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Quantification of Opioid Prescription Practice Changes Due to Hydrocodone Combination Product Rescheduling in an Academic Pain Clinic

Authors Ngo J, Parker D, Meroney M, Mitchell J, Veloz O, Lee O, Cunningham KA, Wilkes D

Received 2 March 2020

Accepted for publication 9 June 2020

Published 25 August 2020 Volume 2020:13 Pages 2163—2168

DOI https://doi.org/10.2147/JPR.S251386

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman


John Ngo,1 David Parker,2 Mathew Meroney,3 Jasmine Mitchell,2 Oscar Veloz,4 Oliver Lee,5 Katherine A Cunningham,2 Denise Wilkes1

1Department of Anesthesiology and Pain Management, University of Texas Medical Branch, Galveston, TX, USA; 2Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA; 3Department of Anesthesiology and Pain Management, University of Florida, Gainesville, FL, USA; 4Department of Anesthesia, Mcgaw Northwestern University Medical Center, Chicago, IL, USA; 5Department of Anesthesia, University of Washington, Seattle, WA, USA

Correspondence: Denise Wilkes
Department of Anesthesiology and Pain Management, University of Texas, Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
Tel +1 409-772-1221
Fax +1 409-747-0011
Email dwilkes@utmb.edu

Purpose: To determine the effect of rescheduling on prescription practices in a large academic hospital-based multidisciplinary practice comprising anesthesiologist-trained pain physicians.
Patients and Methods: We examined the number of HCP prescriptions written and quantity of tablets prescribed during a 6-month period prior to rescheduling and compared this with a 6-month period 1 year after rescheduling. We also examined the changes in prescription of tramadol and acetaminophen with codeine from one period to the next.
Results: Our pain clinic conducted 3,320 office visits during the 6-month period prior to HCP rescheduling and 6,003 office visits in the 6-month period 1 year after rescheduling. The charted data from each of these visits were used for our analysis. The mean number of tablets of HCPs prescribed per patient decreased from 318.48 in the pre-period to 242.27 tablets in the post-period, while the mean number of HCP prescriptions per patient decreased from 2.24 to 1.84. The mean number of acetaminophen with codeine tablets prescribed per patient increased from 3.46 to 15.27 in the pre- and post-period. Similarly, the mean number of tramadol tablets per patient increased from 47.33 to 61.97 in the pre- and post-period. The mean number of acetaminophen with codeine and tramadol prescriptions per patient increased from 0.02 to 0.15 and 0.38 to 0.51 in the pre- and post-period, respectively. In the 6-month post-period, fewer new patients were started on opioids compared to the 6-month pre-period, 16% and 27%, respectively.
Conclusion: Our study showed a significant decrease in the mean number of HCP prescriptions written per patient, as well as a decrease in the mean number of HCP tablets prescribed. Pain physicians in our clinic increased the number of prescriptions for the non-HCPs. The number of acetaminophen with codeine and tramadol tablets prescribed significantly increased. Therefore, the rescheduling of HCPs has profoundly impacted practices within this academic pain clinic.

Keywords: hydrocodone, tramadol, acetaminophen, schedule, reschedule

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