Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users

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.

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.

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.

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.