Background:
According to the most recent data released by the Centers for Disease Control, forty-six Americans die every day due to narcotic prescription drug overdose. Nationally, health care providers wrote two hundred and fifty-nine million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult. In an attempt to reduce misuse, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule three to schedule two on October 6, 2014. These medications now require a triplicate prescription, which has increased restrictions on prescribing and dispensing practices. Although many praised the increased regulation, our project sought to determine whether the new legislation is effective in decreasing total narcotics prescribed or if it simply changed the type of pain medication prescribed.
Methods:
Fourteen Baylor Scott & White pharmacies encompassing a two-hundred-mile radius of central Texas were queried for prescription information on hydrocodone/acetaminophen, morphine, codeine/acetaminophen, and tramadol. Pharmaceutical data from July 2014 through September 2014 before the rescheduling was then compared to data from November 2014 through January 2015 to evaluate trends in prescription drug usage.
Results:
Analysis revealed a 42% percent reduction in hydrocodone/acetaminophen 5/325mg, 14% reduction in hydrocodone/acetaminophen 10/325mg and 7% reduction in oral morphine sulfate after federal rescheduling of hydrocodone combination productions. During the same period, however, there was a 583% increase in codeine/acetaminophen 30/325mg, 827% increase in codeine/acetaminophen 60/325mg, and 9% increase in tramadol 50mg. When all narcotic prescriptions were converted to morphine equivalents, there was only a 3% reduction in total amount of pain medications prescribed after rescheduling.
Conclusions:
While the rescheduling of hydrocodone combination products resulted in a reduced number of prescriptions for both the 5/325mg and 10/325mg formulation, this was offset by a dramatic increase in alternate narcotic analgesics such as codeine/acetaminophen and tramadol which do not require a triplicate prescription. Additionally, there was no significant reduction in total pain medication prescribed after converting all agents to morphine equivalents. Our study illustrates an important and evolving trend trend in narcotic prescription habits after federal rescheduling of hydrocodone combination products and highlights the need for further research on effective means for controlling prescription drug misuse in the United States.