Has the rescheduling of hydrocodone changed ED prescribing practices?

Area of Science:

• Pharmacology
• Public Health
• Emergency Medicine

Background:

• Hydrocodone-containing products (HCPs) were previously classified as Schedule III medications.
• Changes in drug scheduling regulations aim to impact prescribing patterns and medication misuse.
• Emergency departments (EDs) are significant sites for acute pain management and prescription practices.

Purpose of the Study:

• To evaluate the impact of rescheduling hydrocodone-containing products (HCPs) from Schedule III to Schedule II.
• To analyze changes in the proportion of HCP prescriptions for patients discharged from the emergency department (ED).

Main Methods:

• Retrospective analysis of ED records for patients aged 15+ receiving pain prescriptions.
• Categorization of prescriptions into HCPs, other Schedule II, other Schedule III, and non-Schedule II/III medications.
• Statistical comparison (chi-squared, logistic regression) of prescription proportions before and after HCP rescheduling, controlling for demographics.

Main Results:

• HCP prescriptions decreased from 58.1% to 13.2% after rescheduling (P < .001).
• Prescriptions for other Schedule III medications increased from 11.7% to 44.9% (P < .001).
• Non-Schedule II/III prescriptions also increased from 51.8% to 59.3% (P < .001).

Conclusions:

• Rescheduling HCPs to Schedule II substantially reduced their use in the ED setting.
• The rescheduling prompted a significant increase in the prescription of alternative pain management options.
• These findings highlight the effect of regulatory changes on clinical prescribing behaviors for pain relief.