Vicodin and other prescription painkillers will soon be harder to get

Vicodin and other prescription painkillers will soon be harder to get

What tighter restrictions on hydrocodone products mean for you

Published: September 05, 2014 01:00 PM

U.S. healthcare providers write more prescriptions for Vicodin and other narcotic painkillers that combine the opioid hydrocodone with acetaminophen (the active ingredient in Tylenol) than for any other drug. But as of Oct. 6, 2014, when a new ruling from the Drug Enforcement Agency goes into effect, those medications and other hydrocodone-combination products are going to be harder to get.

For more than 40 years, medications that combine hydrocodone and other drugs have been classified as Schedule III controlled substances, but the new rule bumps them up to the stricter Schedule II category. Regulatory agencies have been considering the change for more than a decade, but increasingly grim statistics arising from the opioid epidemic in this country has created a sense of urgency. According to the national Centers for Disease Control and Prevention, abuse and misuse of opioid painkillers send half a million Americans to the emergency room each year for complications from the drugs and claim the lives of 46 people a day, or nearly 17,000 a year.

For more on the risks associated with opioids as well as tips for safe use of those and other pain relievers, see our special report "The Dangers of Painkillers."

“The movement of hydrocodone-combination drugs into the Schedule II category has been a long time coming,” Marvin Lipman, M.D, chief medical adviser for Consumer Reports, said. “The added restrictions will make it more labor-intensive to prescribe and dispense these medications, but that should also decrease unwarranted prescriptions and encourage more selective use of the drugs.”

If you are one of the hundreds of thousands of Americans who take one of these drugs, you may be wondering how the switch to Schedule II will affect how you get your medication. To answer that, we turned to our Best Buy Drugs team and medical advisers for the straight scoop on the impending change.

Photo: Fuse/getty Images

What does it mean when a drug is classified as 'Schedule II'?


Drugs with a potential for abuse are classified by the DEA as controlled substances, and divided into five categories, or “schedules.”

Schedule I drugs are mostly illegal substances that are not considered to have a medical use—for example, heroin and the street drug Ecstasy. Schedule II drugs have acceptable medical uses, but have a high abuse risk and can lead to physical and psychological dependence. Most narcotic painkillers, including fentanyl (Duragesic, Sublimaze, and generic), hydrocodone alone (Zohydro ER), morphine, oxycodone (OxyContin and generic), oxycodone combined with acetaminophen (Percocet and generic), are already classified as Schedule II. The new rule moves hydrocodone-combination drugs into this category with its chemical cousins.  

Schedule III drugs includes a few drugs such as acetaminophen with codeine (Tylenol with codeine and generics) and some stimulants and anabolic steroids, which have a lower abuse risk than Schedule II drugs and are less likely to lead to addiction.

Schedule IV and V drugs, which include sedatives such as alprazolam (Xanax and generic), diazepam (Valium and generic), and lorazepam (Ativan and generic) and some prescription cough drugs, carry the lowest risk of abuse.

How does the switch to Schedule II change the way prescriptions are handled?


Schedule III, IV, and V drugs carry far fewer restrictions. Your doctor can write you a prescription or phone or fax it into your pharmacy. You can also refill your prescription up to five times in six months without going back to your doctor.

With Schedule II drugs, on the other hand, your doctor must write the prescription on paper or electronically transmit it to the pharmacy using a secure system. (Nationwide, about 70 percent of physician practices are now set up for “e-prescribing.”) He or she can fax a prescription to the pharmacy, but unless it is for a patient in a long-term care facility or hospice program, you will still need to present the paper prescription to pick up the medication.

In addition, refills are not allowed with Schedule II drugs and many states and insurance companies only allow you to get up to a month’s worth on a single prescription. But your doctor can write multiple prescriptions for a total of up to 90 days worth—for example, three 30-day prescriptions—with instructions to the pharmacist to fill them sequentially. If you need to take the drug for longer than three months, though, you’ll need to go back to your doctor for another prescription.

What if I need the medication after office hours or there’s some other reason I can’t get a paper prescription from my doctor?


In emergency situations your doctor can phone in a prescription for a few day’s worth of a Schedule II drug, but must still follow up in writing within a certain number of days, depending on the state. If you need additional medication after that, you’ll need another prescription.

Can I fill my prescription while traveling out of state?


It depends. State laws vary on whether or not pharmacists can fill prescriptions for Schedule II drugs written by a doctor in another state. For example, pharmacies in Massachusetts will only honor prescriptions from six other states, while Texas pharmacies will fill prescriptions from all other states, provided they meet Texas requirements. Your best bet is to get your medication before you travel.

If you will be out of state for an extended time and the local pharmacies are unable to fill your prescription, you can have the medication mailed to you. Under federal law, the inner container with the medication must be clearly labeled with prescribing information (in the original container from the pharmacy is fine), but the outer packaging should not reveal the contents.

Is there any advantage to the new rules for people who take the drugs lawfully as prescribed by the doctor?


Yes. No doubt people who take hydrocodone-combination drugs long-term will miss the convenience of phone-in prescriptions and easy refills. But ultimately, closer monitoring by their physician is a good thing. One of the biggest misconceptions about opioids is that they only pose risks to people who intentionally abuse them. But even people who use the drugs legitimately to combat pain can unintentionally get themselves into trouble, especially if they take them longer term.

For more on misconceptions about opioids as well as advice for taking them safely see "Prescription painkillers: 5 surprising facts."

—Teresa Carr


Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

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