Association of hydrocodone schedule change with opioid prescriptions following surgery.
Approach to Improving Safety
Setting of Care
Various regulatory and policy initiatives are being implemented to encourage more responsible opioid prescribing in the face of the ongoing opioid epidemic. One such federal initiative, implemented by the Drug Enforcement Agency in 2014, was to change hydrocodone to a schedule II agent, which restricted hydrocodone to a 90-day supply that could not be prescribed or refilled by telephone. This study examined the effect of the change on hydrocodone prescribing for patients in Michigan who had undergone elective surgery, using a database that measured opioid prescriptions filled by patients. Implementation of the new regulation was associated with an unexpected increase in the amount of opioids filled initially after surgery. Although prescription refill rates decreased, overall there was no significant difference in the total amount of opioids prescribed within the 30-day postoperative period after the schedule change was implemented. The authors hypothesize that the increased restrictions on hydrocodone prescribing may have resulted in surgeons giving larger initial prescriptions in order to ensure postoperative pain control. The effect of national regulatory initiatives on opioid prescribing remains unclear at present, but recent studies have shown that personalized feedback to prescribers may be effective at improving prescribing.