If you take a pain medication that contains the opioid hydrocodone, be prepared for changes in how often you can get your prescription filled and for additional costs. Faced with an epidemic of abuse, addiction and deaths related to hydrocodone use, the federal government has imposed restrictions on what is currently the most widely prescribed drug in the United States.

Beginning this month, patients who take Vicodin, Norco, Lortab and other hydrocodone-containing products (HCPs) will only be given one 90-day supply. Previously classified as Schedule lll drugs under the Controlled Substances Act, they have been moved into the more restrictive Schedule ll category. This is the same class as methadone, morphine, oxycodone and fentanyl. Patients needing refills must now make an appointment to see their health care provider and be reevaluated before they can get another prescription. Depending on where someone lives, the provider may have to be a doctor, as some states are no longer allowing nurses and physician assistants to write opioid scripts.

The reclassification comes amid a rising tide of deaths in the U.S. related to drug use. Every day, 113 people die from drug overdoses. Drug overdose has surpassed motor vehicle crashes as the leading cause of injury death in the U.S., claiming 41,340 lives in 2011. More than half of these deaths were related to pharmaceuticals, most of which were opioids. Misuse and abuse of these prescription pain medications were also responsible for more than 1.4 million emergency room visits.

This deluge coincides with the growing number of medical conditions for which opioids are prescribed. Once reserved for managing acute pain such as that suffered by cancer patients, opioids are now often prescribed as treatment for a litany of everyday aches due to muscle strains and sprains, minor dental surgery and arthritis. The problem is that it doesn’t take long to build up a tolerance. To continue to get relief, users require more of the medication than is safe. This increases their likelihood of overdosing and of becoming addicted. To satisfy their cravings, some people will doctor shop or they will buy off the street, which heightens their chances of becoming a victim of crime. They may also turn to heroin, which is cheaper and easier to obtain. Meanwhile, the increased accessibility and availability of these medications has led to more recreational use. In 2010, more than 12 million people reported they were using opioid painkillers for nonmedical purposes.

In parts of the country like West Virginia where prescription drug abuse is particularly acute, the reclassification has been welcomed. The Mountain State has the highest drug overdose mortality rate in the country; nearly 29 out of every 100,000 people die from drug overdoses.

“Although there is much more that must be done to curb prescription drug abuse, I am confident that rescheduling hydrocodone will undoubtedly begin saving hundreds of thousands of lives immediately,” said U.S. Sen. Joe Manchin, D-W.Va. in a statement.

But within the medical community, there is dissension about how reclassification will affect patients legitimately in need of the medications and how the medical profession itself stands to be burdened. Last year, while reclassification was being debated, the American Association of Neurological Surgeons and Congress of Neurological Surgeons (AANS/CNS) was just one of a number of health organizations to speak out against it: “Reclassification would require more frequent office and emergency room visits, unnecessarily increasing the time and resources allocated to refilling these medication prescriptions, which are often used in modest amounts,” the AANS/CNS said in a statement.

On the other hand, the American Society of Addiction Medication (ASAM) said reclassification coupled with doctors who are more informed can make a difference in reducing the avalanche of overdoses, addictions and deaths related to opioids. According to the organization, most prescribers have had little to no formal pain management or addiction treatment training.

“The vast majority of doctors prescribing hydrocodone are dealing with patients who have significant pain and for whom these drugs provide serious relief,” said Dr. Brad Hall, an ASAM member practicing in West Virginia. “The problems begin when doctors and patients don’t know how or when to taper these medications. A little education about pain management and addiction risk evaluation could go a long way toward stemming the opioid epidemic and overdose rates.”

[Janet Lubman Rathner]