# Hydrocodone Rescheduling and Opioid Prescribing Disparities in Breast Cancer Patients

## TL;DR

A 2014 policy change reduced hydrocodone use most among minority patients with breast cancer, while non-hydrocodone opioids increased only among white patients, raising concerns about equitable pain management.

## Contribution

This study reveals how opioid policy changes disproportionately affect minority and socioeconomically disadvantaged breast cancer patients.

## Key findings

- Hydrocodone use decreased most among dual-eligible racial/ethnic minority breast cancer patients after rescheduling.
- Non-hydrocodone opioid use increased only among non-dual-eligible non-Hispanic White patients.
- Policy changes may worsen access to pain management for vulnerable cancer populations.

## Abstract

This study evaluated the differential impacts of the 2014 hydrocodone rescheduling policy on opioid prescribing patterns among early-stage breast cancer patients, using SEER-Medicare data from 2011 to 2019. Among 52,306 patients, we stratified analyses according to Medicaid dual eligibility and racial/ethnic status. Hydrocodone rescheduling was associated with a significant reduction in hydrocodone use across all groups, with the largest decrease observed among dual-eligible racial/ethnic minority patients (AOR = 0.57). Concurrently, non-hydrocodone opioid use significantly increased only among non-dual-eligible non-Hispanic White patients (AOR = 1.29), suggesting a substitution effect that was not evident in other groups. These findings raise concerns about access to effective pain management following regulatory changes. Our results underscore the need for opioid policies that both prevent misuse and ensure equitable access to pain management, particularly for socioeconomically disadvantaged and minority cancer populations.

Background: Pain is a prevalent issue among breast cancer patients and survivors, with a significant proportion receiving hydrocodone for pain management. However, the rescheduling of hydrocodone from Schedule III to Schedule II by the U.S. Drug Enforcement Administration (DEA) in October 2014 raised concerns about potential barriers to opioid access for cancer patients, particularly among vulnerable populations such as dually eligible Medicare–Medicaid beneficiaries and racial/ethnic minorities. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data including 52,306 early-stage breast cancer patients from 2011 to 2019. We employed multivariable logistic regression models with model specification tests to stratify the subgroups and evaluate the differential effects of the policy change by Medicaid dual eligibility and race–ethnicity, while adjusting for other patient demographics, clinical characteristics, and cancer treatments. Results: The rescheduling of hydrocodone was associated with significantly different effects on prescription opioid use across subgroups, with the most pronounced reduction in hydrocodone prescription observed among dual-eligible racial/ethnic minority patients (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI]: 0.44–0.74; p < 0.001). Non-dual-eligible patients experienced a smaller reduction in hydrocodone use (AOR = 0.84; 95% CI: 0.78–0.90; p < 0.001). Concurrently, non-hydrocodone opioid use significantly increased among non-dual-eligible non-Hispanic White patients (AOR = 1.29; 95% CI: 1.19–1.40; p < 0.001), suggesting a substitution effect, while smaller non-significant increases were observed among other subgroups. Conclusions: Hydrocodone rescheduling led to the greatest reduction in hydrocodone use among dual-eligible racial–ethnic minority patients. The corresponding increase in non-hydrocodone opioid use was limited to non-dual-eligible non-Hispanic White patients. These findings highlight the need for opioid policies that balance misuse prevention with equitable access to pain relief, particularly among underserved populations.