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The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System.
J Am Board Fam Med. 2019 May-Jun; 32(3):362-374.JA

Abstract

BACKGROUND

Hydrocodone-combination analgesics were changed from Schedule III to Schedule II to discourage the prescribing of these analgesics. Our primary aim was to explore the effect of hydrocodone rescheduling on opioid prescribing within an urban safety-net health care system.

METHODS AND DESIGN

Data were extracted from electronic records of ambulatory patients (N = 82,432 patients) prescribed hydrocodone-combination, codeine-combination, or tramadol opioid analgesics (N = 200,675 prescriptions) between October 6, 2013 and October 6, 2015. Data analyses modeled predicted probabilities of hydrocodone-combination prescriptions (HCPs). Chronic opioid therapy (COT) for chronic pain (ie, ≥3 opioid prescriptions/12 months) and morphine milligram equivalency (MME) levels were also examined.

RESULTS

The probability of providers writing HCPs decreased significantly from pre- to postrescheduling (0.525 vs 0.158, respectively, P < .0001). However, this coincided with large probability increases in codeine-combination (0.064 vs 0.269) and tramadol prescriptions (0.412 vs 0.573). The probability of HCPs varied across physician specialty (P < .0001), patient diagnoses (P < .0001), COT versus non-COT patients (P < .0001), and patient characteristics (sex, race/ethnicity, and age; P < .05). COT patients received significantly more opioid prescriptions in the postrescheduling period (M = 4.81 vs M = 4.27; P < .0001). Patients on <20 MME/day increased slightly from pre- to postrescheduling (P < .0001).

DISCUSSION

Significant declines in HCPs occurred after rescheduling; however, one third of patients prescribed opioids remained on doses ≥20 MME/day. Codeine- and tramadol-prescription probabilities increased significantly and providers may have an increased perception of safety about these medications. Physicians and health care systems must reduce their overreliance on opioids in treating pain, especially chronic pain, as all opioids incur some level of risk.

Authors+Show Affiliations

From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS). Thomas.F.Northrup@uth.tmc.edu.From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS).From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS).From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS).From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS).From the Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, TX (TFN, KC, YRV, MZ, ALS); Ambulatory Care Services, Grady Health System, Atlanta, GA (KC); Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, TX (RS, ALS).

Pub Type(s)

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

Language

eng

PubMed ID

31068400

Citation

Northrup, Thomas F., et al. "The Impact of Increased Hydrocodone Regulation On Opioid Prescribing in an Urban Safety-Net Health Care System." Journal of the American Board of Family Medicine : JABFM, vol. 32, no. 3, 2019, pp. 362-374.
Northrup TF, Carroll K, Suchting R, et al. The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System. J Am Board Fam Med. 2019;32(3):362-374.
Northrup, T. F., Carroll, K., Suchting, R., Villarreal, Y. R., Zare, M., & Stotts, A. L. (2019). The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System. Journal of the American Board of Family Medicine : JABFM, 32(3), 362-374. https://doi.org/10.3122/jabfm.2019.03.180356
Northrup TF, et al. The Impact of Increased Hydrocodone Regulation On Opioid Prescribing in an Urban Safety-Net Health Care System. J Am Board Fam Med. 2019 May-Jun;32(3):362-374. PubMed PMID: 31068400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System. AU - Northrup,Thomas F, AU - Carroll,Kelley, AU - Suchting,Robert, AU - Villarreal,Yolanda R, AU - Zare,Mohammad, AU - Stotts,Angela L, PY - 2018/12/03/received PY - 2019/01/17/revised PY - 2019/01/23/accepted PY - 2019/5/10/entrez PY - 2019/5/10/pubmed PY - 2020/6/23/medline KW - Codeine-Combination KW - Hydrocodone KW - Hydrocodone-Combination KW - MME KW - Opioid Prescription KW - Rescheduling KW - Tramadol SP - 362 EP - 374 JF - Journal of the American Board of Family Medicine : JABFM JO - J Am Board Fam Med VL - 32 IS - 3 N2 - BACKGROUND: Hydrocodone-combination analgesics were changed from Schedule III to Schedule II to discourage the prescribing of these analgesics. Our primary aim was to explore the effect of hydrocodone rescheduling on opioid prescribing within an urban safety-net health care system. METHODS AND DESIGN: Data were extracted from electronic records of ambulatory patients (N = 82,432 patients) prescribed hydrocodone-combination, codeine-combination, or tramadol opioid analgesics (N = 200,675 prescriptions) between October 6, 2013 and October 6, 2015. Data analyses modeled predicted probabilities of hydrocodone-combination prescriptions (HCPs). Chronic opioid therapy (COT) for chronic pain (ie, ≥3 opioid prescriptions/12 months) and morphine milligram equivalency (MME) levels were also examined. RESULTS: The probability of providers writing HCPs decreased significantly from pre- to postrescheduling (0.525 vs 0.158, respectively, P < .0001). However, this coincided with large probability increases in codeine-combination (0.064 vs 0.269) and tramadol prescriptions (0.412 vs 0.573). The probability of HCPs varied across physician specialty (P < .0001), patient diagnoses (P < .0001), COT versus non-COT patients (P < .0001), and patient characteristics (sex, race/ethnicity, and age; P < .05). COT patients received significantly more opioid prescriptions in the postrescheduling period (M = 4.81 vs M = 4.27; P < .0001). Patients on <20 MME/day increased slightly from pre- to postrescheduling (P < .0001). DISCUSSION: Significant declines in HCPs occurred after rescheduling; however, one third of patients prescribed opioids remained on doses ≥20 MME/day. Codeine- and tramadol-prescription probabilities increased significantly and providers may have an increased perception of safety about these medications. Physicians and health care systems must reduce their overreliance on opioids in treating pain, especially chronic pain, as all opioids incur some level of risk. SN - 1558-7118 UR - https://www.unboundmedicine.com/medline/citation/31068400/The_Impact_of_Increased_Hydrocodone_Regulation_on_Opioid_Prescribing_in_an_Urban_Safety_Net_Health_Care_System_ L2 - http://www.jabfm.org/cgi/pmidlookup?view=long&amp;pmid=31068400 DB - PRIME DP - Unbound Medicine ER -