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Editor's Correspondence
March 28, 2011

Correcting Several Oversimplifications of Chronic Opioid Therapy

Author Affiliations

Author Affiliation: Rehabilitation Medicine, Tufts University–New England Medical Center, Nashua, New Hampshire.

Arch Intern Med. 2011;171(6):597. doi:10.1001/archinternmed.2011.84

Braden et al1 appropriately reported chronic opioid therapy risk stratification with prescription minimization recommendations but erroneously oversimplified hazard attribution to “high-potency” schedule II opioids and the generic term schedule II long-acting opioids.

Hydrocodone's class III Drug Enforcement Administration (DEA) regulatory designation permits clinicians convenient telephone prescriptions on behalf of patient care, but hydrocodone is roughly equianalgesic with oxycodone, a class II opioid. Clearly, it is erroneous to reproach schedule II over III opioids by inaccurately correlating potency to legislative scheduling. Schedule V liquid codeine is class III as tablets. Ingesting additional tabs of schedule III opioids effectively enhances potency. Oxymorphone is class II but is 10 times more potent than morphine,2 also class II.

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