Addiction & Recovery Perspectives
Better pain management, less overdose and addiction—and what else?
The DEA recently published its Final Rule in the Federal Register that moved hydrocodone combination products (HCPs) from Schedule III to the more restrictive Schedule II. The rule takes effect on Oct. 6, 2014. Hydrocodone is currently THE most prescribed drug in the U.S. with 135 million prescriptions filled annually. Physicians are being instructed to encourage their patients to use over-the-counter pain relievers like ibuprofen and acetaminophen rather than opioids.
“As we start to make this change from the hydrocodone combination products to the non-steroidal anti-inflammatories, we are going to find that we are treating pain better with fewer side effects,” Donald Teater, M.D., medical adviser to the National Safety Council (NSC), said. “This is a movement that will improve our treatment of pain as well as reduce the number of people getting addicted and overdosing.”
This sounds like a win-win – better pain management, less overdose and addiction. Though the vast majority of hydrocodone patients never develop addiction, reducing the supply will certainly limit exposure to these drugs by vulnerable individuals: young people raiding grandma’s medicine cabinet, people with a genetic vulnerability to addiction and so forth. Unfortunately, although we can restrict or even outlaw access to certain drugs, we can’t outlaw addiction.
Patients who are addicted to hydrocodone often have only one source: their personal physician and local pharmacy. Using prescription monitoring programs, physicians can easily determine if their patient is obtaining drugs through another doctor. “Doctor shopping,” unnecessary emergency room visits and outright theft of drugs are not simply bad behavior – they are symptoms of addiction. But many addicts have never had to resort to illegal or inappropriate behavior. They don’t even realize they are addicted!
As a public health and safety strategy, prohibition is nothing new. Although rescheduling hydrocodone stops short of outright prohibition, one might ask “Why stop there?” If these drugs really lack efficacy in pain treatment, why are they still available at all? Of course, if we were consistent with respect to prohibition, tobacco and alcohol would be on top of the list!
Prohibition also has its own unintended consequences. The Harrison Narcotics Tax Act of 1914 essentially created the black market in heroin and other opiates. Up until then, most opiate addicts obtained their drugs legally in over-the-counter remedies or from a physician. Alcohol prohibition (18th Amendment to the U.S. Constitution) had similar social consequences which led ultimately to its repeal.
How will the rescheduling of hydrocodone impact the already flourishing black market in heroin and other opioids? No one knows, but one thing is clear to me: physicians who have been supplying patients with opioid medication over a long period of time have an ethical obligation to treat the addiction.
And the professionals in the substance use disorder field can help with that.