Living with Pain: The Fallout from Rescheduling Hydrocodone

Living with Pain: The Fallout from Rescheduling Hydrocodone

By now you may have heard or read that the Food and Drug Administration has endorsed rescheduling hydrocodone from a Schedule III to a Schedule II drug, as recommended by an FDA advisory panel.

Schedule II medicines are much more powerful and thought to have greater potential for addiction and death than drugs classified as Schedule III.

fda-logo4The FDA’s decision was based upon the large increase in opioid pain medicines that were diverted, stolen or inappropriately given to a non-patient by a patient with an opioid prescription. It is thought that this explains the huge growth in the prescribing of these pain medicines, with OxyContin as the most dangerous and reviled “painkiller.”

The new regulations will likely take effect in 2014 if approved by the Department of Health and Human Services and the Drug Enforcement Agency.

Some medical associations and pain patient groups vehemently opposed these schedule changes, saying that these life-changing and life-saving medicines would become much harder to obtain by legitimate patients seeking relief.

The recommended schedule change will result in several changes for patients, physicians and pharmacists. It would reduce from 180 to 90 days the supply of hydrocodone a patient could have without seeing his/her provider for a new prescription.

“If you are needing chronic therapy of this magnitude you should be seeing your prescriber,” FDA commissioner Janet Woodcock told The New York Times.

For many years the DEA, families of those lost to prescription drug overdoses, and groups such as Physicians for Responsible Opioid Prescribing (PROP) have been urging the FDA to make this change.

“I’m thrilled by this news,” PROP founder Dr. Andrew Kolodny told Medpage Today.

Kolodny, who is chief medical officer of Phoenix House, said it was “bittersweet” announcement for him, because of the “thousands of lives lost since the point at which the DEA first asked FDA about [rescheduling] and all of the patients who became addicted during that time.”

Inherent in Kolodny’s chortling is what is not stated, and has rarely been stated by him or the others who worked so diligently to bring about this policy change. To wit: what cataclysm might these rule changes have upon those of us living with chronic, difficult to treat pain?

I’m not suggesting that the only or even the best treatment for pain resides in the exclusive use of opioid medicines. A holistic mind-body approach that would include various modalities, including opioid medicines, could be appropriate.

However, it must be recognized that millions of us use and need opioid analgesics to provide a modicum of pain relief that other strategies fail to provide.

Instead of focusing on the haggard arguments we’ve hurled at each other over the last several years regarding the safety of opioid analgesics, I want to focus on the real world – how pain patients have faced heavy waves of disrupted treatment, followed by a tsunami of both intended and unintended deadly consequences.

This tsunami has been crashing across the country for the last several years, as state after state responds badly to the perceived epidemic.

As laws and regulations are passed, as government agencies like the FDA, the DEA, and sometimes the FBI investigate physician prescribing practices – sometimes bringing charges against law abiding doctors treating extremely difficult cases of pain — unintended consequences begin to pile up.

This, combined with government agencies bringing regulatory pressures on pharmacies, has caused the pool of physicians willing to treat us to shrink.

This has damaged patients, physicians, pharmacists and families of pain patients in state after state: Florida, Georgia, West Virginia, Kentucky, Ohio, Washington and California to name a few.

With these new rules restricting access to hydrocodone, finding physicians who will treat patients with chronic refractory pain will become even harder.

I keep getting stories from pain patients all over the country who are being fired by their physicians, even those who specialize in treating pain. I hear from those who have no success in finding doctors willing to treat them or pharmacies willing to fill their prescriptions.

Unfortunately, with these new, seemingly appropriate rules, the tsunami will sweep across more of the country, leaving untold thousands without adequate care.

Yes, the public needs protection. But as I’ve said repeatedly, the first concern should be the protection of patients whose only recourse for their ghastly pain are these medicines.

The same may be said for those patients for whom opioid treatment is a staple of a wider treatment program.

We need to monitor these changes very closely.

Mark-MaginnMark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here

National Pain Report welcomes other opinions.

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 represent 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.

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Jenn

Not to mention -seeing doctors is becoming quite expensive. With my health insurance, seeing my pain doctor costs $40 a visit and he requires it every 6 weeks. That on top of Rx costs on top of gas spent in driving around trying to find a pharmacy that can fill my Rx (numerous times, my CVS, for example, has said they are out and the FDA regulates when they can get a new supply), the costs are piling up. Luckily, I have health insurance. It stinks for those who do not.

Pain meds work differently for everyone yet sadly, there is no distinction of this by the FDA.

If you want to get into real science and prevent addiction, what about access to more pharmacologists who can test how patients will react to medicines and specific doses?

Terry Dicey

Do they care about the patients who are in great pain, who find themselves unable to get their medication, and who then are driven to kill themselves to excape the unmitigated pain? Or do they only care about the idiots who accidentally kill themselves taking the medication for recreation?

Anon

@Pete Jackson, you are full of it and apparently do not know the difference between dependence and addiction. Please educate yourself. Your scare tactics are reprehensible!

Ada Tompson

Mr. Maggin

We all understand that there is diversion of Rx opioid drugs, afterall they fetch good $ on the street. We also understand that there are some people who experiment with drugs and become addicted to them. However the discussion should not be about the medical user vs the non medical user. Many medical users are harmed and many morph into non medical users.

You write:

“The FDA’s decision was based upon the large increase in opioid pain medicines that were diverted, stolen or inappropriately given to a non-patient by a patient with an opioid prescription.”

Mr. Maggin, although I agree that there is diversion, you fail to address the root of the problem. The change in medical practice in the prescribing of opioids for chronic non cancer pain driven by misinformation provided to healthcare prescribers. It is the excessive and inappropriate prescribing that has created this problem.

Please read “Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008-2009” (one of many medical journal articles) which refutes your claim and highlights that more than 91% of decedents were ‘chronic pain patients’.

Please stop perpetuating the false notion that there are two groups of patients… we are all patients deserving of safe and effective care based on evidence not on experimentation and marketing misinformation provided by the manufacturers of opioids. Why is the U.S. the top per capita consumer of opioids worldwide and yet everyone is still in pain? We need to improve the way pain is being treated in the first place so we can prevent further harm to patients. Our focus should be on improved care not sales! Transparency would be a good place to start. Provide healthcare professionals and patients with all the information about opioids. Anything else is simply a distraction to resolving this problem.

Mr. Maginn sees the world as two groups of people: people who suffer from pain and who only benefit from opioids, and bad people of low moral character who break the rules and ruin everything for the “good” people, the pain patients. But he is not speaking up for the many people who suffer from pain who also become addicted to their opioid medications – even when taken as prescribed. This is a very convenient dichotomy, one which serves Mr. Maginn’s cause well, unfortunately it is a false one. Studies show that a sizeable percentage – perhaps as large as 35% in one prominent study – of pain patients become addicted or take on addiction-like behavior if they are on these powerful drugs long enough. The fact is, opioids are addictive drugs. Opioids don’t affect people differently simply because they ave been given a prescription. All people – nonmedical users and pain patients alike – are at risk. Imposing more medical oversight on prescription refills for hydrocodone combination products will protect patients, not harm them.

Julie golemon

I totally agree with what you said and it tells it the way it really is.

Nicolette vanconey

The people that rely on pain medication to live a half way normal life due to chronic pain are the only ones that are being hurt and called addicts!! The people that are getting drugs by the truck loads are the ones selling them on the streets and in our schools. They are the ones you should be after. Your not trusting a doctors in this matter. I have never been given pain medication unless I had a proven reason why.