Hydrocodone as it is currently prescribed in the U.S. is a schedule 3 drug. The FDA puts rules and regulations on the prescribing of medications that have a significant potential for abuse, diversion or addiction, and the lower the schedule number, the more the restrictions.
Schedule 1 drugs are illegal in the U. S. They are deemed to have no legitimate medical purpose. Examples are heroin, LDS, methamphetamine, marijuana (strange but true) etc.
Schedule 2 drugs are considered to have legitimate medicinal use, but have a high potential for abuse, diversion and addiction. They require a written prescription, cannot be called or faxed into a pharmacy, and require monthly prescriptions, i.e. no refills without a new prescription. Examples are oxycodone, morphine, hydromorphone and all of the amphetamine-based stimulants for ADD/ADHD like methylphenidate and Adderall.
Schedule 3 drugs are considered to have a lower but still significant potential for abuse, diversion and addiction. The biggest difference in regulation is that prescriptions for schedule 3 drugs can be called or faxed to a pharmacy by physicians, and refills can be prescribed without getting a fresh prescription.
Currently the FDA is reviewing hydrocodone as to whether to reclassify the combination products containing hydrocodone as a schedule 2 drug, changing from its current status at schedule 3. The arguments for change are primarily based on the accumulating evidence that hydrocodone is widely abused and diverted in the U.S. The use of hydrocodone as an opioid analgesic has steadily increased in the U.S. The number of prescriptions of hydrocodone in the U.S. increased by about 50% from 2000 to 2006, and the gross production of hydrocodone more than doubled in that time span.
Non-medical use of hydrocodone has also become extremely prevalent. Data from the 2011 Monitoring the Future Survey reported that 2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th graders had used Vicodin non-medically in the last year. In 2009 the National Survey on Drug Use and Health reported that 9.3% of Americans over age 12 had used hydrocodone non-medically in their lifetime.
So given that hydrocodone is widely abused, that there is a major and growing use both for pain relief and non-medically in the U.S. should hydrocodone be reclassified as a schedule 2 drug? First let’s list some of the anticipated consequences of reclassification of hydrocodone to schedule 2.
- Prescriptions for hydrocodone will be harder to obtain for all patients. To obtain a prescription a patient will need to come to the physician’s office, get a written prescription, and take it to their pharmacy.
- More physicians will be reluctant to prescribe hydrocodone. It will be a process like with oxycodone now. Physicians will face more frustrated and angry patients wanting prescriptions that have to be done exactly according to strict rules. Extra work, expense, and risk will lead even more physicians to stop chronic pain management.
- The cost of managing moderate chronic pain will increase. Managing patients on schedule 2 drugs just takes more office visits, and therefore more money than managing patients on schedule 3 drugs.
I’m sure there will be lots more consequences, intended and unintended consequences, but I predict that reclassification of hydrocodone as a schedule 2 drug will do little to prevent abuse, diversion and addiction, and will make it more difficult for physicians to manage chronic pain and more difficult for patients with legitimate pain to get hydrocodone prescriptions. We have a mess in this country with prescription drug abuse, but reclassification of hydrocodone will just make the mess more work to deal with, not reduce or eliminate the problem.
Edward Pullen is a family physician who blogs at DrPullen.com.