Top 10 Painkillers in US

The nation’s most popular opioid will be more difficult to get starting Oct. 6, 2014. As part of federal efforts to curb prescription drug abuse, the US Drug Enforcement Agency (DEA) is reclassifying hydrocodone-combination drugs (Vicodin/AbbVie) as a schedule 2 controlled substance. That will mean physicians will no longer be able to write prescriptions for a 6-month’s supply, but will be limited to half that. Patients will now have to go to a physician’s office at least every 90 days to get a new prescription.

“That could mean a decrease in hydrocodone-combination sales—that’s probably why there was resistance from the drug companies--but for most doctors it won’t be that big of a deal,” said Mark Melrose, MD, commenting on the switch to schedule 2. Melrose is an emergency medicine specialist who is a partner in Urgent Care Manhattan, a two-location walk-in emergency care practice in New York City.

“If there’s a legitimate need for a patient to get Vicodin, why wouldn’t you prescribe it?” he said. “Even when it was class 3, we still had to follow up with a written prescription and look up a patient on the prescription drug registry,” something most states have now, he said.

But even if the tighter controls mean some doctors will switch appropriate patients to schedule 3 drugs, like acetaminophen with codeine, alternative painkillers have a long way to go to topple the market leader, according to data from IMS Health. Those data show that in 2013, of 201,493,000 prescriptions for codeine and codeine-combination drugs, 127,859,000 were for Vicodin or generic equivalents.
Brand-name OxyContin prescriptions came in at seventh place, with 5,659,000 prescriptions. But adding that total to generic equivalent would not change the drug’s third-place ranking.

The DEA change is part of mounting concern about a national epidemic of prescription drug abuse. Earlier this year, the US Centers for Disease Control and Prevention (CDC) released a study showing that there is a wide variation in opioid prescribing patterns across the nation. For instance, doctors in Alabama prescribed 142.9 opioid prescriptions for every 100 pepole, while doctors in New York prescribed only 59.5 such prescriptions for every 100.

Doctors in Maine prescribed the most long-acting extended release opioid pain-relievers, and physicians in Delaware prescribed high-dose opioids at the highest ate. Only two states were in the top 10 for all 3 categories, Tennessee and West Virginia. The CDC study used IMS data for 2012.

The more recent IMS data provided to MD Magazine show that since then, total sales of codeine and codeine-combination drugs dropped by more than 10 million between 2012 and 2013. Sales of morphine and opium derivatives rose by a few hundred thousand.

IMS, a commercial service, obtains its data from wholesalers.

Most Popular