Technical Preprint: Rationale and Design of a Planned Observational Study to Evaluate the Impact of Hydrocodone Rescheduling on Opioid Prescribing After Surgery

TL;DR

This paper outlines the rationale and design of a planned observational study to evaluate how hydrocodone rescheduling affected opioid prescribing after surgery, using a difference-in-differences approach and preliminary data analysis.

Contribution

It introduces a novel study design leveraging surgeon prescribing patterns to assess policy impact on opioid use post-surgery.

Findings

Preliminary analysis shows differing trends in prescribing among surgeons based on prior hydrocodone use.

The study design aims to isolate the effect of rescheduling from other factors.

Expected to inform policy on opioid prescribing practices after surgical procedures.

Abstract

In October 2014, the US Drug Enforcement Agency (DEA) reclassified hydrocodone from Schedule III to Schedule II of the Controlled Substances Act, resulting in a prohibition on refills in the initial prescription. While this schedule change was associated with overall decreases in the rate of filled hydrocodone prescriptions and opioid dispensing, available studies conflict regarding its impact on acute opioid prescribing among surgical patients. Here, we present the rationale and design of a planned study to measure the effect of hydrocodone rescheduling using a difference-in-differences design that leverages anticipated variation in the relative impact of this policy on patients treated by surgeons that more or less frequently prescribed hydrocodone products versus other opioids prior to the schedule change. Additionally, we present findings from preliminary study conducted on a subset of our full planned sample to assess for potential differences in outcome trends over the 3 years prior to rescheduling among patients treated by surgeons who commonly prescribed hydrocodone versus those treated by surgeons who rarely prescribed hydrocodone.