The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System

Abstract

<h3>Background:</h3> Hydrocodone-combination analgesics were changed from Schedule III to Schedule II to discourage the prescribing of these analgesics. Our primary aim was to explore the effect of hydrocodone rescheduling on opioid prescribing within an urban safety-net health care system. <h3>Methods and Design:</h3> Data were extracted from electronic records of ambulatory patients (N = 82,432 patients) prescribed hydrocodone-combination, codeine-combination, or tramadol opioid analgesics (N = 200,675 prescriptions) between October 6, 2013 and October 6, 2015. Data analyses modeled predicted probabilities of hydrocodone-combination prescriptions (HCPs). Chronic opioid therapy (COT) for chronic pain (ie, ≥3 opioid prescriptions/12 months) and morphine milligram equivalency (MME) levels were also examined. <h3>Results:</h3> The probability of providers writing HCPs decreased significantly from pre- to postrescheduling (0.525 vs 0.158, respectively, <i>P</i> &lt; .0001). However, this coincided with large probability increases in codeine-combination (0.064 vs 0.269) and tramadol prescriptions (0.412 vs 0.573). The probability of HCPs varied across physician specialty (<i>P</i> &lt; .0001), patient diagnoses (<i>P</i> &lt; .0001), COT versus non-COT patients (<i>P</i> &lt; .0001), and patient characteristics (sex, race/ethnicity, and age; <i>P</i> &lt; .05). COT patients received significantly more opioid prescriptions in the postrescheduling period (<i>M</i> = 4.81 vs <i>M</i> = 4.27; <i>P</i> &lt; .0001). Patients on &lt;20 MME/day increased slightly from pre- to postrescheduling (<i>P</i> &lt; .0001). <h3>Discussion:</h3> Significant declines in HCPs occurred after rescheduling; however, one third of patients prescribed opioids remained on doses ≥20 MME/day. Codeine- and tramadol-prescription probabilities increased significantly and providers may have an increased perception of safety about these medications. Physicians and health care systems must reduce their overreliance on opioids in treating pain, especially chronic pain, as all opioids incur some level of risk.