Decreased Opioid Prescribing in a Pediatric Emergency Department After the Rescheduling of Hydrocodone

J Emerg Med. 2017 Apr;52(4):547-553. doi: 10.1016/j.jemermed.2016.08.026. Epub 2016 Oct 7.


Background: The Drug Enforcement Administration (DEA) changed hydrocodone-containing products (HCPs) from Schedule III to II status on October 6, 2014, making codeine-containing products (CCPs) the only non-Schedule II oral opioid agents.

Objectives: We sought to describe prescribing patterns of oral opioid agents in the pediatric emergency department before and after the 2014 DEA rescheduling of HCPs.

Methods: We performed a cross-sectional study evaluating prescribing patterns in the pediatric emergency department at an urban, academic, quaternary care children's hospital system for 6 months before and 6 months after the DEA rescheduling of HCPs. Differences in patient demographics, provider type, and diagnoses were assessed during the two time periods using Pearson's chi-squared test. The Breslow-Day statistic was used to assess differences in prescribing patterns by provider type.

Results: There were 1256 prescriptions for HCPs and CCPs in our pediatric emergency department during the study period, and only 36 prescriptions for alternate oral opioid medications. Prescriptions of all opioid pain medications decreased by 55% after rescheduling. The odds of prescribing HCPs were reduced by 60% after the DEA rescheduling (odds ratio 0.40 [95% confidence interval {CI} 0.30-0.54]; p < 0.001). There was no difference between monthly ordering frequencies for CCPs before or after the DEA rescheduling (p = 0.75).

Conclusions: The period after rescheduling of HCPs was associated with a lower odds of HCP prescriptions in our emergency department without an increase in the prescription of CCPs.

Keywords: DEA rescheduling; codeine; emergency department; hydrocodone; pediatric.

MeSH terms

  • Analgesics, Opioid / pharmacology
  • Analgesics, Opioid / therapeutic use
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data*
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Hydrocodone / therapeutic use*
  • Male
  • Pain / drug therapy
  • Pediatrics / methods
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Workforce


  • Analgesics, Opioid
  • Hydrocodone