E-Prescribing: A Commonsense Solution To Opioid Abuse that Is Being Ignored

Policy Reports | Health

No. 385
Friday, July 08, 2016
by Devon Herrick

Executive Summary

Congress has taken up the growing problem of opioid abuse. Yet for all the talk there appears to be little discussion of a commonsense solution: mandatory electronic prescribing (e-prescribing). This would allow doctors, pharmacies and law enforcement to better monitor inappropriate opioid use, drug-seeking behavior and reduce drug diversion.

Chronic pain is a significant problem in the United States — affecting more than 100 million Americans. Some of the dangers include inappropriate nonmedical use, abuse and the danger that some addicts move on to street drugs like heroin. 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.

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.

Solution: Electronic Prescribing of Controlled Substances. 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.

Ironically, most doctors have been using electronic prescribing of noncontrolled 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.

The DEA has strict regulations governing the design of software certified for e-prescribing. The DEA certificate must be registered with the state board responsible for enforcing regulations on the distribution of narcotics. The process must also use the federally required two-factor identification.

On March 27, 2016, following Minnesota’s lead, New York State became the second state to require all prescriptions to be transmitted electronically. One potential obstacle is that pharmacies must still accept paper prescriptions. The reason is that a pharmacy has no way of knowing whether a given physician has received an e-prescribing waiver from the state or if computer problems made it impossible to issue
electronic prescriptions.

In a study of dentists, within a few months after iSTOP was implemented in New York, opioid prescriptions fell by about half, from 31 percent of dental visits before iSTOP to 14 percent in the following three months. The quantity of pills per prescription also fell. The total numbers of opioid analgesics prescribed fell by three-quarters (78 percent).

Conclusion. Mandatory electronic prescribing with tracking of controlled substances is a solution that policymakers should consider. Better tracking and control of opioid drugs will help keep the next generation of potential abusers away from prescription narcotics. New York State, Minnesota and Maine have taken that step and several other states are considering similar moves. Many physicians and most pharmacies are already equipped to transmit or receive prescriptions electronically. Those who have, found the process less burdensome than they expected.

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