As Congressional leaders move forward on a number of bills meant to help curb the nation’s opioid abuse epidemic, the National Center for Policy Analysis issued a report calling on policymakers to consider the use of one specific health IT tool—mandatory electronic prescribing (e-prescribing).
In a report titled “E-Prescribing: A Commonsense Solution to Opioid Abuse that Is Being Ignored,” Senior Fellow Devon Herrick with the Dallas-based National Center for Policy Analysis notes that while federal policymakers have taken up the growing problem of opioid abuse, there has been little talk about mandatory e-prescribing as a solution.
There are currently a number of legislative proposals in both the House and Senate exploring how health information technology use can be expanded to aid in the nation’s fight against opioid abuse, however most of the legislative proposals focus the use of a specific health IT tool—prescription drug monitoring programs (PDMPs). Recently, the House of Representatives passed a bill, which now goes to the Senate, that makes grants available to further the use of PDMP databases, but the bill does not call for states to require doctors to use the databases before writing prescriptions in order to receive the grant funding.
In the policy report, Herrick analyzes the state of the opioid abuse problem. “Inappropriate nonmedical use and abuse of prescription opioid drugs has skyrocketed in the past 15 years. The U.S. Department of Health and Human Services (HHS) surveys estimate that up to 25 million people used prescription opioids for nonmedical purposes between 2002 and 2011.
According to the report by Herrick, an estimated 80 percent of abused controlled substances are obtained by prescription and legally dispensed to the abuser, an abuser’s friend or a family member. “In many cases, opioids are obtained through so-called “doctor shopping”—seeing multiple doctors and obtaining a prescription from each. According to industry research, for every $1 in fraudulent drug claims, an additional $41 dollars is spent on associated medical claims—unnecessary physician visits, redundant medical tests, unnecessary emergency room visits and the like. Over the course of a dozen years, from 1999 to 2011, the rate of fatal prescription opioid overdoses nearly quadrupled, from 1.4 deaths per 100,000 population to 5.4,” Herrick wrote.
And, Herrick asserts that mandatory e-prescribing would allow doctors, pharmacies and law enforcement to better monitor inappropriate opioid use, drug-seeking behavior and reduce drug diversion.
“Transmitting prescriptions electronically is a way for doctors to directly communicate with pharmacies—rather than handing patients a paper form ripped from a pad. E-prescribing facilitates detection of doctor shopping. In addition, once a prescription for a chronic condition has been prescribed, refills should require less effort by doctors and patients,” Herrick wrote.
He also notes that a large number of doctors have been using electronic prescribing of non-controlled substances for a few years now. But until recently, federal regulations prohibited e-prescribing of controlled substances due to the perceived risks of drug abuse and diversion.
Electronic prescribing of controlled substances is now permitted in all 50 states. Yet, not all pharmacies—and even fewer physicians’ offices—are prepared to transmit prescriptions for controlled substances electronically, according to Herrick’s report.
As previously reported by Healthcare Informatics Managing Editor Rajiv Leventhal, Maine recently became the latest state to pass a law requiring the electronic prescribing of controlled substances for opioids. Minnesota and New York have similar e-prescribing mandates, and in the report, Herrick examines the New York law as a case study. As reported by HCI's Leventhal, the program in New York, known as the Internet System for Tracking Over-Prescribing (iSTOP), went into effect in late March.
In the report, Herrick source statistics from the American Dental Association, in the three months after iSTOP was implemented, opioid prescriptions by dentists fell by about half (31 percent before iSTOP compared to 14 percent in the three following months). The quantity of pills per prescription also fell. The total numbers of opioids prescribed fell by three-fourths (78 percent), he wrote.
Herrick also examines the state of e-prescribing and obstacles to its adoption, noting that the move to e-prescribing is progressing slowly. “In 2008, just over 40 percent of office-based physicians had the capacity to prescribe any drug electronically. Of those with the capability, about one-fourth either did not use it or used it only occasionally. Only a small proportion — about one-fourth — used the advanced features, such as checking for drug interactions and formulary information, and transmitting to pharmacies electronically,” Herrick wrote.
And, he cited a national survey from July 2012 to December 2013 that found the number of electronic prescriptions for controlled substances increased from 1,535 to 52,423. During the period the percentage of all pharmacies capable of receiving prescriptions for controlled substances electronically increased 130 percent, he wrote.
There are a number of technology challenges with implementing e-prescribing systems that system engineers should consider, such as how to deal with delays in processing the prescription at the pharmacy and the occasional unreliability of the network. Other challenges include poor interface and poor user entry design. At the same time, according to HHS, physicians’ main concern with e-prescribing is funding for the hardware and software, and some pharmacies are not connected to networks capable of accepting electronic prescriptions.
Despite these challenges, Herrick concludes, “Drugs derived from opioids are at high risk for diversion, abuse and addiction, and even overdose death. A byproduct of poorly tracked and managed controlled substances are adverse public health spillover effects manifested by other diseases.”
“Mandatory electronic prescribing with tracking of controlled substances is a solution that policymakers should consider. New York State, Minnesota and Maine have taken that step and other states are considering similar moves. Many physicians and most pharmacies are already equipped to transmit or receive prescriptions electronically. The next logical step is to integrate the two-factor authentication and tracking to inhibit abuse and diversion of prescription drugs to the illicit market,” he wrote.
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