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Impact of rescheduling hydrocodone-combination products in an urban Texas county healthcare system

John W. Shumway, MD, Renzhong Ran, MD, Jeff McClusky, BS, Pharm, Zubaid Rafique, MD, Cedric Dark, MD, MPH, W. Frank Peacock, MD, Alexie Cintron, MD, Michelle Ludwig, MD, MPH, PhD


Objective: The objective of this study was to examine the rescheduling of hydrocodone- combination products (HCPs) and associated changes in prescriber patterns in an urban county healthcare system in Texas.

Methods: Pharmacy data were obtained electronically for tramadol, hydrocodone-acetaminophen, and acetaminophen-codeine from 180 days before and after the schedule change on October 6, 2014. χ2 and t tests were used to calculate the significance of changes between the medications over the studied time.

Results: Hydrocodone-acetaminophen saw a decline in dispense events and pills dispensed of 80.2 and 67.9 percent, respectively, in the immediate 30-day period following the scheduling change with a total decrease of 80.8 and 67.5 percent, respectively, in the 180-day period. Acetaminophen-codeine dispense events and total pills dispensed increased by 302.3 and 288.9 percent, respectively, in the immediate 30-day period while 180-day results experienced an increase of 215.1 and 209.8 percent, respectively. There were no major changes with tramadol. Additionally, an increase of 69.5 percent in pills per dispense event of hydrocodone-acetaminophen was noted in the 180-day period following the schedule change.

Conclusion: The scheduling change of HCPs is associated with an immediate decrease in hydrocodone-acetaminophen use at our institution while a simultaneous rise in acetaminophen-codeine products was observed.


hydrocodone-combination products, rescheduling, pain management

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