Statistical significance was indicated by a P value < 0.05. This test was done for each of the individual medications as well as the overall total. Statistical analysis using the Poisson test of means was used to compare the number of prescriptions as well as the quantity of medication dispensed between these time periods. Pharmaceutical data from July 2014 through September 2014 before the rescheduling were then compared to data from November 2014 through January 2015 after rescheduling to evaluate trends in prescription drug usage. Prescription information on oral morphine sulfate was obtained as a control. We also obtained prescription information on several schedule III narcotic medications, including tramadol, codeine/acetaminophen 30/300 mg (Tylenol #3), and codeine/acetaminophen 60/300 mg (Tylenol #4). Our study focused on the most commonly prescribed hydrocodone combination products, namely the hydrocodone/acetaminophen 5/325 mg (Norco 5/325) and 10/325 mg (Norco 10/325) formulations. Our study hypothesized that rescheduling of hydrocodone combination products would lead to a decrease in prescriptions for hydrocodone combination products however, this would be offset by increases in other schedule III narcotic prescriptions such as tramadol and codeine/acetaminophen formulations.įourteen Baylor Scott & White pharmacies encompassing a 200-mile radius in Central Texas were queried for narcotic prescription information from July 2014 through January 2015. Despite the almost universal acknowledgment of the growing prescription drug abuse epidemic in the US, many health care providers worried that changing hydrocodone combination products would only result in increased administrative tasks without a substantial decrease in overall opiate abuse and overdose ( 2). Of these combinations, hydrocodone/acetaminophen products are by far the most popular formulation and were the most frequently prescribed drug from 2007 to 2011 ( 1). Currently, there are at least 93 formulations of hydrocodone in combination with acetaminophen or ibuprofen marketed as either analgesics or cough suppressants in the United States. In an attempt to reduce misuse, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule III to schedule II on October 6, 2014, resulting in significant changes in the prescribing, handling, and distribution of these drugs. In 2011, the Centers for Disease Control and Prevention declared overdose from prescription narcotics to be an epidemic in the United States ( 1). Additionally, there was no significant reduction in total pain medication prescribed after converting all agents to morphine equivalents. While the rescheduling of hydrocodone combination products resulted in a reduced number of prescriptions and the total quantity dispensed of both the hydrocodone/acetaminophen 5/325 mg (Norco 5/325) and 10/325 mg (Norco 10/325) formulations, this was offset by a dramatic increase in alternative narcotic analgesics such as tramadol, codeine/acetaminophen 30/300 mg (Tylenol #3), and codeine/acetaminophen 60/300 mg (Tylenol #4), which do not have schedule II requirements. Fourteen Baylor Scott & White pharmacies encompassing a 200-mile radius in Central Texas were queried for prescription information on hydrocodone/acetaminophen, morphine, codeine/acetaminophen, and tramadol before and after the rescheduling to evaluate trends in prescription drug usage. In an effort to combat this ever-growing problem, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule III to schedule II on October 6, 2014. Nationally, health care providers wrote 259 million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult ( 1).
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