Should hydrocodone be changed to a schedule 2 drug?

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.

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  • John C. Key MD

    I hope it can remain a 3. Everything said above about hydrocodone is certainly true,but there is a parallel and equal legitimate need for it in many patients. Moving it to a 2 with the attendant nonsense and difficulty that there is in writing for 2s seems to be a pretty draconian action that will primarily punish legitmate users.

    Just like raising our DEA permit fee to astronomical levels–that punishes the legitimate docs too!

  • bspa

    No, No, No,
    I live in a small town and my doctors are an hour away. My prescriptions have to be called in. Lord have mercy.

  • Barbara Lantana

    Yes, people abuse drugs and will continue to do so. Changing hydrocodone to a schedule II drug will do nothing to change this. It will only make it more difficult for people with chronic pain to get the pain relief they need. I wonder if any person who works for the FDA realizes how difficult and what a stigma is put on people with chronic pain. We are looked at as drug addicts, not people who are dependent on a medication. More pain centers are getting so reluctant to start someone on medical pain management. We have to get urine tested to prove we are not abusing drugs. We just want to be a productive citizen, go to work, have a decent quality of life. Without these medications we will be on disability, cringe in pain, and not have anything to look forward to. Some physicians get it, some don’t. The ones that do are just as frustrated by having their hands tied with these crazy regulations. As bspa said below, “Lord have mercy.”

  • Molly_Rn

    The way scheduled drugs got their designation was political and not medical as heroin is a wonderful drug for pain and marijuana is more benign than alcohol and cigarettes. Don’t make it harder for people in actual pain to get their medication. Stop those abusing it from getting it by arresting them and the physicians and pharmacies that provide it. Also stop selling the cold medications that are used to manufacture Meth. Too bad if your nose is stopped up; it is a self limiting disease. Meth is evil stuff and we need to stop having Pseudoephedrine on the market period.

    • http://www.facebook.com/quartermoonranch Katie Moon

      Well said, but leave the cold and allergy preparations alone. There are other ways to make meth, all of them horrible.

  • http://www.facebook.com/quartermoonranch Katie Moon

    As an RN and chronic pain patient, who was referred to pain management for continued therapy, I see this becoming another roadblock to adequate pain relief. Just what I need, drive 45 minutes, sit in the office for an hour or three, drive to the pharmacy and wait some more.
    When I wanted to change PCP, several practices asked what medications I was on. When they heard I was taking hydrocodone, I was advised they did not accept patients taking narcotics. The stigma is bad enough already.
    Seeing a pain specialist is expensive enough without paying monthly instead over every 2-3 months. More big government with poorly thought out solutions to problems best handled by physicians.

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