As deaths involving prescription opioids increase, prescribers look toward other ways to curb patient overdoses. One fairly new solution in the medical community is to prescribe controlled substances electronically, but just how far along is this revolutionary approach, and will it help combat the ever-growing opioid epidemic in the country?
Health information network provider Surescripts on Tuesday released the results of research focusing on health data transactions in 2014. The report, titled the "2014 National Progress Report," reviewed how prescribing controlled substances electronically could potentially diminish prescription fraud and abuse in the country.
The Centers for Disease Control (CDC) found that there were 16,235 deaths involving prescription opioids in 2013, an increase of 1% from 2012. In response, the CDC launched several initiatives. One of them included a campaign, titled “When the Prescription Becomes the Problem,” last month at the fourth annual National RX Drug Abuse Summit. The social media activity, designed to raise awareness of prescription painkiller abuse and overdose, ended on May 15 of this year. President Obama’s drug control priorities for the upcoming fiscal year included reducing prescription drug and heroin abuse by allocating additional funding to states with prescription drug monitoring programs (PDMPs), expanding and improving treatment for addicts, and spearheading efforts to make naloxone more readily available to first responders.
Dr. Sean Kelly, chief medical officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston,said in an interview that electronic prescribing of controlled substances (EPCS) has the potential to improve care, reduce fraud and identify potential evidences of abuse by "creating a secure, auditable electronic transmission directly from the prescriber to the pharmacy."
"With EPCS, a paper prescription and a physician’s DEA number are never in the hands of the patient, which minimizes the risk of fraud or theft," he said. "EPCS also improves care for patients with legitimate needs by reducing both wait times at pharmacies and the number of trips they need to make to the doctor’s office."
He added: "EPCS also improves care by reducing prescription errors and inaccuracies."
Prescribing controlled substances electronically can only effectively combat opioid abuse, misuse and overdose if both prescribers and pharmacies are willing to hold up their part of the deal — but that doesn't seem to be the case. Nearly 75% of pharmacies across the country are ready to receive electronic prescriptions for controlled substances, the report found. Their counterparts are not: Only 1.4% of controlled substance prescribers are set up for EPCS.
EPCS for controlled substances is still in the early stages of development, and this is one of the main reasons why prescribers are slow to embrace this new kind of technology, Kelly said. This, however, shouldn't worry early adopters.
"This is similar to the early days of e-prescribing for non-controlled substances," he said. "Initially, it was a new technology that providers were unfamiliar with, but because it significantly improved efficiency and the delivery of care, it has gained rapid adoption."
Even though physicians seem hesitant, the practice of prescribing controlled substances electronically is growing. The study reported a 400% increase in controlled substance e-prescriptions in 2014, totaling 1.67 million nationwide.
Every state in the country handles combatting the opioid epidemic in its own way. Despite only 53% of primary care physicians using prescription monitoring programs (PMPs), the majority of state governments have continued to support them. Structural differences hinder EPCS adoption. To rank states on their readiness to prescribe controlled substances electronically, Surescripts looked at several factors: the percent of enabled pharmacies, the percent of enabled prescribers and the percent of controlled substances prescribed electronically. The study found that Nebraska, California and Michigan are best equipped to handle e-prescribing of controlled substances.
"Total EPCS transaction volume is still so low across the board, so it’s difficult to say why some states are doing better or worse than others," said Paul Uhrig, chief administrative and legal officer, and chief privacy officer at Surescripts. "But it seems to mostly hinge on whether or not a state government makes it a priority. The elimination of regulatory barriers and the implementation of legislative mandates have been the primary drivers of the adoption of EPCS."
He added: "This means we need to work collectively, across the industry, to educate and inform all stakeholders in order to drive utilization of the technology."
As investments in technology to improve delivery and patient care continue to grow, prescribers will become more selective. "This means that it must enable, not impede, the delivery of care," Kelly said. "If the technology is developed and implemented in such a way that it fits easily into providers’ existing workflows, EPCS can gain widespread adoption as a formidable weapon in the fight against prescription drug abuse."
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