Category: Federal Forum Posters
Purpose: Hydrocodone/acetaminophen was the most prescribed drug for 5 consecutive years, from 2007 to 2011, and is directly correlated to the increase in drug overdose deaths. To address this crisis, hydrocodone combination products were rescheduled by the Drug Enforcement Administration (DEA)from a Schedule III to Schedule II on October 6, 2014. The purpose of this research is to evaluate the impact of rescheduling hydrocodone/acetaminophen on prescribing patterns, chronic pain control, and alternative pain management strategies in the primary care setting.
Methods: This study was a retrospective, electronic chart review of patients prescribed hydrocodone/acetaminophen from April 6, 2014 to October 6, 2014. Patients were included if they were prescribed hydrocodone/acetaminophen by a primary care provider (PCP) for at least 90 days and had PCP documentation of chronic pain within 6 months prior to the rescheduling date of October 6, 2014. Patients were excluded if they received chronic opioid therapy for cancer-associated, palliative, or end-of-life pain therapy. They were also excluded if they had a diagnosis of opioid use disorder (OUD) and prescribed buprenorphine/naloxone or methadone. The primary endpoints include the number of patients on hydrocodone/acetaminophen maintained, discontinued, or tapered to a lower dose at 1 month and 6 months after the rescheduling date. In those maintained, discontinued, or tapered to a lower dose, the number of patients initiated on non-opioid and/or non-pharmacologic therapy were evaluated. At the same time frame, secondary endpoints included the change in percentage of patients on opioids, non-opioids, and non-pharmacologic therapy, as well as the change in number of opioids, non-opioids, and non-pharmacologic therapies utilized. The final secondary endpoint evaluated the average change in numeric rating scale (NRS) pain scores pre-and post-scheduling change.
Results: The rescheduling of hydrocodone/acetaminophen resulted in a reduced number of patients maintained on the same regimen, and an increased number of patients discontinued off or tapered to a lower dose of hydrocodone/acetaminophen. The percentage of patients initiated on non-opioid and non-pharmacologic therapy increased overtime in all three groups (maintained, discontinued, and tapered). The percentage of patients prescribed opioids and non-opioids decreased by 12.7% and 8.4%, respectively. The percentage of patients who utilized non-pharmacologic therapy decreased by 12.7%. There was no significant difference in pain control pre- and post-rescheduling as the average numeric rating scale pain score documented at the primary care appointment before and after the rescheduling date was 5.0 and 4.6, respectively (p=0.3158).
Conclusion: This study demonstrated that there is a correlation between the rescheduling of hydrocodone/acetaminophen and prescribing patterns, the use of opioids, non-opioids, and non-pharmacologic therapy decreased post-scheduling change, and there was no difference in pain control pre- and post-scheduling change.
Emily Kalusetsky– PGY2 Health-System Administration Pharmacy Resident, Jesse Brown VA Medical Center, Chicago, IL