The Aftermath of Hydrocodone Rescheduling: Intentional and Unintended Consequences

The U.S. consumes about 99% of the world’s supply of hydrocodone, primarily in hydrocodone combination products (HCPs). The Drug Enforcement Administration’s (DEA) rescheduling of HCPs from Schedule III to the more restrictive Schedule II has changed prescribing patterns. The purpose of our article was to revisit HCP rescheduling to determine the impact this change had and its related consequences. Before 2014, DEA drug classification (scheduling) caused the “Vicodin loophole” which allowed HCP products to be prescribed under less restrictive conditions than single-entity hydrocodone products or oxycodone combination products. The rescheduling of HCPs to the more restrictive Schedule II has resulted in a decrease in HCP use but increased use of other analgesics. Unintended consequences of the rescheduling may include additional healthcare provider work, the potential for added costs, and patient inconvenience. For some patients, the rescheduling of HCPs may mean that they no longer have access to their preferred or effective analgesic or that they have been switched to another possibly less effective or tolerable analgesic. While the rescheduling has reduced the prescribing of hydrocodone, it is not apparent that it resulted in a net decrease in opioid use.