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Hydrocodone will be harder to get under new rules

Hydrocodone combination products such as Vicodin will be slapped with harsher federal restrictions and will be harder to come by for doctors and patients starting Oct. 6, something Jackson County Medical Director Dr. Jim Shames says is long overdue.

The Drug Enforcement Administration Friday released its final decision to reassign hydrocodone from a Schedule III drug classification to Schedule II, tightening government regulations regarding the country's most popular prescription opioid and stiffening criminal charges for those caught illegally possessing and selling it.

According to the DEA's final rule, the Schedule II stamp means prescriptions will not be refilled for Vicodin and a laundry list of other painkillers and cough suppressants that contain hydrocodone. Instead, patients will be required to visit a physician and receive a new prescription before receiving more medication. Also, doctors will no longer be able to call in their prescriptions by telephone to a pharmacy, where the hydrocodone combo drugs will be kept in a special vault.

"There will be some people who will be truly inconvenienced and there will be some people who need to be inconvenienced. In the long term, it's an overdue safety regulation," said Shames. "It will be an additional hardship for anybody who is taking Vicodin on a daily basis, but the chronic use of opiates, taking them everyday because you have pain, it's not a terribly effective — and a fairly dangerous — treatment."

The majority of Jackson County's 30-or-so annual overdose deaths are caused by prescriptions, according to the Medford-based Opioid Prescribers Group, headed by Shames and made up of more than 70 health care professionals who are developing better ways to assess addiction risk for patients, treat chronic pain and get treatment for addicted patients.

The Center for Disease Control considers prescription drug abuse in the United State an epidemic. More than than 80 percent of the world supply of painkillers is consumed in the U.S., according to the Centers for Disease Control, and prescription drug-related overdoses accounted for about 22,000 deaths nationally in 2010 — that's 60 percent of the total number drug overdose-related deaths reported that year.

A recent study from the National Center for Health Statistics shows prescription-drug overdose deaths in the U.S. have surpassed car accidents every year since 2008.

Medical officials say current data about opioid painkillers runs counter to the philosophy of the late 1990s and early 2000s, when the importance of treating chronic pain with opiates was front and center, and the risk of becoming hooked was viewed as slim.

In its final rule, the DEA said "the current analysis of (hydrocodone combination products) by (The United States Department of Health and Human Services) shows they have a high potential for abuse, and abuse may lead to severe psychological or physical dependence. ... The DEA has long held that increased heroin use is driven primarily by an increase in the misuse and abuse of prescription opioid drugs, particularly (hydrocodone combination products).

"Prescription drug abuse has increased exponentially in the last 15 years and is the nation's fastest growing drug problem. Factors including excessive prescriptions, drug availability through friends and family, Internet trafficking, rogue pain clinics, pharmacies that dispense illegitimate prescriptions, and failed safeguards by wholesalers and manufacturers to guard against diversion have all contributed to the prescription drug abuse problem."

Medford pain specialist Dr. Shawn Michael Sills, who struggled with an addiction to painkillers nearly a decade ago, said the reclassification of hydrocodone combos is a good thing.

"I am not 100 percent sure it's going to help (stop abuse)," Sills said. "I think it will help to some degree, but I think that too often regulators focus on this sort of thing, trying to control the supply, than to research how to combat addiction or treat it better. ... I think the people who want to abuse it will just find something else."

AARP of Oregon spokeswoman Shelley Buckingham said the reclassification creates an unnecessary hardship on some seniors.

"I think that the biggest thing is that it's going to create hardship for some people, especially if they live in rural areas or for people who don't drive," she said. "Older people are very concerned about being addicted to these kinds of drugs. There are always some people who are going to have a problem with them, but most people limit themselves as they get older."

Shames said the United States needs to reconsider its approach to using opioids for treating chronic pain.

"I think the big picture here is that it makes the most commonly prescribed opiate harder to freely prescribe. ... I think it stops and makes everyone think," he said.

Reach reporter at Sam Wheeler at 541-776-4471 or swheeler@mailtribune.com. Follow him at www.twitter.com/swhlr.

Vicodin and other hydrocodone combination products have been reclassifed as Schedule II drugs, making them harder to get and increasing penalties for people who abuse them. Mail Tribune / Bob Pennell illustration