On Oct. 6, a federal Drug Enforcement Administration decision to restrict access to hydrocodone combination pain relievers, or HCPs, went into effect. Medications such as Lortab, Norco, Vicodin and generic formulations have moved from Schedule III to Schedule II.
The difference between these two categories is huge. A Schedule II drug is considered to have a strong potential for abuse. Such drugs require a written prescription. Doctors can’t call in, fax or send electronic prescriptions to a pharmacy. Each prescription can last for only a month, and no refills are permitted.
A Schedule III drug has less potential for abuse or addiction and includes barbiturates or amphetamines (frequently prescribed for attention deficit disorder). A physician can call in a prescription and allow five refills over six months.
The reason for this sea change in the prescribing rules for HCPs is to reduce abuse. More prescriptions are written for such pain relievers each year than for any other medications. At last count, the total was more than 130 million HCP prescriptions annually.
No doubt that many hydrocodone-containing drugs are diverted to the black market and abused. The hope is that greater restrictions will make it harder for doctors to prescribe such medications and harder for patients to become addicted to them.
The problem with the new rules, however, is that patients in severe pain will have much more difficulty accessing needed medicine.
One reader shared her story: “What is going on with the new and, in my opinion, asinine DEA ruling regarding Schedule II pain relievers? I have been treated for some time now for chronic pain relating to neck and back issues. I deal with pain on a daily basis, and I am prescribed hydrocodone (10 mg four times daily). Often I do not need the four daily doses.
“I elected this form of treatment rather than chase after various forms of surgeries for both neck and back problems when four doctors gave me conflicting recommendations.
“Yesterday I picked up my prescription, which has one refill left, and was advised that I will not only not be able to receive the final refill, but I will now be required to provide an original written prescription on a monthly basis because of the new DEA ruling. Up till now, I would see my doctor four times a year for follow-up and receive a three-month prescription. Each visit cost me $35 and my insurance company $78, for a total of $113 per visit, or $452 per year. Under this new rule, 12 visits will cost $1,355.28, or, for me in particular, $420. That’s a yearly increase of $280. I am retired on a fixed income.
“What about the inconvenience? I will have to make 12 visits to the doctor – plus extra visits to the pharmacy – if the prescription cannot be filled immediately. I am still independent and able to make all these trips. What about those who cannot, and need assistance because of severe, chronic pain?
“This added cost and inconvenience is unconscionable. Just because the DEA cannot figure out how to control the illegal use of these drugs should not be a reason to penalize millions of responsible individuals in serious pain.”
Balancing the needs of patients in pain against the abuse of such drugs is a dilemma. The new rules may bring additional suffering for those with legitimate need for narcotic pain medicine.