DEA Makes Official Change for Hydrocodone Combination Products to CII

[farmadiazepine]

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perhaps a reality check is in order. Hydrocodone is the most prescribed drug of all classes of drugs in the United States with over 127 million prescriptions issued last year. it is also the most abused drug in the United States. It also has long been misclassified by the government as a less addictive drug thereby promoting it's use over other C-II semisynthetics. ER doctors, PCPS and surgeons all drastically over prescribed this medication for 4 decades leading to rampant drug sharing in the population and 10-100 times the amount prescribed and used in other western populations. Now 97% of all hydrocodone in the world is consumed by our 6% of the world population. This over prescribing has created a gateway drug effect to the more potent drugs (MED per tablet) and long term use of opioids only rarely seen in other countries. Patients are maintained long term on these drugs to avoid withdrawal, not because the medications are very effective for chronic pain. No less than 7 studies have shown patients on high dose chronic opioids when weaned to nothing or very low doses, have the same amount of pain. And high doses lead to overdose and death esp.when used with alcohol or benzos. Given the many docs that don't give a flip and prescribe opioids long term without seeing their patients, this change in hydrocodone status will force most docs to engage in diligent prescribing rather than behaving like drug dealers. Hopefully there will be far fewer opioid scripts in the near future.

Well said

 

[Pharmgrlnxdor]

Is no one else freaking out about how much more work this will be on the pharmacist? I can't imagine how I will get it all done!

 

[txpharmguy]

Not really freaking out, as I personally think the amount of rxs will drop mainly because of the burden it'll place on doctors. Of course, expect an increase in T3 and tramadol

 

[BidingMyTime]

perhaps a reality check is in order. Hydrocodone is the most prescribed drug of all classes of drugs in the United States with over 127 million prescriptions issued last year. it is also the most abused drug in the United States. It also has long been misclassified by the government as a less addictive drug thereby promoting it's use over other C-II semisynthetics. ER doctors, PCPS and surgeons all drastically over prescribed this medication for 4 decades leading to rampant drug sharing in the population and 10-100 times the amount prescribed and used in other western populations. Now 97% of all hydrocodone in the world is consumed by our 6% of the world population. This over prescribing has created a gateway drug effect to the more potent drugs (MED per tablet) and long term use of opioids only rarely seen in other countries. Patients are maintained long term on these drugs to avoid withdrawal, not because the medications are very effective for chronic pain. No less than 7 studies have shown patients on high dose chronic opioids when weaned to nothing or very low doses, have the same amount of pain. And high doses lead to overdose and death esp.when used with alcohol or benzos. Given the many docs that don't give a flip and prescribe opioids long term without seeing their patients, this change in hydrocodone status will force most docs to engage in diligent prescribing rather than behaving like drug dealers. Hopefully there will be far fewer opioid scripts in the near future.

Well, there are plenty of studies that show that pain is quite UNDERtreated in the US as well. The problem is pain is not being APPROPRIATELY treated. Too many primary care doctors are treated chronic pain when they don't understand the best way to treat it. There are several different aspects to this problem....the 1st is doctors who aren't appropriately differentiating between acute and chronic pain (I've seen doctors still in 2014 prescribing fentanyl patches for post-op pain and doctors who don't want to give more than 50mg tramadol BID to patients with permanent pain conditions) , 2nd doctors treating chronic pain the same as they would treat acute pain (chronic pain requiring opiates needs to be treated with around the clock opiates not PRN opiates) , 3rd doctors minimizing acute pain since it will clear on its own (undertreated acute pain has been shown to permanently change pain pathways and lead to chronic pain), 4th doctors (edited to add AND pharmacists) not educating their patients about realistic goals (complete pain removal is usually impossible, the goal is to balance minimizing pain while maximizing daily activities.) 5th doctors who are not trained in pain medicine who are clueless about how to differentiate drug seeking addicts from people with true pain conditions and who do not use any type of reasonable rules in their prescribing--ie random urine checks, not routinely refilling opiates 10 days early every month, not routinely upping the opiate dose every month, pain contracts, etc.) 6th doctors who are clueless about non-opiate methods of treating pain (for the vast majority of people, non-opiate methods should always be used in combination with opiates) ALSO, for clarification, said doctors in the above for brevity's sake, but I refer to any prescribers, and in general ( but certainly not exclusive), it does seem to me that non-physician prescribers are more likely to maltreat pain.

From what I see in my practice, there are many people whose pain is maltreated by doctors, and other people who are clearly addicts who know how to game the system. Frankly, if I had to choose I'd rather let the addicts game the system, then honest people have to live in pain, but fortunately I think a better balance can be struck between the 2, if health care professionals (prescribers primarily, but also pharmacists and everyone else dealing with chronic pain people on a professional level) were better educated (and if the DEA wasn't so overly aggressive with naïve doctors, making other doctors scared to provide any opiates.) Opiates enable many people with chronic pain conditions to hold down jobs & live fulfilling lives....which is FAR better than saying they should just lay on couch all day and suffer rather than take opioids (and yes, I have heard pharmacists actually say that)

There are extremely few cases where hydrocodone/apap is an appropriate solution to chronic pain, so best case scenario is that this change will lead to better pain management (and less addiction) over time....but I'm a bit pessimistic that things will work out that way.