DEA Is Cutting Oxycodone (Again)

DEA Wants to Cut Oxycodone & Other Controls (Again): How Your Pharmacy Can Step Up With Non-Opioid Pain Solutions

The DEA is at it again – and this time, oxycodone, morphine, and other opioid pain killers are in the crosshairs.

In late November, the DEA proposed another round of cuts to Schedule II opioid production for 2026, including a 6.24% decrease in oxycodone, plus smaller reductions in morphine, hydrocodone, hydromorphone, fentanyl, and codeine. If finalized, this will be the 10th consecutive year of opioid supply cuts, and oxycodone production will be down over 70% since 2014.

Here’s the kicker: the DEA is basing these cuts on “medical usage” – the number of prescriptions written – not “medical need.” Prescribing has dropped, but chronic pain has not. In fact, about 24% of U.S. adults now live with chronic pain and 8.5% with high-impact chronic pain, the highest levels ever recorded.

So we have a shrinking opioid supply, rising pain, and patients who still need help. That puts independent pharmacies right in the middle.

Let’s break it down:

• What the new DEA proposal actually means for you
• How to prepare your team and your inventory
• Practical, non-opioid, non-controlled pain solutions you can offer right now

What the DEA Is Proposing – In Pharmacy Terms

The DEA sets aggregate production quotas (APQs) for Schedule I and II drugs – basically a national “ceiling” on how much manufacturers can produce each year. For 2026, they’ve proposed:

• Oxycodone: 6.24% decrease
• Morphine: 0.559% decrease
• Hydrocodone: 0.529% decrease
• Hydromorphone: 0.109% decrease
• Fentanyl: 0.014% decrease
• Codeine: 0.002% decrease

On paper, those numbers look small. But over a decade, they’ve compounded into huge supply reductions – over 70% less oxycodone and nearly 73% less hydrocodone compared to 2014.

Meanwhile, multiple manufacturers have already walked away from key oxycodone/APAP products, and professional groups like ASHP have listed ongoing shortages even when the FDA’s official shortage list doesn’t.

Bottom line:

• You will likely see continued or worsening spot shortages of common oxycodone and hydrocodone products.
• Your chronic pain patients are going to feel those shortages first.
• You’ll need more non-opioid strategies and stronger collaboration with prescribers just to maintain basic continuity of care.

And remember, this is happening on top of broader federal efforts to control drug prices and supply – from Trump’s “most-favored-nation” pricing order and promises to “cut out the middlemen” to today’s tighter production quotas. President Trump Executive Order

Your Pharmacy’s Role: Pain Solutions Without Controlled Substances & DEA Quotas

You can’t change DEA quotas. You can’t force manufacturers to restart discontinued lines.

But you can decide how prepared your pharmacy is to support pain patients when the controlled options are limited. That’s where independent pharmacies can really shine compared to big-box chains.

Think of your store as a Pain Solutions Center, not an “opioid dispenser.” That means:

• Proactively educating patients about what’s happening
• Offering layered, non-opioid options
• Helping prescribers pivot safely when controlled drugs are unavailable or inappropriate

Let’s walk through practical, non-controlled tools you can use.

Non-Opioid Meds You Can Lean On

You know these drug classes, but the strategy now is to use them more intentionally and in combination, where appropriate and safe. Always consider contraindications and prescriber intent.

1. Foundation Options: Acetaminophen and NSAIDs

• Acetaminophen
  • Still a workhorse for mild to moderate pain and fever.
  • Great for patients where NSAIDs are risky (GI, renal, anticoagulants) – but you must reinforce total daily max and combination product awareness.
• Oral NSAIDs (ibuprofen, naproxen, etc.)
  • Useful for inflammatory pain: musculoskeletal injuries, arthritis flares, and dental pain.
  • Create quick-reference counseling sheets on:
    • Taking with food
    • Watching for GI symptoms
    • Interactions with anticoagulants, CKD, and heart failure
• Topical NSAIDs (e.g., diclofenac gel)
  • Solid option for localized arthritis (hands, knees) with lower systemic exposure.
• Topical Compounded Formulas
  • Combining multiple ingredients with various mechanisms of action, patients can get a high amount of pain relief without the use of opioids. Common ingredients include NSAIDs, ‘Caines, Amitriptyline, and Muscle Relaxers

Practical idea:
Create a “First-Line Pain” endcap with acetaminophen, NSAIDs, and clear signage explaining when each is appropriate, plus tear-off counseling sheets your staff can hand to patients.

2. Targeted Topicals and Local Therapies

These are often overlooked, but they offer relief without swallowing pills.

• Lidocaine patches, creams, roll-ons
  • Helpful for localized neuropathic pain, back pain, and post-herpetic neuralgia (per prescriber guidance).
• Capsaicin creams/patches
  • Useful for neuropathic and arthritic pain, if patients can tolerate the burning phase.
• Counterirritant rubs (menthol, camphor, salicylates)
  • Good for muscle strains, overuse injuries, and weekend-warrior issues.
• Heat and cold therapy
  • Reusable hot/cold packs, microwavable packs, wraps – simple, safe, and effective for many acute flares.

Practical idea:
Bundle a “Pain Relief Kit” (e.g., topical NSAID or menthol rub + reusable hot/cold pack + education sheet) and place it near the pharmacy counter. Train techs to suggest it when patients ask about “something for my back,” and they’re not a candidate for opioids.

3. Non-Controlled Rx Adjuncts

These will always be prescriber-driven, but you can educate and suggest when appropriate:

• SNRIs and TCAs for neuropathic and mixed pain (e.g., duloxetine, nortriptyline)
• Rx NSAIDs such as Coxanto / Oxaprozin, which is a fantastic once-a-day option that boosts your bottom line too!
• Muscle relaxants for short-term use in acute spasms (watch for sedation and misuse risk)
• Migraine-specific Rx (triptans, gepants, ditans, certain beta-blockers or CGRP agents)
• OTC Integrative Peptides has fantastic programs that get to the root of many causes of pain.

Your role is to:

• Spot drug-drug interactions
• Educate on onset expectations (“this is not instant like an opioid”)
• Encourage adherence long enough to see whether it helps

Supplements & Lifestyle: The Long Game of Pain Management Without DEA Influence

Pharmacies are perfectly positioned to support whole-person pain care that doesn’t rely on controlled substances. Evidence is mixed for many supplements, but there is enough data – and a strong demand from patients – to build thoughtful protocols (with appropriate disclaimers).

1. Anti-Inflammatory and Joint Support

• Turmeric/curcumin
• Vitamin D
• Omega-3 fatty acids
• Glucosamine/chondroitin (for osteoarthritis, especially knees; counseling on time to benefit is key)
• ALCAT test to remove inflammatory triggers

2. Nerve and Muscle Support

• B-complex vitamins (for some neuropathic complaints, especially in deficiency)
• Magnesium supplements and bath salts, I prefer a magnesium complex for oral dosages

3. Sleep and Stress Support

Sleep and stress are massive amplifiers of pain. Poor sleep = worse pain perception.

• Non-sedative sleep aids (melatonin, magnesium glycinate, where appropriate)
• Calming blends (L-theanine, mild botanicals where appropriate)

Then layer in coaching-style counseling:

• Basic sleep hygiene tips
• Gentle movement recommendations
• When to see PT or behavioral health

Always frame supplements as adjuncts, not cures, and encourage patients to loop in their prescribers.

Devices, Supports, and Rehab-Friendly Products

You can expand your pain category beyond pill bottles:

• TENS units and replacement pads. A great option you can sell is HollyWog’s mobile TENS device
• Braces and supports (knee, wrist, back, ankle)
• Orthotic inserts for foot, knee, and back pain. I recommend Anodyne inserts.
• Ergonomic tools (wrist rests, posture supports, cushions)

Practical idea:
Create a “Move Better, Hurt Less” section in your front end, and put a small laminated card at the pharmacy counter that lists what you carry. When you’re explaining non-opioid options, you can say, “We also have some supports that might help take pressure off that joint – want me to show you?”

Service-Based Solutions: Turn Counseling Into a Program

This is where pharmacy owners can really differentiate themselves.

1. “Pain Check-In” Appointments

Offer short, scheduled sessions (10–20 minutes) where you or a clinical pharmacist:

• Review the patient’s full med list and OTC use
• Check for duplication, interaction, or opportunities to deprescribe
• Layer in evidence-based non-opioid strategies
• Coordinate with the prescriber when controlled meds are involved

You can structure these as:

• MTM visits (if billable under plan rules)
• Cash-pay consults (e.g., “Pain Solutions Review – $XX”)

2. Build a Local Referral Map

Create a preferred network of:

• Physical therapists
• Pain psychologists/behavioral health providers
• Chiropractors, acupuncturists, massage therapists
• Weight management and metabolic clinics

When you can’t offer a pill, you can offer a pathway. Patients remember the pharmacy that didn’t brush them off.

Talking to Patients About DEA Cuts (Without Causing Panic)

Patients in chronic pain are tired of being disbelieved, under-treated, or abruptly cut off. Many already feel blamed for an overdose crisis driven largely by illicit fentanyl, not their prescribed therapy.

When they run into shortages or hear about “DEA cutting supply,” here’s a simple communication framework for your team:

1. Acknowledge
   • “I’m so sorry you’re dealing with this. You’re not alone; this is happening all over the country.”
2. Explain briefly
   • “The DEA is lowering the amount of certain opioid medications that manufacturers are allowed to make each year. That’s why we sometimes see backorders or limited supply, even when the prescription is appropriate.”
3. Reassure your commitment
   • “Our job is to help you find safe, effective options – whether that’s this medication, another prescription, or non-opioid approaches.”
4. Offer a next step
   • “We can talk to your prescriber about alternatives and I can also show you some non-opioid options we’ve had good success with for other patients.”

Train your staff on this script style so they don’t respond with, “We’re out, call your doctor,” and leave it there.

Action Steps for Pharmacy Owners This Month

If you want a quick “to-do” list, here’s where I’d start:

1. Review your pain inventory
   • Ensure strong coverage in acetaminophen, NSAIDs (oral and topical), topicals, supports, and at least a few evidence-backed supplements.
2. Designate a “Pain Solutions” section
   • Group non-opioid pain products together with simple, patient-facing education.
3. Create a short staff training
   • 5-10 minutes on:
     • DEA quota changes
     • How to talk to frustrated patients
     • Which non-opioid options to suggest first
4. Draft a prescriber letter or fax template
   • Explain how you can help when opioids are backordered: suggested non-opioid alternatives, your ability to monitor adherence and side effects, and your availability for MTM-style reviews.
5. Consider a simple pain consult service
   • Even one afternoon a week dedicated to scheduled “pain check-ins” can differentiate your pharmacy and open new revenue streams.
6. Stay plugged into policy
   • Skim DEA quota announcements, shortages lists, and professional association updates so you’re not blindsided by supply changes.

You can’t single-handedly fix DEA quotas or chronic pain in America. But you can make sure that in your corner of the world, pain patients aren’t abandoned just because a controlled medication is harder to get.

Independent pharmacies have always been about access, advocacy, and creativity. This is one more chance to lean into that – and to build a robust, non-controlled pain category that helps your patients and your profitability at the same time.

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