Ask the Pharmacist: What Will Hydrocodone Rescheduling Mean for Pharmacies?

Ask the Pharmacist: What Will Hydrocodone Rescheduling Mean for Pharmacies?

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.

American pharmacist with senior woman in pharmacyAfter 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 AriensSteve 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.

There are 22 comments for this article
  1. Katy at 6:37 am

    The Real addicts will still find a way to get it. The poor pain sufferers are the one that will suffer. Don’t they realize that being so sick as to need these drugs makes it very difficult to get out to go to doc and then to pharmacy and wait both places? Many times they are out of stock and it requires a second trip back.
    God Help Us
    \

  2. Jaswars at 11:30 am

    Once again the DEA had decided what is good for our lives and what is not. This agency is playing god in all sorts of illegal ways and are just destroying every single ounce of our rights as patients. I find this new reclassification of these WEAK drugs as ludicrous. All this will do is cause your pain mgmt clinics to have packed offices with huge wait times everywhere. This is a traffic jam with horrible consequences. The DEA will find an increase of heroin use again as the legit pain sufferer out there is totally fed up with the DEA’S intrusion into our private relationships with our doctors and pharmacies to treat us properly where no where else to turn to the streets to relieve the patients of chronic pain. Good Job you reckless jerk offs.

  3. Reta at 1:48 pm

    We just came back from Breakfast out. Will take one Dulcolax now. And a glass of water.
    Thanks so much

  4. Reta at 10:03 pm

    With my new prescription of Morphine I find take Dulcolax which is helping. I put in a call to my Doctor who will e in the office on Monday. She was closed Friday afternoon.
    Thanks for your assistance from those who answered. And water too.

  5. BL at 9:49 am

    I wonder how much the cost will go up with the extra work now involved in manufacturing, ordering, shipping, storage & filling.

  6. Barb Tracer at 10:03 pm

    Reta, any narcotic containing pain reliever has the potential to cause constipation. As a pharmacist, im surprised someone hasn’t counseled you on using a stool softener or one of the senna based mild laxatives combined with a stool softener. Most patients do well with just a stool softener and plenty of fluid intake throughout the day.

  7. michelle at 7:57 pm

    Won’t this just cause innocent people to go without pain meds when pharmacies decide they don’t want to stock the medication? Or that they don’t want to give it out? I imagine many people will turn to suicide when the only humane option they had is gone. Congrats USA on being like a 3rd world nation.

  8. Pharmacist Steve at 6:52 pm

    @drew.. while your suggestion would make some sense.. first getting all the prescribers on board.. would be a mission impossible and since we are dealing with C-II’s the Pharmacist can’t call and change the quantity on the Rx..
    Secondly, many of the chain stores only order C-II’s once a week as opposed to daily for everything else.. All the C-II’s have to be stored in a safe.. buying bottles of 30-60-90 is going to compound storage problems as opposed to buying bottles of 500’s

  9. Pharmacist Steve at 6:47 pm

    Actually a 28 days supply makes a whole lot of sense.. you eliminate weekends of pts running out of their meds when giving out 30 days supply.

  10. Dennis Kinch at 7:06 pm

    Don’t worry Rita J, the constipation is worth it. Everytime I feel bad about it I say to myself, “Remember how much pain you had?Which would you rather deal with?” I had no morph for 5 years and had to live with that pain and now it’s been 5 years with constipation, which I’ll take any day!

    Also, my tramadol went to high scrutiny last month. I now have to go through the exact same procedure that I do with the morphine.
    So that makes all 3 of my pain meds have gone through this. Thank God, I still take them, and for 5 years they have allowed me a lot of happiness and productivity in my life! I know I’m not alone in this, I just wish it meant as much to the DEA as it does to me.

    And – Why was hydrocodone reclassified again? I lost the point of this fiasco. Is it so we will think the DEA is important and those “coppers” need to keep their jobs? Didn’t Deval Patrick, Gov of Mass find out the hard way that there really is NO epidemic of OD’s? The DEA “do-gooders” made him look really stupid but remember, it was the pain patients of Mass that came out of the woodwork to force the Supreme Court to change the law in that state.
    At some point we need to unite on a national level so we can start running the DEA, if they still exist after this crappy of a year they’ve had I will always be amazed that we are 100 million strong, yet all the attention goes to the “bad guys!” And they always number less than 4 %, while pain sufferers number upwards of 25%!

  11. Drew at 1:13 pm

    “The policy in most stores is that only the Pharmacist can handle, count, and fill these prescriptions”

    Perhaps, preemptively, or as the issue begins to manifest itself to a widely know degree, manufacturers can help mitigate the issue by issuing factory sealed bottles that coincide with the most popular prescribed amounts. For example: 90 count bottles cover 3 a day for 30 days, two such bottles would cover 6 a day. Seems like it would ease counting. Prescribing physicians could also help mitigate the issue by writing for these amounts (by that, I mean whatever is closest to the intended amount without going over/under to an obscene degree).

    Am I off base here? Factory-sealed bottles of the proper size can just be dropped in the bag without opening, correct?

  12. BL at 10:38 pm

    Kurt W.G. Matthies, yes it is very difficult. Any system that has majority Medicaid patients will always be the most restrictive with these meds. They are also training the drs of tomorrow and they are training them to be stricter than the ones before them.

  13. Just Some Dude at 7:58 pm

    I have to take MS Contin 3 X day & hydrocodone for severe pain. I guess now my hydrocodone script will be written like the MS Contin (3 separate scripts with a date for when I can get it filled). This of course won’t stop addicts- just impose more hardships on pain sufferers…

  14. Kurt W.G. Matthies at 7:51 pm

    @BL – very difficult to find any doctor who will write for three CII thirty-day supple Rx during one visit. I used to get this from a pain doc over 10 years ago, but since 2011, I’ve been having monthly visits for my Rx.

    This year, my current University of Colorado system only writes for a 28 day supply of controlled Rx each month for all patients — it’s a matter of policy handed down from the Medical Director for all of their satellite offices. UC Med now owns hospital systems and clinics in every major metro area in Colorado, and in Cheyenne, Wyoming.

    This means a doctor’s appointment every 4 weeks, period.

  15. Kim Miller at 5:52 pm

    I see longer wait times for all pharmacy customers as well as many more primary care physicians saying, “This is too much trouble, get thee to a pain doctor.”

    I see a whole lot more suffering for those people who used to get hydrocodone and their providers say “no more” and for those who come in future and might have been humanely prescribed hydrocodone and will now leave with an NSAID to eat up their stomach and intestines instead, or tramadol, which is next to useless.

    I think it was the last of hope of humane treatment by the medical community for some people and now it too, is off the table.

    ***** SEPTEMBER IS PAIN AWARENESS MONTH ******

  16. Reta Jiminez at 5:28 pm

    I get my new prescription for Hydrocodone each month from my Doctors office.
    A new prescription replacing Oxycotin is Morphine.
    My concern on the Morphine is can it cause constipation ????