Effects of Hydrocodone Rescheduling on Pain Management Practices Among Older Breast Cancer Patients

TL;DR

After hydrocodone became harder to prescribe, doctors gave it less to older breast cancer patients and used other opioids instead, with little change in other pain treatments.

Contribution

This study is the first to examine how hydrocodone rescheduling affected pain management specifically in older breast cancer patients.

Findings

Hydrocodone use dropped from 55% to 40% after rescheduling, while non-hydrocodone opioid use rose from 43% to 50%.

There were no significant changes in NSAID or antidepressant use after hydrocodone rescheduling.

Hydrocodone dosage decreased significantly, but non-hydrocodone opioid dosages stayed stable.

Abstract

We analyzed a large national database to assess hydrocodone rescheduling’s impact on hydrocodone, non-hydrocodone opioids, and non-opioid pain management among 52,792 women aged ≥66 years with early-stage breast cancer from 2011 to 2019. Results showed a significant decrease in hydrocodone use and dosage, alongside a significant increase in the use of non-hydrocodone opioids, with no significant changes in nonsteroidal anti-inflammatory drugs (NSAIDs) or antidepressant use. These findings suggest policy-driven reductions in hydrocodone use led clinicians to shift to other opioids, with minimal impact on non-opioid strategies, warranting further research on the appropriateness and outcomes of evolving opioid prescribing patterns.

Hydrocodone, a commonly prescribed opioid, was rescheduled from Schedule III to Schedule II in October 2014, imposing stricter prescribing regulations. While prior studies have examined its effects in general populations, its impact on breast cancer patients remains unclear. We evaluated changes in pain management among older women with early-stage breast cancer following this policy change. Using SEER-Medicare data from 2011–2019, we identified a retrospective cohort of 52,792 women aged ≥66 years. We assessed trends in the use of hydrocodone, non-hydrocodone opioids, NSAIDs, and antidepressants before and after rescheduling. Hydrocodone use declined from 55% to 40%, while non-hydrocodone opioid use increased from 43% to 50%. Multivariable logistic regression adjusted for demographic and clinical factors confirmed a significant decrease in hydrocodone use (AOR: 0.81, 95% CI: 0.75–0.86) and an increase in non-hydrocodone opioid use (AOR: 1.25, 95% CI: 1.21–1.30). Hydrocodone dosage also declined, while non-hydrocodone opioid dosages remained stable. No significant changes were observed in NSAID or antidepressant use. These findings suggest that hydrocodone rescheduling significantly altered opioid prescribing patterns, reducing hydrocodone use and prompting a shift toward alternative opioids. Further research is warranted to evaluate the appropriateness and outcomes of such shifts in cancer pain management.

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