this survey did not include many of them, to see whether the change has resulted in more harm than good.
- Chambers JF et al. “The Impact of Hydrocodone Rescheduling in People with Pain: The First 100 Days.” Presented at: AAPM 2015. March 19-22, 2015; National Harbor, Maryland.