Background: Pain is a prevalent issue among breast cancer patients and survivors, with a significant proportion receiving hydrocodone for pain management. However, the rescheduling of hydrocodone from Schedule III to Schedule II by the U.S. Drug Enforcement Administration (DEA) in October 2014 raised concerns about potential barriers to opioid access for cancer patients, particularly among vulnerable populations such as dually eligible Medicare–Medicaid beneficiaries and racial/ethnic minorities.Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data including 52,306 early-stage breast cancer patients from 2011 to 2019. We employed multivariable logistic regression models with model specification tests to stratify the subgroups and evaluate the differential effects of the policy change by Medicaid dual eligibility and race–ethnicity, while adjusting for other patient demographics, clinical characteristics, and cancer treatments.Results: The rescheduling of hydrocodone was associated with significantly different effects on prescription opioid use across subgroups, with the most pronounced reduction in hydrocodone prescription observed among dual-eligible racial/ethnic minority patients (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI]: 0.44–0.74;p< 0.001). Non-dual-eligible patients experienced a smaller reduction in hydrocodone use (AOR = 0.84; 95% CI: 0.78–0.90;p< 0.001). Concurrently, non-hydrocodone opioid use significantly increased among non-dual-eligible non-Hispanic White patients (AOR = 1.29; 95% CI: 1.19–1.40;p< 0.001), suggesting a substitution effect, while smaller non-significant increases were observed among other subgroups.Conclusions: Hydrocodone rescheduling led to the greatest reduction in hydrocodone use among dual-eligible racial–ethnic minority patients. The corresponding increase in non-hydrocodone opioid use was limited to non-dual-eligible non-Hispanic White patients. These findings highlight the need for opioid policies that balance misuse prevention with equitable access to pain relief, particularly among underserved populations.
背景：疼痛是乳腺癌患者及幸存者中普遍存在的问题，其中相当比例患者使用氢可酮进行疼痛管理。然而，美国缉毒局于2014年10月将氢可酮从管制级别III调整为II级，这引发了对癌症患者（特别是医疗补助-医疗保险双重资格受益人和少数族裔等弱势群体）获取阿片类药物可能面临障碍的担忧。 方法：我们利用监测、流行病学和最终结果数据库与医疗保险关联数据，对2011年至2019年间52,306名早期乳腺癌患者开展回顾性队列研究。通过多变量逻辑回归模型及模型设定检验，我们按医疗补助双重资格状态和种族/民族进行亚组分层，在调整患者人口统计学特征、临床指标及癌症治疗方案后，评估政策变化对各亚组产生的差异化影响。 结果：氢可酮管制级别调整对各亚组处方阿片类药物的使用产生显著差异影响。其中双重资格的少数族裔患者氢可酮处方降幅最为显著（校正比值比[AOR]=0.57；95%置信区间[CI]：0.44–0.74；p<0.001）。非双重资格患者的氢可酮使用降幅较小（AOR=0.84；95% CI：0.78–0.90；p<0.001）。与此同时，非双重资格的非西班牙裔白人患者中非氢可酮类阿片药物使用显著增加（AOR=1.29；95% CI：1.19–1.40；p<0.001），表明存在替代效应，而其他亚组仅出现较小幅度且无统计学意义的增长。 结论：氢可酮管制级别调整导致双重资格少数族裔患者的氢可酮使用量下降最为明显。非氢可酮类阿片药物使用的相应增长仅局限于非双重资格的非西班牙裔白人患者。这些发现提示，阿片类药物政策需要在防止滥用与保障疼痛缓解的公平可及性之间取得平衡，特别是在医疗服务不足的人群中。
Hydrocodone Rescheduling and Opioid Prescribing Disparities in Breast Cancer Patients
肿瘤(癌症)患者之家