Top 10 Painkillers in US

OCTOBER 06, 2014
Gale Scott
This list is from 2014. To see data from the most recent version, check out MD Magazine's coverage of the 2017 list of top drugs by spend.

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 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.

At second place, oxycodone with acetaminophen (generic Percocet) was dispensed through prescriptions 32,962,000 times.

Third in popularity was oxycodone HCL (generic OxyContin) with 16,440,000 prescriptions that year.

Fourth place went to acetaminophen with codeine, 11,225,000 prescriptions.

In fifth, was morphine sulfate, with 9,658,000 prescriptions.

Next, at sixth place was fentanyl, with 6,468,000 prescriptions.

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.

Ranking eighth in sales was methadone, which was prescribed 3,860,000 times--a tally that has dropped from 4,090,000 in prescriptions in 2012.

Ninth was hydromorphone HCL (generic Dilaudid) with 3,587,000 prescriptions.

Oxymorphone HCL, extended release (Opana ER) was tenth, with 756,000 prescriptions.

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 population, while doctors in New York prescribed only 59.5 such prescriptions for every 100 population.

But 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 show that since then, total sales of codeine and codeine-combination drugs have dropped from 212,009.000 in 2012 to 201,493,000 in 2013.

Sales of morphine and opium derivatives rose to 22,329,000 in 2013 from 22,033.000 in 2012.

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

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