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

Authors

  • 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

DOI:

https://doi.org/10.5055/jom.2018.0457

Keywords:

hydrocodone-combination products, rescheduling, pain management

Abstract

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.

Author Biographies

John W. Shumway, MD

Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas

Renzhong Ran, MD

Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas

Jeff McClusky, BS, Pharm

Pharmacy Services, Harris Health System, Harris Health System, Houston, Texas

Zubaid Rafique, MD

Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas

Cedric Dark, MD, MPH

Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas

W. Frank Peacock, MD

Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas

Alexie Cintron, MD

Department of Medicine, Section of Geriatrics, Baylor College of Medicine, Houston, Texas.

Michelle Ludwig, MD, MPH, PhD

Assistant Professor, Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas; Adjunct Assistant Professor, Division of Epidemiology, Human Genetics & Environmental Sciences, UT School of Public Health, Dallas, Texas; Smith Clinic, Attwell Radiation Therapy Center, Houston, Texas

References

IMS Health National Prescription Audit: Top 25 medicines by dispensed prescriptions (U.S.). Available at http://www.imshealth.com/. Accessed June 1, 2017.

International Narcotics Control Board: Narcotic Drugs 2016—Estimated World Requirements for 2017—Statistics for 2015. New York, NY: United Nations, 2017. Report E/INCB/2016/2.

Drug Enforcement Administration, DOJ: Schedules of controlled substances: Rescheduling of hydrocodone combination products from schedule III to schedule II. Final rule. Fed Regist. 2014; 79(163): 49661-49682.

Rosenblum A, Parrino M, Schnoll SH, et al.: Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend. 2007; 90(1): 64-71.

Crane EH: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD: Center for Behavioral Health Statistics and Quality, 2013. CBHSQ Report.

Food and Drug Administration Center for Drug Evaluation and Research: Drug Safety and Risk Management Advisory Committee (DSaRM) [online transcript]. 2013. Available at https://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/drugsafetyandriskmanagmentadvisorycommittee/ucm346941.pdf. Accessed March 20, 2017.

The Texas State Board of Pharmacy: Q & A regarding the rescheduling of hydrocodone-combination drug products. 2014. Available at https://www.pharmacy.texas.gov/files_pdf/Q_A_on_Hydrocodone_ReScheduling.pdf. Accessed March 11, 2017.

Seago S, Dezman ZDW, Comer MPH, et al.: Change in prescription habits after federal rescheduling of hydrocodone combination products. Proc (Bayl Univ Med Cent). 2016; 29(3): 268-270.

Schultz S, Chamberlain C, Vulcan M, et al.: Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center. J Opioid Manag. 2016; 2(2): 119-122.

Oehler EC, Day RL, Robinson DB, et al.: Has the rescheduling of hydrocodone changed ED prescribing practices? Am J Emerg Med. 2016; 34(12): 2388-2391.

Jones CM, Lurie PG, Throckmorton DC: Effect of US Drug Enforcement Administration's rescheduling of hydrocodone combination analgesic products on opioid analgesic prescribing. JAMA Intern Med. 2016; 176(3): 399-402.

Grasso MA, Dezman ZD, Comer AC, et al.: The decline in hydrocodone/acetaminophen prescriptions in emergency departments in the veterans health administration between 2009 to 2015. West J Emerg Med. 2016; 17(4): 396-403.

IMS Institute for Healthcare Informatics: Medicines use and spending in the U.S.: A review of 2015 and outlook to 2020. Available at https://static1.squarespace.com/static/54d50ceee4b05797b34869cf/t/5711197b45bf21650748e8ad/1460738430435/IMS+Health+2015.pdf. Accessed March 11, 2017.

Wastila LJ, Bishop C: The influence of multiple copy prescription programs on analgesic utilization. J Pharm Care Pain Symptom Control. 1996; 4(3): 3-19.

Simoni-Wastila L, Qian J: Influence of prescription monitoring programs on analgesic utilization by an insured retiree population. Pharmacoepidemiol Drug Saf. 2012; 21(12): 1261-1268.

Best J, Dark C, Pandya M: Norco is now a Schedule II drug! What do Texans have to say? Texas College of Emergency Physicians. 2014. Available at http://www.texacep.org/page/1411norco/Norco-is-now-a-Schedule-II-drug-What-do-Texans-have-to-say.htm. Accessed August 4, 2017.

Rodriguez RF, Castillo JM, Del Pilar Castillo M, et al.: Codeine/acetaminophen and hydrocodone/acetaminophen combination tablets for the management of chronic cancer pain in adults: A 23-day, prospective, double-blind, randomized, parallel-group study. Clin Ther. 2007; 29(4): 581-587.

Chang AK, Bijur PE, Munjal KG, et al.: Randomized clinical trial of hydrocodone/acetaminophen versus codeine/acetaminophen in the treatment of acute extremity pain after emergency department discharge. Acad Emerg Med. 2014; 21(3): 227-235.

Haynes A, Kleinschmidt K, Forrester MB, et al.: Trends in analgesic exposures reported to Texas poison centers following increased regulation of hydrocodone. Clin Toxicol (Phila). 2016; 54(5): 434-40.

DePriest AZ, Puet BL, Holt AC, et al.: Metabolism and disposition of prescription opioids: A review. Forensic Sci Rev. 2015; 27(2): 115-145.

Rodriguez RF, Castillo JM, Castillo MP, et al.: Hydrocodone/acetaminophen and tramadol chlorhydrate combination tablets for the management of chronic cancer pain: A double-blind comparative trial. Clin J Pain. 2008; 24(1): 1-4.

Department of Health and Human Services, PHS, Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology: Drug utilization review for hydrocodone-containing combination products and comparators. Available at http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndAnalgesicDrugProductsAdvisoryCommittee/UCM330683.pdf. Accessed June 1, 2017.

Published

07/01/2018

How to Cite

Shumway, MD, J. W., R. Ran, MD, J. McClusky, BS, Pharm, Z. Rafique, MD, C. Dark, MD, MPH, W. F. Peacock, MD, A. Cintron, MD, and M. Ludwig, MD, MPH, PhD. “Impact of Rescheduling Hydrocodone-Combination Products in an Urban Texas County Healthcare System”. Journal of Opioid Management, vol. 14, no. 4, July 2018, pp. 257-64, doi:10.5055/jom.2018.0457.