title: Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center.
abstract: BACKGROUND
  Hydrocodone-containing products were recently rescheduled from Drug Enforcement Agency (DEA) schedule III to schedule II due to concerns of abuse and misuse. These changes went into effect on October 6, 2014.
  
  
  OBJECTIVE
  This quality improvement project involved a retrospective analysis to determine the effect of the DEA schedule change on prescribing habits of hydrocodone-containing products as well as the remaining schedule III and IV opioids, codeine (schedule III) and tramadol (schedule IV).
  
  
  METHODS
  The authors performed a medication use evaluation at our academic level 1 trauma hospital system on outpatient use of hydrocodone-containing products, tramadol, and codeine-containing products for 6 months before and 6 months after the change to schedule II using our electronic record and pharmacy system.
  
  
  RESULTS
  A total of 88,428 prescription orders were analyzed. Comparison of prescriptions before and after the DEA schedule changes showed hydrocodone prescriptions reduced from an average of 225.97 per day to 1.20 per day. In addition, tramadol increased from 60.04 per day to 91.85 per day and codeine from 6.81 per day to 98.94 per day.
  
  
  CONCLUSIONS
  Our data show a very substantial decrease in utilization of hydrocodone-containing products and concomitant increase in the utilization of tramadol and codeine products at our hospital after the DEA schedule change.
authors.affiliation: Parkland Health & Hospital System, Dallas, Texas.
authors.forename: Steven
authors.initials: S
authors.lastname: Schultz
authors.affiliation: Psych MA, Parkland Health & Hospital System, Dallas, Texas.
authors.forename: Carol
authors.initials: C
authors.lastname: Chamberlain
authors.affiliation: Parkland Health & Hospital System, Dallas, Texas.
authors.forename: Marius
authors.initials: M
authors.lastname: Vulcan
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Humair
authors.initials: H
authors.lastname: Rana
authors.affiliation: Informatics Pharmacist, Department of Pharmacy, Parkland Health & Hospital System, Dallas, Texas.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: John C
authors.initials: JC
authors.lastname: Alexander
mesh_terms: D000046:Academic Medical Centers; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D003061:Codeine / Q000627:therapeutic use; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence / Q000379:methods*; D057286:Electronic Health Records; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D006853:Hydrocodone / Q000009:adverse effects / Q000627:therapeutic use*; D010607:Pharmacy Service, Hospital; D011050:Policy Making; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013781:Texas; D014147:Tramadol / Q000627:therapeutic use; D014193:Trauma Centers
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D014147:Tramadol; D006853:Hydrocodone; D003061:Codeine