Bad news for patients and doctors; effect on addicts questionable.
Vicodin is one of a several brand names for the combination of hydrocodone and acetaminophen. Previously listed as a schedule III drug, it will move in early October to schedule II by order of the Drug Enforcement Administration. Patients will be limited to one prescription at a time for a 90-day supply of the drug.
Schedule III drugs can be dispensed by pharmacies with a verbal order from a physician or, in some states, a physician assistant or nurse practitioner, and refills are allowed. Schedule II drugs require a written prescription, with no refills permitted. In addition, some states require a special form for schedule II prescriptions, and only physicians can prescribe these drugs.
The change is an attempt to curtail the nationwide epidemic of prescription drug abuse that started when pain was erroneously designated the “fifth vital sign.”
As pointed out in a Los Angeles Times opinion piece, the plan may not work because addicts who are determined to obtain Vicodin may not be sufficiently deterred, especially if unscrupulous doctors continue to provide them with prescriptions.
A major problem is “doctor shopping,” which involves addicts going to multiple doctors, complaining of chronic pain, and receiving multiple concurrent prescriptions for pain pills. Statewide databases monitoring narcotic prescriptions can help prevent this, but are ineffective if patients use aliases or doctors do not check the database before prescribing.
An anecdote from my days as a surgical hospitalist illustrates what will be a real concern for patients and doctors. I covered weekends for several surgeons in a suburban community. Besides rounding on their patients and consulting on emergencies at the hospital, I had to deal with calls from their private patients.
At least once or twice every weekend, patients who had undergone surgery a few days before would call me on a Saturday or Sunday morning (sometimes at 6 am) to say that they had run out of pain medication. I often wondered why it didn’t occur to them to call their surgeons’ offices when they were down to 3 pills on Friday afternoon. Nevertheless, I had to deal with the issue. I would call their pharmacy and prescribe a few Vicodin tablets, the only narcotic that could be ordered over the telephone.
As of October, that will no longer be possible. Patients will have to be seen and given a written prescription. This will be exceedingly inconvenient for both patients and physicians.
You might ask why surgeons couldn’t simply write for more narcotic pain pills at the time of the surgery. Of course, that might happen and probably will, but it could result in increasing numbers of unused pills, often sold on the street.
Patients with cancer and other legitimate chronic pain issues will have an even bigger problem. In order to obtain Vicodin, they will have to incur the expense and inconvenience of an office visit every time they need a Vicodin refill. Some of these patients are homebound, and getting to a doctor’s office means using an ambulette.
Opioid addiction is a very real problem, but making Vicodin a schedule II drug will not solve it. Addicts will find workarounds, and patients and doctors will suffer.
What do you think?