Adverse Effects on Codeine Prescriptions in California Arising from Governmental Regulations

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Abstract
To the Editor: Adverse reactions to new drugs or other therapeutic interventions are familiar, but government regulations or funding policies may also produce unexpected adverse effects.In California, until recently, Medicaid (Medi-Cal) regulations, which affect over 3 million people, produced a restricted formulary limiting non-Schedule-II analgesics prescribed for outpatients to codeine-containing compounds, salicylates, and acetaminophen. Propoxyphene, hydrocodone, and pentazocine are restricted; and nonsteroidal, non-narcotic, anti-inflammatory analgesics may be used only for arthritis. Plain codeine is classified as a Schedule-II-controlled substance requiring a prescription in triplicate and registration of "habitués."This well-intentioned regulation has been followed by an increase in codeine-combination . . .

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