Hydrocodone is an opioid narcotic “first synthesized in Germany in 1920 by Carl Mannich and Helen Lowenheim”. (Hydrocodone) Since 1943, hydrocodone use has increased to the point that practically everyone agrees that something needs to change. Hydrocodone is presently a schedule III medication (drugs with an abuse risk less than schedule II). (Controlled drugs) There is currently a petition from the DEA (Drug Enforcement Administration) to reschedule hydrocodone to a schedule II medication (drugs with a high abuse risk but also have safe and accepted medical use in the United States). (Controlled drugs) “On January 24-25, 2012 the Drug safety and Risk Management Advisory committee (DSaRM) meet and voted 19-10 in favor of the rescheduling of hydrocodone”, (Rescheduling) and at present awaiting the final decision from the FDA if the schedule will change. Rescheduling of hydrocodone was first considered in 1999 when the DEA noted a rise in hydrocodone related abuse and deaths. In 2004, when the Advisory committee first met, they agreed there was not enough information to change the schedule at that time. The DEA continued to collect data. In 2009, they resubmitted a petition for reevaluation, citing continued rise in number of prescriptions and increased misuse and frank abuse of hydrocodone. In a 2009 article, (Emergency Department Visits Involving Non-medical Use of Selected Prescription Drug) the CDC demonstrated a steady rise in opioid abuse and prescription opioid related deaths from 2004-2008.
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They found a 111% increase in ER visits involving nonmedical use of hydrocodone, from 144,600 visits to 305,900 visits. In 2007-2008 -a single year- the volume increased 29%. (2004-2008) The Drug Abuse Warning network (DAWN) “a public health information system that tracks the abuse and misuse of opioid type medication such as hydrocodone”, (2004-2008) utilized “trained reporters to collect data from hospital related Emergency room visits via chart review’. (2004-2008) DAWN’s statistics reveal a steady rise in abuse and deaths related to opioid (hydrocodone) painkillers, and the average patient age is getting younger each year. Medical examiner findings parallel the results of DAWN’s research. The rescheduling of hydrocodone has become a nation-wide issue. Some feel the rescheduling of hydrocodone will hinder chronic pain patients from receiving their medications. I read several blogs by patients on this subject. They are worried about the change.
Many state that without this medication, they cannot live a “normal life” and be a productive member of society. Patients are not the only group that have concerns. There are several pharmacy groups who oppose the rescheduling of hydrocodone. They feel the rescheduling of hydrocodone will create barriers for patients with chronic pain who need the medication. They also believe that hydrocodone, if rescheduled, will “go up in cost due to the requirement for secure storage, recordkeeping, and inventory management”. (APhA) Some physicians oppose the rescheduling of hydrocodone, Dr. Fudin, a Chronic Pain Management Physician, has stated that the “rescheduling of hydrocodone will not solve the abuse problem that the FDA is hoping it will. The patients that are abusing hydrocodone will just move on to something else. Plus rescheduling of hydrocodone will lead to inadequate medications for chronic pain patients”. (Fudin) Dr. Webster voices some of the same concerns. In his presentation “Rescheduling Hydrocodone: Patient and Public health Considerations”, Dr. Webster stated that of those who abuse hydrocodone, 55% of them get their medications from family or friends and rescheduling hydrocodone is not likely to change that.
Dr. Webster also stated that the rescheduling of hydrocodone could easily effect the costs of the medication, increase insurance cost and make patient access to the medication difficult. He also voiced concerns that rescheduling would cause a “balloon effect”: that those abusing the hydrocodone will find another mediation to take its place. Replacements could have worse side effects and increase the risk of illegal drug use and abuse. (Fudin) Dr. Bob Twillman, The Director of Policy and Advocacy for the American Academy of Pain Management, also opposes the rescheduling of hydrocodone. Dr. Twillman was one of the individuals on the 2012 FDA advisory committee. His 2013 article also addresses changes to the official FDA policy which would allow opioid painkillers only be used in “severe” pain, no dose greater than 100 mg of oral morphine per day, and no more than 90 days’ worth. Although Dr. Twillman never officially stated how he voted, his position is clear. He feels that the rescheduling of hydrocodone will cause harm to chronic pain patients and really have little to no effect of the high abuse rate.
Dr. Twillman uses an aphorism “a rising tide lifts all boats” (Twillman) to suggest that the increase in production of hydrocodone has increased both the proper use (to help patients that need it) and the abuse of the medication. Dr. Twillman states that a good solution should be to decrease access to hydrocodone for the ones who abuse it, and increase access for the patients who need it. Dr. Twillman also discusses the “squeezing the balloon” (Twillman) effect, when you take away one supply of an abused opioid another will just take its place. Although Dr. Fudin and Dr. Twillman make valid points against rescheduling of hydrocodone, there is overwhelming evidence that hydrocodone is the “#1” abused narcotic in the United States and even those who oppose rescheduling agree that there needs to be a change. The State of New York has already taken steps without waiting on the FDA decision.
The state put in effect a “1 STOP law”, (Mulder) which restricts the number of hydrocodone tablets a patient can receive. Instead of the standard six month prescription, physicians are only allowed to write for a 90 day supply. Furthermore, any time a physician writes a prescription for hydrocodone or any other narcotic, they are required to check a prescription database which shows how many prescriptions each patient has had. This is done to prevent “doctor shoppers” and drug-seekers from obtaining multiple prescriptions at different physicians and emergency rooms. Dr. Brian Johnson, Addiction Medicine Specialist, is happy about the changes. He feels the new system will bring to light how addictive hydrocodone really is. The article “Prescription Painkiller Overdoses, A growing epidemic”, shows how dramatically the death rates from prescription painkillers have increased over the past several years – “an astounding 400% increase among women and 265% among men’. (Prescription) not only has the death rate increased, the ages at death are getting younger. It’s reported that every 3 minutes a women is treated in the emergency room for opioid medication overdose.
Historically, women are more likely to have “chronic pain, abuse painkillers and doctor shop”. As a result, hydrocodone abuse is even affecting the unborn. There has been a “300% increase in neonatal abstinence syndrome (NAS), a group of problems that can occur in newborns when exposed to prescription painkillers hydrocodone in the womb”. (Prescription) The rescheduling of hydrocodone continues to be a “hot” topic. It is not only academics and regulatory entities like the FDA who find this topic difficult. In my 20 years as an Emergency room nurse, I have seen many patients who truly need this medication. I have also seen the “drug seekers”, “ER hoppers”. I have dealt with patients who call to find out what physician is working , the ones who only come to be seen when Dr. “X” is working, knowing they will receive their narcotics. I see daily the pressure placed on the physicians to give the patients what they want, so in return the patients will give the facility a good satisfaction rating. Based on my research on this subject, my opinion is, for the rescheduling of hydrocodone.
“2004-2008, Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs — United State.” 18 June 2010. Center for Disease Control and Prevention. Web. 23 Jan. 2014. . “APhA, other pharmacy groups oppose rescheduling hydrocodone in letter to HHS.” 12 Nov. 2013. American Pharmacy Association. Web. 9 Feb. 2014. . “Controlled Drugs.” 2002-2013. Texas State Board of Pharmacy. Web. 23 Jan. 2014. . Fudin, Dr. Jeffrey. “Effect of Rescheduling Hydrocodone is Unknown.” 26 Jan. 2013. Dr. Jeffrey Fudin. Web. 9 Feb. 2014. . Gunter, Dr. Jen. ” New Restrictions on Hydrocodone are unlikely to solve any Problem.” n.d. Dr. Jen Gunter. Web. 23 January 2014. . “Hydrocodone.” 11 Feb. 2014. Wikipedia. Web. 12 Feb. 2014. . Mulder, James T. “New restrictions on painkiller prescriptions take effect Saturday.” 18 Feb. 2013. The Post-Standard Central New York. Web. 9 Feb. 2014. . “Prescription Painkiller Overdoses, A growing epidemic, especially among women.” July 2013. Center for Disease Control and Prevention. Web. 23 Jan. 2014. . “Rescheduling of hydrocodone Proposal.” 24-25 jan. 2013. Drug Safety and Risk Management Advisory committee (DSaRM). Web. 19 Jan. 2014. . Twilliman, Bob, Ph.D., FAPM, Director of Policy and Advocacy for the American Academy of Pain Management (AAPM). “Rescheduling Hydrocodone.” 05 Feb. 2013: 1-5. Livestrong Foundation. Web. 9 Feb. 2014. .