DEA change means ODs will lose prescribing authority in some states

DEA change means some ODs will lose power to prescribe hydrocodone combo products

A more restrictive policy for hydrocodone combination products goes into effect Oct. 6. This gives ODs a new reason to advocate for their ability to prescribe these drugs in their respective states.

The DEA does allow states to decide what health care professionals can prescribe within a schedule.

A final rule issued by the Drug Enforcement Administration (DEA) reschedules all hydrocodone combination products as Schedule II controlled substances on this effective date. This class is more restrictive than the current Schedule III.

Although this "upscheduling" is intended to prevent opioid abuse, the AOA fears an unintended consequence of the measure would be limiting prescribing authority for some ODs.

Not all states allow ODs to prescribe Schedule II medications. Successful AOA lobbying efforts in 2012 delayed the rescheduling of this class of drugs—thus buying ODs more time to enact a "fix" to state law that would maintain their prescribing authority for hydrocodone combination products.

A number of states have enacted such a fix over the past few years. They include Alaska, Arkansas, Arizona, Colorado, Georgia, Illinois, Iowa, Kentucky, Oklahoma, Rhode Island and Utah.

In states where no such provision exists, ODs may be limited in what they can prescribe after Oct. 6. With a broad Schedule II mandate in effect, the AOA estimates ODs in up to 16 states will lose their prescribing authority.

How to advocate for a fix in your state
The DEA does allow states to decide what health care professionals can prescribe within a schedule. This means ODs can still advocate for a fix in state law to maintain prescribing authority for these types of drugs.

There are two ways to accomplish this:

  • Adding "hydrocodone-containing medications regardless of schedule," or

  • Adding Schedule II narcotics.

ODs use hydrocodone combination drugs to manage post-operative pain, aid the process of treating eye injuries or infections, or help remove foreign bodies from the eye.

Schedule II drugs differ from Schedule III in that there's a higher potential for abuse—yet no official or organization has ever cited optometry's prescribing authority as a contributor to opioid abuse. In fact, ODs prescribe such medications in small doses and usually with no refills.

For more information, contact Brian Reuwer, the AOA's associate director of State Government Relations, at BReuwer@aoa.org.

August 28, 2014

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