Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center


  • Steven Schultz, PharmD
  • Carol Chamberlain, PharmD, Psych MA
  • Marius Vulcan, MD
  • Humair Rana, MD
  • Bhavin Patel, PharmD, MBA
  • John C. Alexander, MD



hydrocodone, Drug Enforcement Agency, tramadol, codeine


Background: Hydrocodone-containing products were recently rescheduled from Drug Enforcement Agency (DEA) schedule III to schedule II due to concerns of abuse and misuse. These changes went into effect on October 6, 2014.

Objective: This quality improvement project involved a retrospective analysis to determine the effect of the DEA schedule change on prescribing habits of hydrocodone-containing products as well as the remaining schedule III and IV opioids, codeine (schedule III) and tramadol (schedule IV).

Methods: The authors performed a medication use evaluation at our academic level 1 trauma hospital system on outpatient use of hydrocodone-containing products, tramadol, and codeine-containing products for 6 months before and 6 months after the change to schedule II using our electronic record and pharmacy system.

Results: A total of 88,428 prescription orders were analyzed. Comparison of prescriptions before and after the DEA schedule changes showed hydrocodone prescriptions reduced from an average of 225.97 per day to 1.20 per day. In addition, tramadol increased from 60.04 per day to 91.85 per day and codeine from 6.81 per day to 98.94 per day.

Conclusions: Our data show a very substantial decrease in utilization of hydrocodone- containing products and concomitant increase in the utilization of tramadol and codeine products at our hospital after the DEA schedule change.

Author Biographies

Steven Schultz, PharmD

Parkland Health & Hospital System, Dallas, Texas

Carol Chamberlain, PharmD, Psych MA


Carol Chamberlain, PharmD, Psych MA, Parkland

Marius Vulcan, MD

Parkland Health & Hospital System, Dallas, Texas

Humair Rana, MD

University of Texas Southwestern Medical Center, Dallas, Texas

Bhavin Patel, PharmD, MBA

Informatics Pharmacist, Department of Pharmacy, Parkland Health & Hospital System, Dallas, Texas.

John C. Alexander, MD

Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas


Schedules of Controlled Substances: Rescheduling of hydrocodone combination products from schedule III to schedule II. Fed Regist. 2014; 79(163): 49661-49682.

Available at Accessed February 15, 2016.

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Wastila L, Bishop C: The influence of multiple copy prescription on analgesic utilization. J Pharm Care Pain Symptom Control. 1996; 4: 5-19.

Haynes A, Kleinschmidt K, Forrester M, et al.: A comparison of opioid analgesic exposures reported to poison centers before & after hydrocodone reclassification to schedule II. Clin Toxicol. 2015; 53: 639-777.



How to Cite

Schultz, PharmD, S., C. Chamberlain, PharmD, Psych MA, M. Vulcan, MD, H. Rana, MD, B. Patel, PharmD, MBA, and J. C. Alexander, MD. “Analgesic Utilization before and After Rescheduling of Hydrocodone in a Large Academic Level 1 Trauma Center”. Journal of Opioid Management, vol. 12, no. 2, Mar. 2016, pp. 119-22, doi:10.5055/jom.2016.0323.