The Battle Over Hydrocodone: Pharmacists Take a Surprising Stand

US Senator Joe Manchin (D - WV) has authored a piece of legislation that would reschedule hydrocodone from schedule III to schedule II (via an amendment to the Prescription Drug User Fee Act).  This sounds simple enough and enjoys bipartisan support on the Hill. 

1) Most claims people (and even many clinical people) think hydrocodone is already a schedule II drug.
2) There's no doubt that hydrocone-containing products are dangerous, come with significant risk of addiction, and should be better controlled than they currently are. 
3) This represents an opportunity for politicians and regulators to show that they're at least willing to take some easy steps to stem the tide of prescription drug over-utilization and abuse in this country. 

You would think, at least. 

A letter was sent last week to all members of the House and Senate from five aligned groups that have two things in common: first, they are either made up of or represent pharmacists; and second, they don't want to see this bill pass.  The groups?  The American Pharmacists Association, Food Marketing Institute, International Academy of Compounding Pharmacists (really?), National Association of Chain Drug Stores, and National Pharmacists Association. 

The letter states, in part:
“We understand the concerns about diversion and abuse of these products and we share these concerns.  Nevertheless, moving all of these hydrocodone products to Schedule II will result in significant barriers for patients who have a legitimate need for these products, and it will result in adding to the nation’s healthcare costs with no assurance of a reduction in diversion and abuse.”

That is absolutely wrong headed. 

What are the practical implications of moving hydrocodone products to schedule II?
- They can't be prescribed as easily physicians and some states restrict NPs and PAs from precribing schedule II drugs at all.
- The drugs will become more costly for pharmacies to obtain and inventory will become more expensive to manage (given the stringent storage and inventory assessment requirements). 

Making hydrocodone harder to obtain WILL NOT impact patients that truly need the drugs.  The real issue here is that pharmacy margins, already thin, are going to take a hit.  I acknowledge this is a real economic issue and an unfortunate unintended consequence of doing the right thing.

Michael
On Twitter @PRIUM1