Effects of hydrocodone rescheduling on opioid use outcomes: A systematic review

Usmani, Silken A; Hollmann, Josef; Goodin, Amie; Hincapie-Castillo, Juan M.; Adkins, Lauren; Ourhaan, Natalie; Oueini, Razanne; Bhagwandass, Hemita; Easey, Taylor; Vouri, Scott Martin

doi:10.1016/j.japh.2020.09.013

Cited by 15 publications

(14 citation statements)

References 46 publications

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“…31,32 Further, formulation changes, such as that seen with oxycodone, 27 could play a role in the observed differences in degree of variation in distribution for a particular opioid in a particular year. However, the federal reclassification of hydrocodone from a Schedule III to a Schedule II drug in 2014 33 did not appreciably impact the variation (2011 percentile ratio = 6.11, 2019 ratio = 7.99).…”

Section: Discussionmentioning

confidence: 93%

Declines and pronounced state level disparities in prescription opioid distribution in the United States

Madera

Ruffino

Feliz

et al. 2022

Preprint

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The United States (US) opioid epidemic is a persistent and pervasive public health emergency that now claims the lives of over 100,000 Americans per year. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain, and identified state-level differences between 2010 and 2019. Data on opioid production quotas and distribution of ten prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) for 2010 to 2019 were obtained from the Drug Enforcement Administration. Total opioid production quotas increased substantially from 2010 to 2013 before decreasing 41.5% from 2013 (87.6 morphine mg equivalent metric tons) to 2019 (51.3). The peak year for distribution of all ten prescription opioids was between 2010 and 2013, except for codeine (2015). The largest quantities of opioid distribution were observed in Tennessee (520.70 morphine mg equivalent or MME per person) and Delaware (251.45) in 2011 and 2019. There was a 52.0% overall decrease in opioid distribution per capita from 2010 to 2019, with the largest decrease in Florida (-61.6%) and smallest in Texas (-18.6%). Southern states had the highest per capita distribution for eight of the ten opioids in 2019. The highest to lowest state ratio of total opioid distribution, corrected for population, decreased from 5.25 in 2011 to 2.78 in 2019. The mean 95 th /5 th ratio was relatively consistent in 2011 (4.78 +0.70) compared to 2019 (5.64+0.98). In conclusion, this study found a sustained decline in distribution of ten prescription opioids during the last half-decade. Distribution was non-homogeneous at the state level. Analysis of state-level differences revealed a threefold difference in the 95 th :5 th percentile ratio between states which was unchanged over the past decade. Production quotas did not correspond with the distribution, particularly in the 2010-2016 period. Future research focused on identifying factors contributing to the observed regional variability in opioid distribution could prove valuable to understanding, and potentially remediating, the pronounced disparities in prescription opioid-related harm in the US.

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Section: Discussionmentioning

confidence: 93%

Declines and pronounced state level disparities in prescription opioid distribution in the United States

Madera

Ruffino

Feliz

et al. 2022

Preprint

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“…The treatment and non‐medical use data presented here support recent studies that indicate no evidence of unintended harms with codeine re‐scheduling. This differs from that seen with re‐scheduling of hydrocodone in the United States with a shift to other opioids [12]. This also contrasts with perceptions of pharmacists and consumers, and with concerns raised in submissions to the Therapeutic Goods Administration [13].…”

Section: Figurementioning

confidence: 90%

Commentary on McCoy et al.: More pieces of the mosaic describing outcomes of the Australian up‐scheduling of over‐the‐counter codeine to prescription only

2021

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“…Findings from US studies investigating the effects of re‐scheduling hydrocodone containing products from Schedule III to Schedule II in 2014 demonstrated that opioid restriction can lead to unintended consequences. One systematic review [68] evaluated changes in opioid dispensing and use after hydrocodone containing products were moved and it was found that re‐scheduling was associated with a decline in prescriptions for hydrocodone, but with an increase in prescriptions and use of other Schedule II and non‐Schedule II opioid medications. Additionally, after hydrocodone was restricted, a sharp increase in illegal opioid sales in the on‐line black‐market sales was observed [69].…”

Section: Discussionmentioning

confidence: 99%

A prospective cohort study evaluating the impact of upscheduling codeine in Australia among frequent users of codeine

2021

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Aim To evaluate and document the impacts of re‐scheduling codeine to a prescription‐only medication in Australia in February 2018. Design Prospective cohort study. Participants completed an on‐line survey with a range of outcome measures at four time‐points, once before codeine was re‐scheduled (November 2017) and three times after the event: 1 month after (February 2018), 4 months after (June 2018) and 12 months after (February 2019). Setting Australia. Participants Participants were 260 Australians aged 18 years and above who reported regular over‐the‐counter (OTC) codeine use and, at the time of the study, were not engaged in treatment for codeine dependence. Measurements Survey measures included estimates of daily average codeine use (mg) and overall daily average opioid use [calculated using an oral morphine equivalent daily dose (OMEDD, mg)], opioid use disorder with regard to codeine use (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule‐IV), pain and pain self‐efficacy, anxiety and depression and health service use. Findings A reduction in total daily codeine use (mg) from 64.3 mg [95% confidence interval (CI) = 46.7–81.9] in November 2017 (baseline) to 27.6 mg (95% CI = 19.2–36.0) in February 2019 (final time‐point) was observed. A decline in the proportion of participants who met criteria for an opioid use disorder was also evident, with 51.2% (n = 133) at baseline relative to 33.3% (n = 58) at the 12‐month follow‐up. This study had an overall participant retention rate of 67% at the final time‐point. Conclusion Re‐scheduling codeine in Australia has been accompanied by significant reductions in codeine use and prevalence rates of opioid use disorder in a cohort of individuals who regularly use the medication, without apparent adverse impacts on pain or measures of anxiety and depression.

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Effects of hydrocodone rescheduling on opioid use outcomes: A systematic review

Cited by 15 publications

References 46 publications

Declines and pronounced state level disparities in prescription opioid distribution in the United States

Declines and pronounced state level disparities in prescription opioid distribution in the United States

Commentary on McCoy et al.: More pieces of the mosaic describing outcomes of the Australian up‐scheduling of over‐the‐counter codeine to prescription only

A prospective cohort study evaluating the impact of upscheduling codeine in Australia among frequent users of codeine

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