Hydrocodone Rescheduling and Opioid Prescribing Disparities in Breast Cancer Patients

Area of Science:

• Oncology
• Pain Management
• Health Policy

Background:

• Pain is common in breast cancer patients, often managed with hydrocodone.
• Hydrocodone rescheduling in 2014 raised concerns about opioid access for cancer patients, especially vulnerable groups.

Purpose of the Study:

• To evaluate the impact of hydrocodone rescheduling on opioid prescription patterns.
• To assess differential effects across patient subgroups based on Medicaid dual eligibility and race-ethnicity.

Main Methods:

• Retrospective cohort study using SEER-Medicare data (52,306 early-stage breast cancer patients, 2011-2019).
• Multivariable logistic regression models to analyze prescription opioid use changes post-rescheduling.
• Stratified analysis by dual eligibility and race-ethnicity.

Main Results:

• Hydrocodone rescheduling significantly reduced hydrocodone prescriptions, most notably in dual-eligible racial/ethnic minority patients (AOR=0.57).
• Non-dual-eligible patients showed a smaller reduction in hydrocodone use (AOR=0.84).
• Non-hydrocodone opioid use increased significantly among non-dual-eligible non-Hispanic White patients, suggesting substitution.

Conclusions:

• Hydrocodone rescheduling disproportionately reduced opioid use among dual-eligible racial/ethnic minority breast cancer patients.
• Increased non-hydrocodone opioid use was primarily observed in non-dual-eligible non-Hispanic White patients.
• Opioid policies must balance misuse prevention with equitable pain management access for underserved populations.