Vicodin, one of the most popular and routinely prescribed analgesic drugs in dentistry, has become a little tougher to acquire. In a recent rule change published by the Drug Enforcement Agency (DEA) , hydrocodone combination product (HCP) drugs, including popularly prescribed drugs Vicodin and Norco, have been reassigned from Schedule III to the more restrictive Schedule II.

Hydrocodone combination product drugs, which include the potent semi-synthetic opioid analgesic hydrocodone administered in combination with acetaminophen (e.g., Tylenol), are the most commonly prescribed medications in the United States, according to an article published by the American Academy of Family Practitioners . These drugs have long been thought and used by practitioners as the first line of defense against pain, hence their popularity among physicians. However, these drugs also have a very high potential for addiction, abuse, and diversion, as compared to the lesser analgesics ibuprofen or acetaminophen .

In response to a frightening rise in prescription drug overdoses related to HCPs, the FDA has tightened regulations for these drugs with a new rule that took effect on October 6^th, 2014. While these drugs used to be obtained under Schedule III rules, meaning that prescriptions could be phoned and faxed in to a pharmacy without an office visit, the stricter schedule II rules will now apply. Schedule II drugs, which are classified as drugs with the highest potential for abuse, require that patients must visit their doctor in person to receive a prescription, and no refills can be given (meaning that a new prescription must be written out for each disbursement of drugs). This has been done in hopes that creating more safeguards to HCP drugs will help prevent their over-prescription and decrease the number of drugs abused and diverted from their prescribed purpose.

So what does this mean for us as dentists? In theory, not much should change. The most prudent course of action has always been to give a thorough examination before prescribing any medications, including pain medication. In fact, in many cases the prescription of HCP drugs may not even be necessary. A Cochrane review showed that a combination of ibuprofen and acetaminophen at over-the-counter doses was more effective at reducing pain than opiate-containing drugs . It should then be our goal as health professionals to relay this information to patients in order to help reduce the amount of (in many cases, needlessly prescribed) HCP drugs in circulation. In any case, the potential public health benefits of this rule change will undoubtedly outweigh any potential drawbacks. [RG4]Here too a reference is necessary for this claim. You can footnote all three at the end of this excellent blog.