June 18, 2012 1:10 pm Dr. Webster Leave a Comment (Edit)
The U.S. Senate has signed legislation applying the same rules to all hydrocodone products that apply to other strong analgesics. If the president signs on, drugs that combine hydrocodone with acetaminophen or other products will move from Schedule III to the more restrictive Schedule II under the Controlled Substances Act. Voices are rising in protest, including from pharmacist groups and patient advocates. Their concerns have merit, but perhaps it is time to put patient safety first.
Hydrocodone is the No. 1 prescribed drug in America, a staple for emergency-room injuries, post-operative pain and dental procedures. Yet approximately one in 10 high school seniorshas abused hydrocodone during the past year, according to the National Institutes of Health. Hydrocodone is the most abused prescription drug in Utah and many other areas of the country. Recreational drug users who participate in investigations of the abuse potential of opioid-like formulations cite hydrocodone as their drug of choice. It is cheap and, most importantly, abundantly available.
This easy access for nonmedical purposes has cost our society billions of dollars in substance-abuse treatment and human tragedies, including deaths. Rescheduling hydrocodone from Schedule III to Schedule II would toughen the process of obtaining, refilling or forging hydrocodone prescriptions.
Yet if this law is passed, it will have untoward consequences as well. Some honest patients will find it more difficult to find a physician to prescribe them appropriate amounts of the medication because of the hassle and perceived risk. Schedule III medications can be called in to a pharmacy, but Schedule II medications cannot, thus requiring patients to be seen for refills at least monthly. Such a requirement could be difficult and costly for some elderly or disabled patients, for those in rural or underserved areas and those who are uninsured.
These concerns are grave. However, the primary concern of most physicians is and should be patient and public safety. Misuse of these medications by millions of youth and others is partly due to easy access. If the new law persuades responsible patients to store their medications securely, fewer will be taken from medicine cabinets for nonmedical purposes, and tragedies may be avoided.
We cannot know now what impact the new law would have but can hope that, on balance, it brings more benefit than detriment. One way to ensure that the rescheduling achieves its intended purpose is for all of us to insist that Congress measure the impact of the law on patient and public safety, including access to care. Contact your senator today.
Lynn Webster, MD
@LynnRWebsterMD
www.facebook.com/lynnwebstermd
Filed Under: Pain Medication Abuse