Should We Make Vicodin Harder to Get? (Updated October 24, 2013)

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Originally posted June 18, 2013:

We have a problem in the U.S. Vicodin (hydrocodone/acetaminophen) is the number one drug prescribed for any reason in this country. Most folks are shocked to hear that. Should we make it harder to get and if so, how?

This has been a discussion for years that heated up in January 2013 when the FDA voted in favor of reclassifying hydrocodone-containing drugs (Vicodin, Norco, Lortab) from schedule III to schedule II drugs.

Ok, so what does that really change? Rescheduling from schedule III to schedule II means you cannot receive refills of this drug without a new triplicate prescription written out by your doctor. Some schedule II drugs you may know include Oxycontin, Dilaudid, morphine, and fentanyl (Duragesic) patches.

There is no question a prescription for a schedule II drug is harder to get. Electronic prescribing, done by most physicians now, is not allowed for schedule II drugs so you have to visit your doc to get an actual triplicate prescription. Every thirty days.

Schedule II drugs are tracked more carefully, so if multiple doctors are prescribing it or patients are refilling them at different pharmacies we will know this. Again, refills are not allowed with schedule II drug prescriptions so you get thirty days at a time. Trust me, this is a hassle for patients, pharmacists, and physicians.

Will rescheduling Vicodin curb abuse? Nobody really knows. Many doctors already shy away from prescribing schedule II drugs because they feel the burden of refilling triplicate prescriptions is too much to handle in their practices. Maybe the burden of making hydrocodone a schedule II drug will help us appreciate how potent this medication is, so we take it more seriously. The abuse and misuse of these medications in this country cannot be ignored and I wonder if this kind of intervention will be effective in curbing this problem.

Your move.

Dr O.

Updated October 24, 2013:

The FDA has just made the recommendation to reclassify hydrocodone combination painkillers from schedule III to schedule II.

What does this mean for you? You will be able to get up to a 90-day supply at one time, but you will need to see their prescriber and bring a physical prescription into the pharmacy for each refill. This is half the current supply you can get without a new prescription—at the moment you can refill a prescription up to five times in six months without revisiting your healthcare provider.

The change will also affect who is allowed to prescribe hydrocodone combinations in some states, and how those drugs are stored and tracked in pharmacies.

The FDA’s decision follows a recommendation from an advisory panel in January, and there are a few more steps before the change becomes part of the law. The FDA will submit an official recommendation by December, and changes will not take effect until some time in 2014.

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