The Reclassification of Hyrocodone to a Schedule II Drug... Dire Mistake

Ever had your teeth pulled and received some medicine for it? Had a broken foot? Gave birth? You probably received Hydrocodone.. Not so easy anymore

Hydrocodone is an analgesic pain reliever known to help people with moderate to severe pain. It is given to patients who suffer chronic pain to take daily as a regimen, and given to people for acute situations if their tooth was pulled, a broken foot, or some kind of ailment that called for a potent pain medication stronger than the Tylenol, which seems like a sugar pill in these situations.

Hydrocodone, known as Vicodin, Norco, Lortab, and some other names, had always been a Schedule III Drug by the FDA, meaning if someone were prescribed the medication, they could receive a prescription that could last them up to six months, they only had to see the doctor twice a year, and this medication could be called in. However, in October of 2014 this medication was made into a Schedule II drug.

The FDA had justifiable reasons to worry about hydrocodone; it is an opioid which is addicting, and prescription painkiller abuse has been a major problem in this country for a long time. It was fairly easy to get a prescription and then sell it to someone. This led to readily available medication on the streets that one may build a tolerance to quickly, resulting in a need to take more and more, which can be fatal. Hydrocodone contains Tylenol (Acetomenophin) yet after a while, though ones liver is being destroyed by it, they may not feel nauseous as when they first tried the medication. This can lead to overdose. Due to the readily available medication so prominent on the street causing so many deaths, the FDA had growing concerns that this medication was being over prescribed when other medications could help, and wanted to put it in a more regulated class of drugs so that doctors would not prescribe as easily. Studies have shown that Tylenol 3 with Codeine yielded just as well of satisfaction rates for acute settings as hydrocodone, and it's a much less potent medication that is a lot harder to become addicted to. This made the FDA believe there should be a change in prescribing habits, so they changed Hydrocodone to a Schedule II. As a Schedule II, Hydrocodone can no longer have refills or be called in. This means that every month someone will have to go to the doctor's office and receive a written prescription for one month, and be required to go again in another month. The cycle will continue and continue.

Problems with this

We have already seen several problems affiliated with this change in classification. The primary goal was to curtail drug abuse by limiting the availability of the drug. But by doing so, abusers have switched to harder drugs, including heroin. Studies show that heroin usage has increased drastically. This poses even greater dangers and fears for continues abuse and overdose. Heroin is cheap, and an addiction someone may be able to afford if they know their limits. Generally though, people don't know their limits. 

Heroin usage has increased by over 24%. Such an increase is alarmingly worrisome, but it will stay this way shall Hydrocodone become much harder for patients to get.

Secondly, there are acute situations in which Tylenol 3 with Codeine (30mg Codeine) or Tylenol 4 with Codeine (60mg Codeine) may just not be the right medication. This is especially true with people who are suffering kidney stones, appendix removals, and labor. Often, doctors are no longer giving Hydrocodone for acute situations known to be more painful in general; situations in which they would generally prescribe more hydrocodone because they see how painful it can be. So patients are not always receiving adequate care.

THIS does not just occur to acute situations. Chronic pain sufferers are now often being changed medications, primarily to Tylenol 3 and 4 instead of their Hydrocodone, and are suffering tremendous pain in light of it. Though they may have been on Hydrocodone for years, doctors are iffy about prescribing it because Schedule II drugs come with a lot more auditing... But some doctors are so paranoid they are making patients suffer.

The fact that someone may no longer get a refill and have to see a doctor monthly can be very hard for people who live in areas where access to the local doctor is rather far away, or may cause them to have to miss work. Patient who have had this medication for years and years, knowing its pros and cons, and having a full relationship and understanding with their doctor with a mutual agreement for a need for this medication are now having to see the doctor monthly, repeating themselves, and getting the same medication they had received before.

The implementation of Schedule II also generally infers a recommendation to have a specialist prescribe. So many primary doctors are not prescribing Hydrocodone at all, and patients are having to go to Pain Management for this. While not bad in theory, Pain Management clinics are often very rare in rural areas and there is a general shortage already nationwide. The are already becoming full and no longer accepting new patients as the number of patients has skyrocketed since primary docs are sending them off. This is yet affecting patients in a negative way.

So I do see pros. Studies have shown Tylenol 3 in acute settings at the ER often yields the same results as Hydrocodone, meaning we have unnecessarily been giving non essential medication out rampantly. However, the FDA should have simply made this noted to the hospitals and doctors as an urgent notice that prescriptions for Hydrocodone may be unnecessary. The FDA constantly sends out emergency advisories to hospitals and doctors if there is a recall, shortage, or dire hypothetical situations that may call for unforeseeable changes. So the FDA should have spread the news to every hospital and medical practitioner nationwide and noted a general warning for abuse potential and possibility of patients faking an injury to obtain medication to sell. 

But that is all they should have done. They should not have made it a Schedule II drug. 
If someone wants to abuse a drug or a class of drugs, they will do so and find a way, legal or not. To think that someone who is selling their script of Hydrocodone and has been for months upon years is going to get this medication no longer prescribed is a folly. Those who have been prescribed for the long-term are usually those who are the ones selling and they will generally keep their prescriptions, though they may have to go to Pain Management or make some changes. Making Hydrocodone a Schedule II will make room for incentive for these dealers to raise their prices which will make abusers just turn to heroin or try more dangerous opiate/opioids.

UNLIKE marijuana that really doesn't have a substitute, one could substitute a hydrocodone for an oxycodone, morphine sulfate, dialoded, methadone, oxymorphone, hydromorphone, fentanyl and a huge list of other medications... or heroin. With fentanyl and heroin being widespread and cheap, I can easily see people switch their medications just to save money, but switch it to a more dangerous medication.

I can also see abusers faking more ailments, inflicting self-harm, or doing something else dangerous to try to score a script of hydrocodone.

Some dental patients may get Hydrocodone but few in quantity and want more. Some patients who have had surgical procedures may feel the same. The doctor can't just call it in anymore. They would have the go out of their way to pick it up, drop it off, wait, and hope that they received enough. They can't gamble with it anymore. 

Hydrocodone is in the same class as Oxycodone and a host of other stronger opiate/opioids. Doctors may decide to put patients on one of these more potent medications as a change since they are just as liable as with Hydrocodone, and this could stir some conflict.

Do you see how this can go wrong?!!

YES, we have a prescription painkiller abuse problem that has caused lethal consequences. YES, patients, especially in acute settings, have often had just as effective medications not sought out by doctors until now. YES, people aren't going to be prescribed something nearly as much that they do not need. YES, it is going to be harder for someone to get this from the doctor for a fake ailment. It is very good that Tylenol 3 with Codeine and Tylenol 4 with Codeine are now prescribed more and availability for Hydrocodone to be bought on the streets illegally for abuse is lower. However, many patients now have to suffer and it is unfair. Availability which opens the door to abuse may be curtailed, but people who have been on this medication for legitimate purposes for years may now be switched to a weaker medication that does nothing to help them. People will be inconvenienced with getting these meds, even if they have had it forever. Patient John Doe has been on Hydrocodone 10/325, qty. 180 for 5 years and hasn't needed to up his dosage to a new med. If he did, he would just go to the doctor. John Doe lives in a rural town in the midwest, about 45 minutes from his doctor. Now he has to see a Pain Management Doctor which is even further. He must take off work once a month for this, frustrating him as he uses vacations. Nothing has changed in his health. His need for it is documented and legitimate. But now he has to go through these obstacles. Acute situations known to need a potent painkiller may not be treated with such. Having kidney stones? Be careful, your doctor may either not give you Hydrocodone or they will limit is severely. Was yours limited, you went to the ER, and now you need more? Sorry, you're going to have to go to the ER again. Even if you're in pain, YOU have to go. 

Unlike Adderral where there are exceptions to the rule, Hydrocodone is faced with the toughest of schedule II restrictions. Even as a Schedule II, popular medication known as Adderral may be called in by the doctor for a full month's worth of medication. Why can't Hydrocodone get this status?

An abuser is going to abuse regardless. By limiting availability we are doing some good, and we have opened doors to a medication severely underutilized to take place of such potent Hydrocodone, but the need for Hydrocodone in acute and chronic pain situations is huge and making it so restricted is harming more than it is helping. From inconveniencing the rural worker, to costing more, to being under treated, making Hydrocodone a Schedule II controlled substance was a huge mistake that will cause us to notice the harm soon. The FDA and DEA need to get out of our doctor's offices and let laissez faire do what it is known to do. Healthcare needs reform, but access to healthcare does, not American healthcare itself which is better than any health care system in the world.