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Clin Toxicol (Phila) ; 57(11): 1064-1072, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30789065


Background: From 1999 to 2010, the annual number of US deaths due to opioid overdose increased about 400% as the number of opioids prescribed yearly also increased by approximately 400%. Over this period, hydrocodone combination products drove the opioid epidemic, as they became the most frequently prescribed medication in the United States. Our objective was to determine if the Drug Enforcement Administration's (DEA) 2014 policy change - which made it more difficult to prescribe hydrocodone combination products by moving them from Schedule III to Schedule II - reduced the total amount of opioid prescriptions as intended. Methods: We conducted a longitudinal analysis of the 10 most populous US states, beginning at the time each state began collecting data on opioid prescribing, and concluding at the end of 2016. The exposure was the DEA-mandated October 6, 2014 hydrocodone combination product schedule change. Results: After the DEA's schedule change for hydrocodone combination products, the total number of opioids prescribed each year per 100 people did not substantially change in California, Florida, Michigan, or New York. Although prescription rates dropped for hydrocodone combination products (CA: 43.2, 35.0; MI: 66.8, 55.6; NY: 20.8, 15.1), the reduction was commensurately counteracted by increased rates for tramadol (CA: 0.2, 9.9; MI: 0.1, 17.3; NY: 0.0, 7.6) and oxycodone (CA: 8.7, 9.7; MI: 10.3, 11.9; NY: 18.1, 18.8). Surprisingly, the other 6 states assessed had no viable mechanism in place for assessing state-wide opioid prescription totals, routinely expunged collected data, or only instituted a reporting mechanism toward the end of our study. Conclusion: Total opioid prescriptions were relatively unchanged following the 2014 DEA-mandated schedule change, however, physicians did change their prescribing habits by substituting tramadol for hydrocodone combination products. This substitution of similar medications for hydrocodone suggests alternative approaches are needed to reduce total US opioid prescription rates. Additionally, the current lack of standardized prescription reporting by states makes detailed opioid prescription analysis alarmingly difficult and insufficient to guide policy or monitor the impact of policy changes.

Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Hidrocodona , Política de Saúde , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição , Tramadol , Estados Unidos , United States Office of National Drug Control Policy
Pharmacoepidemiol Drug Saf ; 28(1): 70-79, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30187574


PURPOSE: In October 2014, the US Drug Enforcement Agency moved hydrocodone combination products (HCPs) from schedule III to II of the Controlled Substances Act, further restricting their access. The aim of the study is to quantify the effect of hydrocodone's "upscheduling" on the use of opioid and nonopioid analgesics among chronic users. METHODS: Using IQVIA LRx LifeLink anonymized pharmacy data 2013 to 2015, we performed interrupted time series analysis and group-based trajectory modeling to characterize the effect of rescheduling on 316 731 long-term hydrocodone users. Main measures were the number of prescriptions, patients, tablets, and morphine milligram equivalents of opioids and nonopioid analgesics pre and post the policy change. We used logistic regression to assess the relationship between sociodemographic characteristics and these measures. RESULTS: The schedule change was associated with significant declines in opioid prescriptions (20.9%, from 421 798 to 333 627) and the number of patients using opioids (11.4%, from 307 974 to 272 804). Majority of hydrocodone users filled prescriptions for nonopioid analgesics with some declines in the number of users after the schedule change (5.2%, from 181 085 to 171 758). Based on group-based trajectory models, majority of patients continued to fill HCP prescriptions consistently after the policy change, while 15.4% showed large declines in HCP use, accounting for two-thirds of the decrease in opioid volume. There was no evidence that the policy change was associated with significant increases in the use of alternative analgesics. CONCLUSIONS: The upscheduling of hydrocodone led to reductions in opioid use, which were concentrated among a small subset of chronic hydrocodone users, without evidence of commensurate increases in the use of alternative pharmacologic pain treatments.

Dor Crônica/tratamento farmacológico , Substâncias Controladas , Uso de Medicamentos/estatística & dados numéricos , Hidrocodona/uso terapêutico , United States Office of National Drug Control Policy/legislação & jurisprudência , Adulto , Idoso , Analgésicos não Narcóticos/uso terapêutico , Estudos de Coortes , Combinação de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/tendências , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Políticas , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estados Unidos , United States Office of National Drug Control Policy/estatística & dados numéricos