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State Reclassifies Hydrocodone

 State: NY


Hydrocodone Moves to Schedule II on State Drug List


By Michael Whiteley, Eastern Bureau Chief


New York officials moved a step ahead of federal drug regulators on Wednesday and shifted hydrocone – the most commonly prescribed painkiller in the nation – from Schedule III to Schedule II of the state's controlled substances list.


New York Attorney Eric Schneiderman sent an open letter to the state's doctors and pharmacists alerting them to the change, which imposes a new set of restrictions on the highly addictive opioid.


The schedule change took effect last Saturday. It was part of the Internet System for Tracking Over-Prescribing (I-STOP) Act, which Gov. Andrew Cuomo signed into law on Aug. 27, 2012.


Moving hydrocodone to Schedule II prohibits automatic refills of any drug containing hydrocodone and bans New York's doctors from prescribing more than a 30-day supply. Common brand-name drugs containing hydrocodone include Vicodin, Lortab and Tussionex.


The National Council on Compensation Insurance reported that combinations of hydrocodone and acetaminophen were the drugs most commonly prescribed to injured workers in 2007 and 2008. The medication fell behind OxyContin and Lidoderm in 2009.


"Hydrocodone is highly addictive and widely abused," Schneiderman said in a press release. "By implementing new rules for hydrocodone, including ensuring follow-up visits with patients instead of providing automatic refills, medical professionals can prevent more New Yorkers from being trapped in a damaging cycle of addiction."


In January, an advisory panel to the U.S. Food and Drug Administration recommended moving hydrocodone from Schedule III to Schedule II on the U.S. Drug Enforcement administration's controlled substances list. Federal regulations allow patients to refill Schedule III prescriptions up to five times. Federal regulations prohibit automatic refills of Schedule II drugs but allow doctors to issue multiple prescriptions that provide a patient with no more than a 90-day supply.


Pharmacists say the change in New York requires them to keep hydrocodone in locked cabinets and will require patients to see their doctors to get prescriptions refilled.


Selig Corman, a consulting pharmacist for professional affairs to the Pharmacists Society of the State of New York, said Wednesday the scheduling change caught some doctors by surprise.


"Pharmacists have been aware of this and began warning their customers that they were getting their last refills in January," Corman said. "But a lot of doctors haven't been aware of this change. It was up to their patients to begin scheduling doctors' visits."


Titan Pharmacy, a Queens, N.Y., business focused on injured workers, began sending out notices three months ago alerting workers' compensation patients that they will need monthly appointments with their treating physicians.


"It's not had a big impact on injured workers, because most of them are seeing their doctors once a month anyway," Rontiris said.


He said pharmacies face a bigger challenge when the balance of the I-STOP requirements take effect.


Beginning next August, pharmacies will have uploaded data to the state's prescription drug-monitoring program on the Schedule II-V substances in "real-time" instead of once each month.


Also in August, doctors will have to have registered to use the new I-STOP database and will have to begin checking it before prescribing controlled substances.


The legislation, passed as Senate 7637 in June 2012, also requires doctors to use electronic prescriptions for controlled substances beginning on Jan. 1, 2014.


Corman said the state's pharmacists are working with health officials to implement the new law. He said state regulators are expected to interpret the "real-time" provision of I-STOP as requiring pharmacists to upload controlled substances data once a day.


Schneiderman said Wednesday that hydrocodone is among a group of opioids that contribute to three of every four prescription-drug overdose deaths each year.


Statewide, prescriptions for hydrocodone increased 18.4% − from 3.8 million to 4.5 million − between 2007 and 2009, Schneiderman said. He said prescriptions for oxycodone jumped by 82% between 2007 and 2009.


Schneiderman said:

• Hydrocodone was the most commonly prescribed controlled prescription drug in Albany County, followed by the anti-insomnia drug Ambien and Xanax, an anti-anxiety drug, from 2008 through 2010.

• Hydrocodone was the most commonly prescribed controlled drug in Nassau County, followed by Ambien and oxycodone, between 2008 and 2010.

• Hydrocodone and oxycodone were the most commonly prescribed opioids in New York City in 2010, with more than 787,000 hydrocodone prescriptions filled that year. Schneiderman said requiring patients to see their doctors to obtain refills will boost physician oversight and give doctors additional chances to spot drug abuse and addiction.

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