Trends in hydrocodone combination product exposures reported to California Poison Control System (CPCS) following DEA rescheduling

Abstract

Context

On October 6, 2014, the United States Drug Enforcement Administration (DEA) implemented a regulatory change for hydrocodone combination products (HCPs), moving them from Schedule III to II, in an effort to decrease drug overdoses. Existing research suggests this regulatory action reduced HCP prescribing and dispensing; however, there is limited research assessing its possible effects on overdoses and accidental exposures.

Objective

To analyze the changes in opioid exposures reported to the California Poison Control System (CPCS) before and after DEA rescheduling of HCPs.

Methods

We collected monthly exposure data reported to CPCS from 2012 to 2019 and conducted interrupted time series analyses to assess changes in exposures after rescheduling for HCPs, tramadol, oxycodone, morphine, codeine, fentanyl, and heroin. Additional analyses were done to assess any changes in exposures resulting in severe outcomes (moderate or major health effects). For HCPs, we also conducted logistic regressions to identify characteristics of exposures resulting in severe outcomes before and after rescheduling.

Results

Overall monthly opioid exposures reported to CPCS decreased after DEA rescheduling of HCPs. These decreases were significant for HCP, tramadol, and morphine (p < 0.001). Exposures significantly increased for heroin and fentanyl (p < 0.001). There were no significant changes in the share of severe outcomes attributed to HCP exposures after rescheduling.

Discussion

The DEA rescheduling of HCPs was associated with a significant decrease in HCP exposures and prescription opioid exposures overall, but was associated with increased fentanyl and heroin exposures. While other initiatives may have contributed to this decrease, our findings suggest that rescheduling may be a useful regulatory strategy to reduce drug exposures.

Conclusion

DEA rescheduling of HCPs was associated with a significant reduction in prescription opioid exposures, suggesting that rescheduling high-risk drugs may be an effective strategy to improve public health.

Keywords:

• Hydrocodone
• analgesics
• opioid
• drug overdose
• public health
• drug and narcotic control

Acknowledgments

The authors acknowledge Dr. Evans Whitaker for his assistance in gathering data concerning hydrocodone-related topic trends in scientific literature and the popular press, and Dr. James Lightwood for his insight on data analysis and potential confounding factors.

Disclosure statement

The authors declare they have no actual or potential competing financial interests.

Author contributions

All authors worked together to design the study, analyze the data, interpret the results, and revise the manuscript. KN, CP, MQ, and AW drafted the manuscript, JL collected CPCS data, DA conducted interrupted time series analysis, and AW prepared the figures.

Data availability statement

Data for replication can be obtained by recruiting a collaborator employed by California Poison Control System (CPCS) and submitting a Data Request Form to the CPCS.

Additional information

Funding

This work was supported by National Institutes of Health #DA046051 (Apollonio). The funders had no role in the design or conduct of the study.