On January 25, 2013 an FDA advisory panel of experts voted 19 to 10 to change hydrocodone containing products from schedule III controlled drugs to the more restricted schedule II controlled substance category. The FDA is expected to adopt this recommendations despite strong opposition from several groups. Hydrocodone medications include Vicodin, Lortab, Norco, and generic versions.
How will this affect how hydrocodone containing products are prescribed
Schedule II drugs, in most states, cannot be prescribed or refilled by telephone, fax, or any other electronic means. Prescribers will have to provide paper prescriptions each month (or sooner). This scenario would encourage prescribers to write for larger quantities or stronger pain killers because they will lose the ability to adjust patient doses between the various strengths of hydrocodone. The ultimate response would be more powerful medications will be prescribed with larger supplies provided to the patient.
The Florida pill-mill problem in the past may become a nationwide situation if patients under the influence of multiple opioids, muscle relaxants, and benzodiazepines are forced onto roadways to pick up these hard copy prescriptions each month from their doctor.
Will the change create more work for pharmacists
It will be an inconvenience at first because of the strict record and accountability requirements for schedule II drugs. Pharmacies will adapt.
How will doctors and nurses be impacted
It will create more work for prescribers and patients. It will force thousands of patients often with little more than sciatica or migraines to travel to their physicians office to pick up a hard copy prescription and refills will be limited leading to prescribing of larger quantities of these medications.
This is similar to how ADHD drugs, almost all of them amphetamines which are schedule II class drugs, are prescribed. Patients need new prescriptions every month. This dilemma is very challenging for prescribers who are attempting to see patients and often necessitates office staff copying the last prescription for the prescriber to blindly sign.
Will it impact abuse of hydrocodone products
Hydrocodone prescriptions may decrease in favor of stronger, more powerful opioids such as controlled release OxyContin (oxycodone). Physicians have always been very receptive to controlled-release products that limit the number of daily doses with the belief that they improve compliance. However, this is possibly at the risk of increasing addiction or misuse. Pain doctors may prefer to prescribe 60 OxyContin tablets instead of 300 Vicodin tablets even though the 60 Oxycontin tablets actually contain more opioids.
We may see more sharing of hydrocodone between patients, illicit use, and purchase of opioids over the internet or the street. The street value of hydrocodone will increase. It will not reduce the abuse of hydrocodone or other opioids. Oxycontin is currently a schedule II drug but it is still misused and abused.
How will the switch from schedule III to schedule II affect treatment of pain patients
They will be given larger and more powerful pain killers sooner. It will be an inconvenience for patients with chronic pain to pick up prescriptions every month.
What are alternative schedule III drugs that may be used in place of hydrocodone containing products
Twenty years ago Tylenol with codeine was very popular because Vicodin and Lortab were brand only. Maybe there will be an increase in prescribing of Tylenol with codeine or Ultram (tramadol).
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