Those who keep a close eye on the pharmaceutical news know that our country has a drug trafficking, abuse, addiction and overdose problem of epidemic proportions. Now, I have been very outspoken about how misleading these statistics are sometimes presented. For example, we call it an “accidental” overdose when someone decides to willingly experiment with taking a half bottle of vodka and popping 20 narcotic painkillers (for which he had no prescription to begin with). We call that death an “accident” as if the drug itself was to blame. But that is hardly what we typically think of when we talk about an “accident” in normal life.
But however wrongly and misleadingly the statistics about drug abuse and overdose are presented, it is hard to deny that hydrocodone is often implicated in these stories of abuse, addiction and death. We use it a lot. It is prescribed a lot.
In an attempt to decrease the utilization of hydrocodone combination products (such as generics of Vicodin, Norco or Lortab) the DEA recently announced that as of October 6, 2014 all such products will become Schedule II controlled substances (they are currently Schedule III). To be fair – this decision was made because they are convinced now that hydrocodone combinations are addictive enough for this classification. They’re probably right. This means prescriptions for these products can NOT have refills and will be tracked more stringently. This means they will probably now be stored in a safe or locked drawer in the pharmacy.
Sounds like a lot more security, right? Sounds like a good plan, right? Sounds like this will reduce our problem with addiction, abuse and overdose, right?
The easiest way to expose the foolishness of this attempt to deal with the REAL overdose and abuse problem we have as a nation is to think about it from the perspective of the individuals who are causing the problem.
Let’s do that. Come with me for an imaginary journey into the minds of certain individuals who just picked up the news about the hydrocodone rescheduling. Let’s listen in to their thoughts.
Do you imagine them thinking along these lines?
Scum Bad Drug Dealer: “Oh no. The U.S. has now gotten serious. Hydrocodone will be Schedule II. Darn. What will I do? Hmmm. Now probably is a good time to just take my earnings and stop dealing. Clearly this country means business. Maybe I should go into car sales or go back to school and get that accounting degree I always wanted. Rats. I never saw this coming. Time to tell my customers that I’m through.”
Pill-Mill Prescriber: “Oh no. What am I going to do? I was making such a great living handing out hydrocodone combination pill prescriptions to my patients who came and complained about pain that I know they didn’t have. But the cash business and insurance reimbursements were so nice!! It was so convenient to just FAX those prescriptions to the pharmacy! Now I have to actually WRITE them! This is awful. Now I might have to start practicing medicine again! But who will hire me? And where will I find patients who want to see me for my clinical knowledge rather than my ability to write for narcotics? This is a tragedy. I’m finished. I guess I’ll have to turn in my Porche and multi-million dollar house. Those folks at the DEA are just too smart for me.”
Rogue Unethical Pharmacist: “Oh no. Now Hydrocodone is schedule II. What will I do about all those fake or unnecessary prescriptions for hydrocodone that I had been filling for unreasonably high cash prices? Now I actually have to write down and keep track of each tablet I give out! This will ruin me! There is no way I could possibly falsify records any more. Darn those DEA agents. My business is finished. Guess I just have to make money the old fashioned way now and actually work for it. So sad. Hmmmm. What is the markup on vitamins? Maybe I could open a GNC.“
Medicaid-Abusing Doctor-Hopping Addict: “Oh no. Hydrocodone combinations are now schedule II. No refills? Now I have to go back to the doctor EVERY time I need a new prescription to maintain my habit (and sell a few on the side). This is terrible. I don’t think I have time for this. I mean, once I collect my Medicaid check, food stamps and other free services that the stupid taxpayers of this state give me for nothing…I hardly have time to hit 3 Emergency rooms any more! Plus it will probably take longer to get these prescriptions now. Who has time for that? I’ve got TV shows to watch! This is bunk. I guess it is time to come clean. Give up the habit and all the freebies that I get and go to work. Well, it was nice while it lasted. Is K-mart hiring?“
Now, if you can honestly picture any of the above conversations going on in the mind of any of these individuals…then yes…this hydrocodone rescheduling will be a great success. And if you HONESTLY think that the REAL problem in our society with hydrocodone is from little old ladies having knee replacement surgery or cancer patients who are trying to just get through another day…then I’m afraid I have nothing more to say. You can continue to imagine that our problem all begins when someone gets a hydrocodone prescription after a tooth extraction and they turn into a drug-seeking abuser and addict overnight.
But you’re wrong. The studies and data prove it if you’re willing to do the research. Our nation’s drug problem is not an accident. The hospital ED is not typically filled with people who mistakenly (oops!) took too much (though yes…that SOMETIMES happens). We have a much deeper, much larger, much harder problem on our hands. I wish solving it was as easy as moving a drug to a new schedule. I wish we could stop overdose deaths just by eliminating refills on a prescription. That would be great. But it’s not the answer. And I’m sorry to say that this latest move is a waste of time.
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