Should Hydrocodone be a Schedule 2 Drug?

Hydrocodone as it is currently prescribed in the U.S. is a schedule 3 drug.  The FDA puts rules and regulations on the prescribing of medications that have a significant potential for abuse, diversion or addiction, and the lower the schedule number, the more the restrictions.  Schedule 1 drugs are illegal in the U. S.  They are deemed to have no legitimate medical purpose.  Examples are heroin, LDS, methamphetamine, marijuana (strange but true) etc. Schedule 2 drugs are considered to have legitimate medicinal use, but have a high potential for abuse, diversion and addiction.  They require a written prescription, cannot be called or faxed into a pharmacy, and require monthly prescriptions, i.e. no refills without a new prescription. Examples are oxycodone, morphine, hydromorphone and all of the amphetamine-based stimulants for ADD/ADHD like methylphenidate and Adderall.  Schedule 3 drugs are considered to have a lower but still significant potential for abuse, diversion and addiction. The biggest difference in regulation is that prescriptions for schedule 3 drugs can be called or faxed to a pharmacy by physicians, and refills can be prescribed without getting a fresh prescription.

Currently the FDA is reviewing hydrocodone as to whether to reclassify the combination products containing hydrocodone as a schedule 2 drug, changing from its current status at schedule 3. The arguments for change are primarily based on the accumulating evidence that hydrocodone is widely abused and diverted in the U.S.  The use of hydrocodone as an opioid analgesic has steadily increased in the U.S.  The number of prescriptions of hydrocodone in the U.S. increased by about 50% from 2000 to 2006, and the gross production of hydrocodone more than doubled in that time span. (FDA info).

Non-medical use of hydrocodone has also become extremely prevalent.  Data from the 2011 Monitoring the Future Survey reported that 2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12 graders had used Vicodin non-medically in the last year.  In 2009 the National Survey on Drug Use and Health reported that 9.3% of Americans over age 12 had used hydrocodone non-medically in their lifetime.

So given that hydrocodone is widely abused, that there is a major and growing use both for pain relief and non-medically in the U.S. should hydrocodone be reclassified as a schedule 2 drug?  First let’s list some of the anticipated consequences of reclassification of hydrocodone to schedule 2.

  • Prescriptions for hydrocodone will be harder to obtain for all patients.  To obtain a prescription  a patient will need to come to the physician’s office, get a written prescription, and take it to their pharmacy.
  • More physicians will be reluctant to prescribe hydrocodone.  (see Can’t Find a Doctor to Prescribe Pain Meds?) It will be a process like with oxycodone now.  Physicians will face more frustrated and angry patients wanting prescriptions that have to be done exactly according to strict rules. Extra work, expense, and risk will lead even more physicians to stop chronic pain management.
  • The cost of managing moderate chronic pain will increase.  Managing patients on schedule 2 drugs just takes more office visits, and therefore more money than managing patients on schedule 3 drugs.

I’m sure there will be lots more consequences, intended and unintended consequences, but I predict that reclassification of hydrocodone as a schedule 2 drug will do little to prevent abuse, diversion and addiction, and will make it more difficult for physicians to manage chronic pain and more difficult for patients with legitimate pain to get hydrocodone prescriptions.   We have a mess in this country with prescription drug abuse, but reclassification of hydrocodone will just make the mess more work to deal with, not reduce or eliminate the problem.

6 Responses to Should Hydrocodone be a Schedule 2 Drug?

  1. “classifying as a schedule 2 will only impact those suffering chronic pain” Thats is right my meds cost me 89 cent a month. now it will cost me co pay 20$ a month… that is a big jump. thanks

  2. classifying as a schedule 2 will only impact those suffering chronic pain=abusers will pay more for their street drug purchases and those who illegally sell their prescriptions will get more=legitimate pain patients who have been playing by the rules and know to be careful with this will suffer.

  3. Some of us are dying and in pain. How is this going to help us? Back to the alcohol I guess. No prescription required and takes away the pain. Sure there are bad consequences for both.

    We’re in pain and need to be treated for it. I wouldn’t sale one Vicodin. I need them myself. What’s next they must be given and taken in the presence of a RN?

    Maybe the doctors need to screen better as to who needs them or not. If you are just going to sale them then you shouldn’t be getting them.

    I’m a Veteran. Don’t punish us for your fix!

  4. Another meaningless government action by the disfucntional FDA which does more to prevent progress than make it. This is a paperwork nightmare. It will require constantly writting refills and the use of 10 federal script pads a year, instead of 1 every two years. But they could care less. Now since I have to get my tripcate script out anyway, I might as well write morphine and oxycodone. Just watch the use of these other meds go up. It will not work, but they will not change it back and no one will be punished or fired for starting this bullshit. Only an old, out of practice, academic imbecile could have thought of this.

  5. Dealing with my Hospice patients and their terminal pain issues we use large amounts of class 2 and 3 drugs. We also have a strict disposal protocol of narcotics upon passing. I encourage Hospice staff around the country to abide is close scrutiny of following the use of these medications and proper disposal as to not contribute to unintended use by family or non-family individuals. I don’t know if just changing the class of a medication would make a difference since a new hard copies of prescriptions are require and no refills allows

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