In a smart move to curb abuse of painkillers, the FDA decided in January to move these drugs to a different category of controlled substances. Prescription drugs are classified into classes or “schedules” that reflect their level of abuse and addiction potential. These hydrocodone combination drugs, like Oxycodone, were Schedule III, considered “lower potential for abuse,” but are now classified as Schedule II – “very high potential for abuse and dependence.” Legal penalties for misuse of Schedule II drugs are much more severe.While this may slow the rampant escalation of addiction to these drugs, a McKnight’s blog post describes how this new ruling can adversely affect seniors, particularly those in long-term care. The blog post’s author, a nurse, explained that because many patients in long-term care facilities have chronic pain, use of these painkillers is high. The post cites research estimating that as many as 80% of these seniors require pain medication management.
Restrictions for Nurses
To illustrate how this impacts dispensing painkillers in this type of facility, nurses have restrictions about directly communicating a doctor’s orders to a pharmacy. With Schedule III pain medication, nurses can act as a liaison between the doctor and pharmacist to have a prescription filled for a patient. That changes with Schedule II drugs, which require a doctor to order the medication directly and only after seeing the patient. So a patient just transferred to a care facility after surgery, for example, would have to make do with a less potent painkiller until the attending doctor is able to assess the patient and order stronger drugs. This is less-than-optimal care.
Of course this will also affect end-of-life care for terminal senior patients. There are abuses of painkillers in all demographics and doctors should be more circumspect in prescribing dangerously additive drugs. But as the author emphasized, patients suffering pain in skilled-nursing facilities in rehab or long-term care might be best served by a rethinking of the applications and implications of this FDA ruling.