Impact of Hydrocodone Rescheduling on Pharmaceutical Pain Management in End-of-Life Lung Cancer Patients

Objective: Lung cancer is the leading cause of cancer mortality in the USA, and terminal patients endure severe pain. In October 2014, hydrocodone was rescheduled from Schedule III to Schedule II to curb misuse, yet its specific impact on end-of-life lung cancer pain management remains unclear. The objective of this study is to evaluate the impact of hydrocodone rescheduling on pharmaceutical pain management among end-of-life lung cancer patients in the USA. Methods: We conducted a retrospective study using SEER-Medicare data including 24,804 patients aged ≥66 with stage IV lung cancer who died between 2011 and 2019. We examined hydrocodone, opioid, NSAID, and antidepressant use in the last three months of life and used multivariable logistic and OLS regression to assess the effects of hydrocodone rescheduling and time trends, adjusting for demographic and clinical factors. Results: Hydrocodone was used by 47.5% of patients and any opioids by 75.4%. Although the hydrocodone rescheduling showed a nonsignificant immediate reduction in use (AOR = 0.92, p = .0795) and dosages (estimate = -1.78 MME, p = .358), significant declining trends were observed over time for hydrocodone (AOR = 0.92 per 12 months, p < .001; −1.15 MME per 12 months, p = .003) and overall opioids (AOR = 0.94 per 12 months, p < .001; −2.44 MME per 12 months, p = .002). NSAIDs and antidepressants use remained stable. Conclusion: Our study is the first to examine hydrocodone rescheduling's impact on pain management in end-of-life lung cancer care. While no immediate significant changes were observed, the overall decline in opioid use over time reflects broader clinical and regulatory shifts, highlighting the need for balanced, multimodal pain management strategies.