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FDA Advisory Panel Recommends Restricting Hydrocodone

The FDA is expected to tighten restrictions on painkillers containing hydrocodone, like Vicodin, following Friday’s vote by an advisory panel. Under these controls, only written (not faxed or called in) prescriptions from a doctor would be filled, no refills would be allowed, and nurse practitioners and physician assistants could not prescribe the drugs*. These same restrictions already apply to drugs containing oxycodone (including Oxycontin and Percocet). Reducing addiction to prescription painkillers is the goal of the recommendation, though experts debate whether this is an effective approach. Patient advocates argue such constraints will be an enormous burden to those who rely on these drugs for chronic pain.

Prescription drug addiction is not a trivial problem. One hundred people die every day in the US from a drug overdose and the CDC attributes most of those deaths to prescription painkillers. In 2010, about 12 million Americans reported using prescription painkillers recreationally in the previous year.

No one should have to live with the unrelenting misery of chronic pain. Because¬†opioids can make the brain more sensitive to pain and make migraine more difficult to treat, I no longer advocate broadly for the use of opioids for headache or migraine management. In fact,¬†the long-term efficacy and potential harmful effects of opioid use for any type of chronic pain are in question. If opioids aren’t the answer, then patients must have access to other effective therapies, drug or otherwise. Unfortunately, alternative solutions aren’t always available. Pain patients may have to pay the cost — financial as well as physical — of dragging themselves to the doctor each month for medication to manage their pain.

Is there a way to prevent drug abuse without increasing the suffering of people who live with horrible pain?

*States differ on how they implement these restrictions. Some allow doctors to write prescriptions to be filled at a future date. Some allow physician assistants and nurse practitioners to write prescriptions with the approval of a licensed physician.

3 Responses to FDA Advisory Panel Recommends Restricting Hydrocodone

  1. Kate says:

    I think the state pharmacy tracking of controlled substance prescriptions is good. As of now, not all states even have a system which will say John Doe just filled an opiate prescription last week for a month’s supply at the pharmacy down the road. Thankfully more are adding them.

    Also, the standard pain management contract between doctor and patient is good, but only if they follow through. Doing mid-month UA testing should be done more. Its easy for someone to sell 90% of their meds and then just take them for the couple days before their appointment just in case they get a UA. If they get called in on short notice mid-month, not so easy. Doing that for a new patient could help weed some out.

    I

  2. Kate says:

    Oops that cut out early:

    I’m not sure how much help it’ll do to make Vicodin Schedule II. Although it’ll probably cut down on the prescriptions (as many doctors don’t have the Schedule II prescription pads / training), I don’t think it would cut down much on abuse, as there are still some doctors who give out too many meds (and some who give out too few / none), and it makes it such that for short term pain, people won’t be able to get anything reasonably strong from their primary doctor, dentist, etc.

    I think the methods we are using now would do better at preventing abuse while not making it too hard for legitimate patients to get meds if they were enacted more widespread (lots of doctors who aren’t pain management specialists don’t require a contract, etc), and enforced more (I’ve heard of people signing a contract but never having a UA or having anything checked up on).

    I can say that pain meds have been the one thing to consistently significantly help my NDPH pain. I had gone to the dozens of doctors and tried over 50 treatments before I had two doctors recommend it. No idea how I’d manage without them anymore. I do think its a good idea to have the hoops to jump through for them and have them as a last resort, but there are some folks who will benefit from them.

    Also, FYI, Physicians Assistants can prescribe Schedule II meds, but it either needs to be under doctor supervision, or they need an extra training course for them. Lots of pain clinics (including mine) as they can prescribe the meds and have lower salaries, but get insurance reimbursements similar to doctors.

    Another thing: Not all patients on Schedule IIs are made to go to the doctor every month. Yes you need a new paper prescription, but some doctors will do future “fill by” dates (different than post dating, which is illegal), let you come to the office to pick up a prescription without an appointment, or even mail them.

    But yes most of the time you need a monthly appointment and prescription, especially if you aren’t stable. I actually like this, as chronic pain is far from constant, and treatments always need treatment. Plus appointments are so short you often don’t accomplish everything in a 20 minute monthly appointment.

    Good post; thanks! Best wishes.

    *****
    Thanks for all the information and for sharing your perspective, Kate! I appreciate your corrections. I was only thinking about the hassle of getting to appointments, not the benefit of actually having such frequent appointments — great point. I’m glad you’ve found something that helps your headaches.

    Take care,
    Kerrie

  3. Thank u for this info. After using OxyContin for a while and knowing getting the rx filled involved 24 hr waiting period ( imposed by some drugstores here in MA)…having restrictions u speak of for hydrcodone..sounds like I may need to be jumping thru more hoops. Bad for mirgrane, fibro, ms and TMJ – but good to stop abuse. One more hurdle isn’t what I need.

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