DEA aims to cut pain drug's use
BY MARC KAUFMAN
Washington Post Service
WASHINGTON - The Drug Enforcement Administration is working to make one of the most widely prescribed medications more difficult for patients to obtain as part of its stepped-up offensive against the diversion and abuse of prescription painkillers.
Top DEA officials confirm that the agency is eager to change the official listing of the narcotic hydrocodone -- which was prescribed more than 100 million times last year -- to the highly restricted Schedule II category of the Controlled Substances Act. A painkiller and cough suppressant sold as Lortab, Vicodin and 200 generic brands, hydrocodone combined with other medications has long been available under the less stringent rules of Schedule III.
The DEA effort is part of a broad campaign to address the problem of prescription drug abuse. The initiative has repeatedly pitted the agency against doctors, pharmacists and pain sufferers, and it is doing so again with the hydrocodone proposal.
Pain specialists and pharmacy representatives say the new restrictions would be a burden on the millions of Americans who need the drug to treat serious pain from arthritis, AIDS, cancer and chronic injuries, and that many sufferers are likely to be prescribed other, less effective drugs as a result.
If the change is made, patients, would have to visit their doctors more often for hydrocodone prescriptions, because they could not be refilled; doctors could no longer phone in prescriptions; and pharmacists would have to fill out more paperwork and keep the drugs in a safe. Improper prescribing would carry greater penalties.
The DEA says the change is necessary because hydrocodone is being widely misused -- with a 48 percent increase in emergency room reports of hydrocodone abuse from 1998 to 2001. The drug, a semisynthetic chemical cousin of opium, produces a morphine-like euphoria if taken without a medical purpose but generally does not produce a similar ''high'' in patients with severe or chronic pain.
DEA officials would not say when they might begin to change the schedule, but other federal officials said the DEA wants to act soon.
''Rescheduling the drug will bring more hoops and barriers to getting access to the drugs, and it may prevent some minimal amount of abuse,'' said Richard Payne, president of the American Pain Society. ``But my concern is that it will come at the cost of denying access to thousands of patients.''
Wow. I know there was a thread about moving the other way with this stuff, but this would be disasterous to my ability to practice medicine in the Emergency setting. I can't prescribe Schedule II controlled substances, but I regularly write for Lortab 7.5 in limited quantities.
I find that practitioners now are generally more unwilling to appropriately treat pain than they were even ten years ago, and a vast majority of the physicians I know won't even write for a Schedule II in outpatient setting. What's left? Basically the designer NSAIDs (you would be better off taking an Advil unless you have GI problems), Tylenol #3, which I find to cause more nausea, and Darvon (great drug, I think should be OTC, but sometimes just won't cut it).
I suppose I will just start prescribing Stadol NS for everything. It will sure as hell get you more high than a Vicodin will, but that and Talwin-NX would be the only really effective analgesics left at my disposal.
It's kind of sad.