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

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.