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. 2018 May;66(5):945-953.
doi: 10.1111/jgs.15332. Epub 2018 Apr 14.

Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products

Yong-Fang Kuo  1   2   3   4 , Mukaila A Raji  1   2   3 , Victor Liaw  5 , Jacques Baillargeon  3   4 , James S Goodwin  1   2   3   4
Affiliations

Opioid Prescriptions in Older Medicare Beneficiaries After the 2014 Federal Rescheduling of Hydrocodone Products

Yong-Fang Kuo et al. J Am Geriatr Soc. 2018 May.

Abstract

Objectives: To examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults, who are among the largest consumers of prescription opioids in the United States.

Design: Retrospective cohort study.

Setting: United States.

Participants: A 20% sample of Medicare Part D beneficiaries aged 65 and older from 2013 through 2015 (> 2,500,000 beneficiaries each year) MEASUREMENTS: From January 2013 to December 2015, we calculated the monthly prevalence of opioid prescriptions and the prevalence of individuals who received prescriptions for a 90-day supply or longer (prolonged), as well as hospitalizations related to opioid toxicity in 2013 and 2015.

Results: From 2013 to 2015, the proportion of Medicare Part D enrollees who received a hydrocodone prescription in a year decreased from 21.9% to 18.3%. Monthly rates for hydrocodone prescriptions declined significantly in 2014. The risk of receiving prolonged opioid prescriptions decreased by approximately 7% in the multivariable analyses comparing 2015 to 2013 (prevalence ratio=0.93, 95% confidence interval (CI)=0.93-0.94). Medicare enrollees with an original entitlement because of disability or with Medicaid eligibility had smaller decreases in prolonged prescriptions and, unexpectedly, small increases in high-dose prescriptions. Opioid-related hospitalizations did not change significantly, but opioid-related hospitalizations without a documented opioid prescription increased (odds ratio=1.24, 95% CI=1.03-1.50).

Conclusion: The 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. The unexpected increase in opioid-related hospitalizations without documented opioid prescriptions may represent an increase in illegal use.

Keywords: Medicare; Opioid; Overdose; Regulation.

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Conflict of interest statement

Conflict of Interest: The authors have no financial or personal conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Monthly opioid prescriptions according to type of opioid from January 2013 to December 2015. Points represent the rate of opioid supply for hydrocodone, schedule II drugs excluding hydrocodone, schedule III drugs excluding hydrocodone, tramadol, and any opioid supply during the month.
Figure 2
Figure 2
Rates of prescriptions for prolonged opioid use before and after hydrocodone rescheduling in the 50 U.S. states in (A) 2013 and (B) 2015 based on quintiles of 2013 rates. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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