Impact of hydrocodone reclassification on analgesic prescribing in the Veterans Health Administration

Abstract

Purpose. The impact of hydrocodone reclassification on analgesic prescribing in the Veterans Health Administration (VHA) was quantified. Methods. In this retrospective observational study, the volume of opioid medication dispensed was calculated quarterly from October 2011 to September 2015 using national VHA administrative data. Four volume measures were examined (prescription count, tablets dispensed, days' supply dispensed, and unique patients) for 4 opioid groups: hydrocodone combination products (HCPs), other opioid combination products, tramadol, and single-agent Schedule II opioids. HCP prescription count was further tabulated within longitudinal course of receipt groups: short-term, intermediateterm, and long-term. The initiation frequency of alternative analgesic pharmacotherapy, including opioid and nonopioid medications, was assessed among patients who discontinued long-term HCP receipt at reclassification. Results. HCP prescriptions declined by 172,535 (19.4%) in the quarter after reclassification, whereas other opioid categories remained unchanged. The number of HCP prescriptions decreased by 10.7% among patients with short-term opioid receipt, and by 23.3% and 19.4% for intermediateand long-term receipt groups, respectively. Among 13,416 individuals who discontinued receipt of long-term HCPs, replacement analgesics were not identified in 8,055 (60.0%) patients, whereas prescriptions for alternative opioids were observed in 3,557 (26.5%) and nonopioids in 2,753 (20.5%). Conclusion. HCP dispensing in VHA declined by 19.4% in the quarter after reclassification, which was driven largely by patients receiving longterm therapy. More than 13,000 veterans discontinued receipt of long-term HCP therapy after reclassification and the majority did not receive a replacement analgesic through VHA.