Due to continued pressures related to prescription drug abuse, the DEA and local state organizations (Boards of Pharmacy, Boards of Medicine) are considering the reclassification of Hydrocodone (and combination products such as Vicodin, Norco, etc) as a Schedule 2 medication.
Codeine and tramadol. The more things change, the more they stay the same! Remember Emprin #3 and 4. Watch for codeine making a come back. Tramadol is still not a CS under federal law.
It depends upon your perspective. Pain Mgt Services will continue to prescribe oxycodone, morphine sulfate, hydromorphone, and anticonvulsants for peripherpheral neuropathy. Post-operative care after short procedures will likely remain as hydromorphone, oxycodone, and hydrocodone/APAP.
Hi Michelle. The move of hydrocodone to Schedule II isn't just being considered, it is going to happen effective October 6, 2014. (DEA Final Rule published August 22, 2014 - http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-19922.pdf ). And Tramadol was made a Schedule IV drug by DEA effective August 18, 2014 (http://www.gpo.gov/fdsys/pkg/FR-2014-07-02/pdf/2014-15548.pdf ). For prescribers with Schedule II privileges, I would guess that not much will change, but I agree with Barry that codeine may well make a comeback.
Considering efficacy, safety,and the increased incidence of side effects using codeine as an analgesic compared to other opioids, the return of increased codeine prescribing could result in greater harm thean good.
http://www.cmaj.ca/content/183/3/349.1.full
http://www.guideline.gov/content.aspx?id=15702&search=codeine
I agree Alan - For years medication safety committees worked hard to decrease codeine prescribing...and the literature details the issues of questionable effectiveness, variable metabolism related to genetics, as well as having a negative side-effect profile. Why does the US consume so many pain medications compared to the rest of the world.........
I agree with the other contributors that the remaining Schedule III opioids will increase in popularity as hydrocodone products become more restricted and more of a hassle to prescribe and refill. Likely candidates are tramadol and codeine. I think there will also be a resurgence of non-opioid analgesics, especially NSAIDS, among those who had previously been prescribing hydrocodone products. Practitioners who already use Schedule II opioids such as morphine and oxycodone will continue to use those, so for those prescribers, the move of hydrocodone to Schedule II will not have much of an impact. The main impact will be on patients who want to continue to receive hydrocodone products, because prescriptions will be restricted to a maximum of 90 days between visits with the prescriber (instead of the previous availability of prescriptions with refills out to a maximum of 6 months).
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