It is all about harm reduction, and we have reached the tipping point where something needs to happen to bring about more responsible prescribing by physicians. The fact that hydrocodone can be refilled for years without ever the patient having to be seen by a physician is a tragedy. There are many reasons to make hydrocodone a schedule II drug regardless of the protestations of those that find free wheeling use of the drug convenient or physicians that find it easy to prescribe.
1. There is no evidence hydrocodone is any less addictive or potent than Schedule II opioids.
2. There is more hydrocodone prescribed in the US than any other drug in any class- 136,000,000 prescriptions a year. It is the most prescribed drug in the country by far, and the US uses well over 90% of all hydrocodone in the entire world. This is highly suggestive the ease of prescribing has resulted in such massive overuse.
3. Physicians have prescribed the drug in ways that are if not substandard care, are overt malpractice, without repercussions for decades. Surgeons will prescribe a one month supply with a refill, enabling patients to acquire large quantities of the drug unnecessarily and also encourage use of the drug through over prescribing. Such high dose use around the time of surgery leads to long term dependence on the drug, substance abuse, and addiction in many. PCPs call in refills without a thought. NPs prescribe it by the truck load as if it were candy.
4. The refillable nature of the drug leads to drug diversion. It is way too easy for a nurse in a clinic to call in their own supply or even the public to call in their own supply of the drug.
It is time to put a halt to the prescribing of a potent opioid narcotic for every bruise, bump, and scrape. It is time for surgeons to stop creating chronic pain patients through injudicious prescribing. It is time for patients to grow up and accept a little pain....life is not pain free, and everyone in the rest of the world with the exception of the US patients seems to know this and accept it.