Effects of Rescheduling Hydrocodone on Opioid Prescribing in Ohio

Abstract

Background: We quantified opioid prescribing after the 2014 rescheduling of hydrocodone from schedule III to II in the United States using a state-wide prescription database and studied trends three years before and after the policy change, focusing on certain specialties.

Methods: We used Ohio's state prescription drug monitoring program database, which includes all filled schedule II and III prescriptions regardless of payer or pharmacy, to conduct an interrupted time series analysis of the nine most prescribed opioids: hydrocodone, oxycodone, tramadol, codeine, and others. We analyzed hydrocodone prescribing trends for the physician specialties of internal medicine, anesthesiology, and emergency medicine. We evaluated trends 37 months before and after the rescheduling change.

Results: Rescheduling was associated with a hydrocodone level change of -26,358 (95% confidence interval [CI] = -36,700 to -16,016) prescriptions (-5.8%) and an additional decrease in prescriptions of -1,568 (95% CI = -2,296 to -839) per month (-0.8%). Codeine prescribing temporarily increased, at a level change of 6,304 (95% CI = 3,003 to 9,606) prescriptions (18.5%), indicating a substitution effect. Hydrocodone prescriptions by specialty were associated with a level change of -805 (95% CI = -1,280 to -330) prescriptions (-8.5%) for anesthesiologists and a level change of -14,619 (95% CI = -23,710 to -5,528) prescriptions (-10.2%) for internists. There was no effect on prescriptions by emergency physicians.

Conclusions: The 2014 federal rescheduling of hydrocodone was associated with declines in hydrocodone prescriptions in Ohio beyond what had already been occurring, and hydrocodone may have been briefly substituted with codeine. These results indicate that rescheduling did have a lasting effect but affected prescribing specialties variably.

Keywords: Hydrocodone; Ohio; Opioid; Opioid Prescription; Prescribing; Rescheduling.

Figure 1

The overall change in monthly hydrocodone prescription rates by all physician specialties before and after the rescheduling change in October 2014.

Figure 2

The overall change in monthly prescription rates by all physician specialties for different opioids. a, Oxycodone monthly prescription rates were increasing by 298.7 (0.1%) per month before the schedule change. There was a nonsignificant level change of 18,729.2 (6.9%) additional prescriptions, followed by an additional drop of –2,273.5 (–0.8%) prescriptions per month. b, Codeine monthly prescriptions were decreasing by –283.4 (–0.8%) per month before the schedule change. There was a significant level change of 6,304.3 (18.5%) additional prescriptions, followed by a nonsignificant drop of –33.7 (–0.2%) prescriptions per month. c, Tramadol monthly prescriptions were increasing by 706.7 (0.4%) prescriptions per month before the schedule change. There was no significant level change, followed by a drop of –1,963.3 (–1.3%) prescriptions per month. d, Monthly prescription rates for a composite of hydromorphone, meperidine, methadone, morphine, and oxymorphone were decreasing by –219.8 (–0.4%) prescriptions per month before the schedule change. There was no significant level change, followed by a nonsignificant additional decrease of 134.2 (–0.4%) prescriptions per month.

Figure 3

The overall change in monthly prescription rates of hydrocodone by physician specialties of anesthesiology, emergency medicine, and internal medicine. a, Monthly hydrocodone prescription rates in anesthesiology showed a significant level change of –804.9 (–8.5%) prescriptions. b, Monthly hydrocodone prescription rates in emergency medicine showed no statistically significant effect on prescriptions. c, Monthly hydrocodone prescription rates in internal medicine showed a significant level change of –14,618.9 (–10.2%) prescriptions.