On October 6th, all hydrocodone combination products will be reclassified in the U.S. as a Schedule II drugs under the Controlled Substances Act. For all of those involved in dealing with chronic pain — prescribers, pharmacists, and patients — the impact could be more than minimal.
For the Pharmacist and his/her staff at your local pharmacy, it means that these drugs now have to be kept in a locked safe and a perpetual inventory has to be kept. The policy in most stores is that only the Pharmacist can handle, count, and fill these prescriptions.
After each prescription is filled, the Pharmacist must log out the number of doses of every drug dispensed, which is normally kept on a paper form in a folder. They also have to count any doses remaining so that the inventory is correct.
This is a very time consuming function that is mandated by the DEA and there is no provision for recouping that cost.
It has been reported that the major drug store chains have removed the controlled substances count out of the computation of tech staffing hours. So, at least indirectly, the Pharmacists may have more of an incentive to “Just say no” to patients who have a prescription for hydrocodone.
There are three opiate drugs left on the market that are not Schedule II drugs. Tylenol with Codeine, Synalgos-DC and Tramadol. The first is a Schedule III medication and the second has dihydrocodeine – which is primarily used by the rest of the world for pain management and is a Schedule V drug. Tramadol was recently reclassified by the DEA as a Schedule IV drug.
In my opinion, rescheduling hydrocodone is going to cause many substance abusers and some legitimate pain patients to try heroin. It is also going to increase the “street price” of hydrocodone products and thus pharmacies are going to be at an increased risk of addicts holding up and robbing pharmacies.
Walgreens recently announced that they are beginning to install time delayed safes to deter robberies — which could place pharmacy staff and customers at increased risk of harm if caught in the middle of a hold up.
It is not clear if the limit on a 90 day initial supply of hydrocodone applies to a single prescription or three 30 day prescriptions. Of course, insurance policies could come into play on coverage.
The DEA has approved a process for controlled drugs to be electronically sent to the pharmacy, but my understanding is that the protocol is so onerous that not many pharmacys’ software systems have been upgraded to handle them.
One thing that is certain is that the bureaucrats keep expanding a system — developed 100 years ago — that has failed to produce the expected outcomes. This “tweak” will be no different.
Steve Ariens is a retired pharmacist and patient advocate who has a blog called Pharmacist Steve. Steve’s wife is a chronic pain patient.
If you have a question for Steve, send it to AskthePharmacist@nationalpainreport.com.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.