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02/01/2013

Protecting Us from Pain Control

Craig Klugman, Ph.D.

Last week, an FDA advisory panel suggested that hydrocodone-based pain control medications be reclassified from Schedule III to Schedule II. The panel made the recommendation out of a concern that an increasing number of people are becoming addicted to painkillers.

The expressed worry is that the non-medical use of these prescription painkillers is becoming an “epidemic” to quote a frequently used term. Hydrocodone is currently a Schedule III substance, which means it has some potential for abuse. Such drugs must be prescribed by a physician who can send the order to a pharmacy orally, in writing, or by fax and it may be refilled up to 5 times within 6 months before a new prescription is required. Schedule II drugs have a high potential for abuse such as morphine, opium, and codeine. These drugs require a signed, written prescription delivered by hand or fax to the pharmacy (via phone is only permitted in emergency situations). The Drug Enforcement Agency (DEA) allows multiple prescriptions for no more than a 90-day supply but many states limit the quantity to a 30-day supply. Schedule II drugs cannot be refilled, thus a new doctor’s visit and prescription is required for each renewal.

Hydrocodone is found in many popular painkillers like Vicodin, Norco, Lortab, OxyContin and about 200 other medications. Every year, more than 69 tons of oxycodone are distributed through U.S. pharmacies. In 2012 sales of hydrocodone drugs soared in Appalachia and the Midwest. In 2008 there were 14,800 overdose deaths.

The intention is that rescheduling will make it more difficult for people to procure large amounts of hydrocodone for personal non-medical use or to sell to others. There is no data to support this premise. The flipside is that individuals who need relief from moderate to severe pain will find getting help more difficult. Patients with such pain would need to visit their doctor more often, increasing the cost of care and being a major inconvenience. For seniors, those with disabilities, and individuals with pain-related conditions (e.g. fibromyalgia) the challenges of mobility and transportation are significant. Not to mention that many physicians are reluctant to prescribe Schedule II drugs in doses necessary to relieve severe pain, in order to stay below the DEA’s radar.

At the same time, a 2011 Institute of Medicine report described that 116 million American experience chronic pain and that the U.S. needs to train health care professionals to help these patients find relief. In this latest move, he U.S. has decided that the epidemic of addiction outweighs the epidemic of uncontrolled pain.

The notion that we would keep people in pain to combat a perceived threat is certainly an imbalance of justice. This is another example of the failed war on drugs begun in 1971 that has imprisoned nearly 500,000, placed over one million on probation, and nearly 300,000 on parole. This is the same thinking that now subjects me to a registry simply for buying a nasal decongestant because a few people might use an ingredient in the pill to make meth.

The war on drugs is not only an expensive and socially damaging failure, but the blinders that prevent us from admitting its failure and to change tactics. To continue on our current path means turning a growing portion of our population into criminals for seeking pain relief or requires millions of Americans to suffer in pain. The advisory board recommendations are one more step in a direction that penalizes legitimate medical need in pursuit of misguided policies.

 

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