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Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery.
JAMA Surg. 2018 12 01; 153(12):1111-1119.JS

Abstract

Importance

In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood.

Objective

To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone.

Design, Setting, and Participants

An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion.

Main Outcomes and Measures

The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use.

Results

Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female; P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg). There were no significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55), but there was a significant decrease in the refill rate (β = -5.2% [1.3%]; P < .001).

Conclusions and Relevance

Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.

Authors+Show Affiliations

Department of Surgery, University of Michigan, Ann Arbor.Department of Surgery, University of Michigan, Ann Arbor.Department of Surgery, University of Michigan, Ann Arbor.Department of Urology, University of Michigan, Ann Arbor.Department of Surgery, University of Michigan, Ann Arbor.Department of Surgery, University of Michigan, Ann Arbor.Department of Anesthesiology, University of Michigan, Ann Arbor.Department of Surgery, University of Michigan, Ann Arbor. Michigan Opioid Prescribing Engagement Network, Ann Arbor.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30140896

Citation

Habbouche, Joe, et al. "Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery." JAMA Surgery, vol. 153, no. 12, 2018, pp. 1111-1119.
Habbouche J, Lee J, Steiger R, et al. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. JAMA Surg. 2018;153(12):1111-1119.
Habbouche, J., Lee, J., Steiger, R., Dupree, J. M., Khalsa, C., Englesbe, M., Brummett, C., & Waljee, J. (2018). Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. JAMA Surgery, 153(12), 1111-1119. https://doi.org/10.1001/jamasurg.2018.2651
Habbouche J, et al. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. JAMA Surg. 2018 12 1;153(12):1111-1119. PubMed PMID: 30140896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery. AU - Habbouche,Joe, AU - Lee,Jay, AU - Steiger,Rena, AU - Dupree,James M, AU - Khalsa,Caitlin, AU - Englesbe,Michael, AU - Brummett,Chad, AU - Waljee,Jennifer, PY - 2018/8/25/pubmed PY - 2019/10/8/medline PY - 2018/8/25/entrez SP - 1111 EP - 1119 JF - JAMA surgery JO - JAMA Surg VL - 153 IS - 12 N2 - Importance: In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood. Objective: To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone. Design, Setting, and Participants: An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion. Main Outcomes and Measures: The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use. Results: Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female; P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg). There were no significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55), but there was a significant decrease in the refill rate (β = -5.2% [1.3%]; P < .001). Conclusions and Relevance: Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/30140896/Association_of_Hydrocodone_Schedule_Change_With_Opioid_Prescriptions_Following_Surgery_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2018.2651 DB - PRIME DP - Unbound Medicine ER -