Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery

Abstract

Importance: In 2014, the US Drug Enforcement Administration moved hydrocodone-containing analgesics from schedule III to the more restrictive schedule II to limit prescribing and decrease nonmedical opioid use. The association of this policy change with postoperative prescribing is not well understood.

Objective: To examine the hypothesis that the amount of opioids prescribed following surgery is associated with the rescheduling of hydrocodone.

Design, setting, and participants: An interrupted time series analysis of outpatient opioid prescriptions was conducted to examine the trends in the amount of postoperative opioids filled before and after the schedule change. Opioid prescriptions filled between January 2012 and October 2015 were analyzed using insurance claims data from the Michigan Value Collaborative, which includes data from 75 hospitals across Michigan. A total of 21 955 adult inpatients 18 to 64 years of age who underwent 1 of 19 common elective surgical procedures and filled an opioid prescription within 14 days of discharge to home were eligible for inclusion.

Main outcomes and measures: The primary outcome was the trends in the mean amount of opioids filled in oral morphine equivalents (OMEs) for the initial postoperative prescriptions before and after the schedule change date of October 6, 2014, compared using interrupted time series and multivariable regression analyses. Secondary outcomes included the total amount of opioids filled and the refill rate for the 30-day postoperative period. Subgroup analyses were performed by hydrocodone prescriptions, nonhydrocodone prescriptions, surgical procedure, and prior opioid use.

Results: Data from 21 955 patients undergoing surgical procedures across 75 hospitals and 5120 prescribers were analyzed. Cohorts before and after the schedule change were equivalent with respect to sex (10 197 of 15 791 [64.6%] vs 3966 of 6169 [64.3%] female; P = .69) and mean (SE) age (47.9 [11.2] vs 47.7 [11.3] years; P = .19). After the schedule change, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs (β = 35.1 [13.2]; P < .01), equivalent to 7 tablets of hydrocodone (5 mg). There were no significant differences in the total OMEs filled during the 30-day postoperative period before and after the schedule change (β = 18.3 [30.5]; P = .55), but there was a significant decrease in the refill rate (β = -5.2% [1.3%]; P < .001).

Conclusions and relevance: Changing hydrocodone from schedule III to schedule II was associated with an increase in the amount of opioids filled in the initial prescription following surgery. Opioid-related policies require close follow-up to identify and address early unintended effects given the multitude of competing factors that influence health care professional prescribing behaviors.

Figure 1.. Interrupted Time Series Analysis Showing Mean Change in Oral Morphine Equivalents (OMEs) Filled for All Opioids in Initial Postoperative Prescriptions Following the Hydrocodone Schedule Change of October 2014

Figure 2.. Interrupted Time Series Analysis Showing Mean Change in Oral Morphine Equivalents (OMEs) Filled for Hydrocodone in the Initial Postoperative Prescription Following the Hydrocodone Schedule Change of October 2014

Figure 3.. Adjusted Differences in Oral Morphine Equivalents (OMEs) Filled in the Initial Postoperative Prescription After the Hydrocodone Schedule Change for All Patients by Surgical Procedure and by Preoperative Opioid Use

OB/GYN indicates obstetrics and gynecology; error bars, the variation around point estimates.