New rules make hydrocodone painkillers harder to refill

ST. LOUIS – It’s going to be more difficult to refill prescriptions for the most popular painkillers starting today, when new federal rules move products with hydrocodone into a stricter drug class reserved for the most dangerous and addictive substances.

In approving the change, the Drug Enforcement Administration cited the 7 million Americans who abuse prescription drugs and the 100,000 overdose deaths from painkillers in the last decade. Hydrocodone combinations, including Vicodin, Lortab and Norco, now account for more prescriptions than any other drug, with more than 130 million filled each year.

Proponents of the new rules believe many prescriptions go to younger people for recreational use because they are less likely to suffer from arthritis or other chronic pain conditions.

But many doctors, pharmacists and patients say the rule change effectively punishes people suffering from pain conditions because a small minority of the population abuses the drugs. The changes will be most burdensome for patients with cancer, disabilities and those who live in rural areas or in nursing homes, advocates say.

“For some patients who are legitimately using hydrocodone products for pain, this will be more challenging for them,” said Amy Tiemeier, associate professor at St. Louis College of Pharmacy. “For physicians, the hassle will make them think twice about whether it’s really necessary to prescribe this drug or maybe they should prescribe something else that has less addiction potential.”

The changes mean:

• Prescriptions for hydrocodone combination painkillers can be only for a 30-day supply.

• No refills will be allowed.

• Each prescription must be handwritten by a doctor, not called in or faxed to a pharmacy.

• Only doctors can write the prescriptions, not nurse practitioners, physician assistants or other midlevel providers.

“This is going to have a big impact on our practice,” said Dr. Robert Swarm, chief of pain management at Washington University in St. Louis. “Every time you prescribe a medication the doctor has to sign a piece of paper, and the patient has to get to the pharmacist. In a lot of situations that’s difficult to put together.”

Previously, doctors could prescribe a 30-day supply of hydrocodone combination drugs with up to five refills. Under the new classification there is some flexibility for post-dating prescriptions to allow for a 90-day supply, and doctors may be able to call in emergency short-term prescriptions for an injury or other acute need. But pharmacies don’t have to agree to those concessions, doctors said.

“The spirit of (the new rule) is every time the medicine is dispensed, the doctor is supposed to make a conscious review of the case and a decision to write a new prescription,” Swarm said.

That could lead to more emergency room visits or an even bigger black market for people seeking painkillers. And patients who decide to self-medicate with over-the-counter drugs run the risk of liver damage from taking too much.

Now there won’t be many options for prescription painkillers in the less restrictive classifications. Tylenol with codeine won’t be as tightly controlled, but the drug’s effects are more variable and potentially more risky compared to hydrocodone products, Swarm said.