Hydrocodone Rescheduling: The First 100 Days--Survey Points to Unintended Increases in Patient Suffering Caused by Reduced Access to Prescription Medications
March 20, 2015 – Logan, Utah – Preliminary analysis of an online pain patient survey conducted by the National Fibromyalgia & Chronic Pain Association (NFMCPA) was presented as a scientific poster at the American Academy of Pain Medicine’s 31st annual meeting in National Harbor, Maryland. Responses to the questionnaire highlight the dilemmas encountered by people suffering from unrelenting chronic pain who are being denied hydrocodone medications in the wake of stricter federal regulations enacted on October 6, 2014. These regulations were intended to reduce criminal activity related to opioid medications, as well as deaths caused by drug overdoses. Preliminary analysis of data from “Hydrocodone Rescheduling: The First 100 Days” points to escalating problems faced by chronic pain patients, including lack of access to professionals who will write prescriptions, problems filling prescriptions in pharmacies, higher costs, and stigmatization, all as unintended consequences of rescheduling hydrocodone from Schedule III to Schedule II.
Healthcare professionals partnered with the NFMCPA to create the survey to track rescheduling’s effects on patients’ lives during the first 100 days of the new policy. Access information for the SurveyMonkey hosted questionnaire was distributed via email announcements, newsletters and Facebook postings to more than 210,000 total NFMCPA constituents and fans. Additionally, other participants were recruited through its website, social media and by other patient organizations, including the U.S. Pain Foundation, utilizing similar recruitment methods. More than 3,000 responders took the survey within 72 hours of the announcements. Preliminary data analysis shows that this new ruling is causing a significant burden, both medically and monetarily, on individuals suffering with chronic pain conditions.
“These survey results point to the fact that when hydrocodone rescheduling laws were put into effect, federal agencies did not adequately predict the negative consequences these regulations would have on people suffering with chronic pain,” said Jan Chambers, president and founder of the NFMCPA.”
Hydrocodone has been the most widely prescribed medication in the United States, with 130 million prescriptions written annually. Hydrocodone in combination with other medications, such as acetaminophen or ibuprofen, is frequently prescribed following dental and other surgeries, and for pain caused by medical issues such as broken bones, peripheral neuropathy and arthritic conditions. The new Drug Enforcement Administration (DEA) regulation rescheduling hydrocodone from a Schedule III to Schedule II effectively limits patients to a maximum 30-day supply since physicians are unwilling to provide three separate dated scripts for the maximum 90 day supply between doctor visits allowed by law. Patients must see a doctor for each new refill, which has to be handwritten because these prescriptions can no longer be phoned or faxed into pharmacies by prescribers.
In the Final Rule, published in the Federal Register (Federal Register Volume 79, Number 163; 21CFR Part 1308), the DEA cites increased problems with abuse, addiction and overdose deaths as reasons for the move to the stricter schedule. Most other opioid medications, including oxycodone, have been in Schedule II since the passage of the federal Controlled Substances Act in 1970.
Unfortunately, Chambers said, no support programs to help patients deal with the changes were created to prevent the foreseeable denials of prescription hydrocodone, or changes to less-effective medications.
“Inadequate attention seems to have been paid to how patients would cope with higher expenditures, difficulty in obtain an appointment to see their physician every 30 days, feeling like they are being treated as criminals when seeking pain-relieving drugs, and inadequate pain relief or withdrawal symptoms when the 30-day prescription runs out over a weekend or holiday or from a shortage at their designated pharmacy. Survey results also point to discrimination against, and stigmatization of, people suffering with chronic pain.”
The survey is a cross sectional, anonymous, blinded design. Most responders reported multiple pain diagnoses with the most common complaints being fibromyalgia (91%), low back pain (62%) and neck pain (44%). Approximately two-thirds of survey responders reported being unable to access hydrocodone-combination prescriptions. More than 15% of the responders reported negative impacts on doctor-patient relationships. People who had been getting the same medication at the same dose for many years reported being told that their doctors will no longer prescribe hydrocodone medications for them. Others were denied hydrocodone prescriptions at pharmacies they had frequented for years with no prior issues.
People also cited higher expenses from more frequent doctor’s visits, changes to other prescription medications, higher medication co-pays, greater transportation expenses for extra doctor visits and lost work revenue related to unrelenting pain. Some had to travel to several pharmacies to fill a prescription or were notified that pharmacies would no longer allow relatives to pick up prescriptions, causing additional hardship to people who are less mobile because of pain. Shockingly, 27% (n=931) reported suicidal thoughts due to being denied their hydrocodone prescriptions.
More than 2300 written comments were recorded by responders, reflecting the following prototype: Hydrocodone rescheduling makes legitimate chronic pain sufferers feel as though they are criminals and all we want is to live life pain-free and be our normal selves again without being treated like pill addicts.
About the National Fibromyalgia & Chronic Pain Association: The NFMCPA is a 501(c) 3 non-profit patient advocacy organization. It unites patients, policy makers, and healthcare, medical and scientific communities to transform lives through visionary support, advocacy, research and education of fibromyalgia and chronic pain illnesses. It is globally the largest association representing people suffering with fibromyalgia and other chronic pain conditions. The NFMCPA publishes the Fibromyalgia & Chronic Pain LIFE magazine and the monthly, on-line Advocate Voice Newsletter. These publications and membership are free to registered users of its website, www.fmcpaware.org.