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 6th, 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.Here
too a reference is necessary for this claim. You can footnote all three at the
end of this excellent blog.