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Are Electronic Prescriptions for Opioids a Good or Bad Idea?

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Doctor holding pill bottle at computerAlthough we have seen some decline in painkiller addiction, the abuse of prescription pain medication remains a major problem. Part of the reason that painkillers are still a major contributor to the opioid epidemic is due to the sheer volume of painkillers making their way to civilians’ hands. According to recent estimates, the United States — which represents just five percent of the global population — consumes more than 80 percent of the global supply of prescription opioids.1 This figure is so high because there are so many more painkillers prescribed in the United States than virtually anywhere else in the world.

Studies have found that 99 percent of physicians prescribe more pain medication than is recommended by the CDC.2 Furthermore, about one in four physicians will prescribe up to 30 days’ worth of painkillers at a time, which is how long it takes for the brain to begin experiencing lasting neurological changes characteristic of addiction. Perhaps most importantly, painkiller abuse is still often a precursor to heroin addiction. Needless to say, it’s still very important to curb the diversion and misuse of prescription painkillers, leading to frequent discussions about potential diversion strategies among lawmakers and medical professionals.

The latest of these discussions involves the use of electronic prescriptions for controlled pharmaceutical substances, which industry leaders believe will stem the overflow of prescription drugs and help keep them from getting into the wrong hands. On paper, electronic prescriptions appear to have many benefits, but could the risks outweigh them? And how, exactly, would electronic prescriptions work?

How Electronic Prescriptions Work

Prior to the advent of the Digital Age, we received prescriptions from our doctors almost exclusively on paper. Typically, this meant the doctor wrote the prescription by hand on a designated pad or type it into a computer template to be printed; in either case, we would leave our doctors’ offices with paper prescriptions. The problem with this scenario — actually, there are a few — is that there are many things that can happen to the paper prescription between the time it’s handed to the patient and when it’s finally handed to the pharmacist. It could be lost, which would mean having to write another prescription for the patient. However, an even bigger problem would be if the patient merely says the prescription is lost so that he or she could get a duplicate prescription and have it filled at a different pharmacy. Even with proper safety measures in place, there are too many ways for paper prescriptions to go wrong.

Rather than being written on paper, electronic prescriptions are completely digital. When a patient requires medication, the doctor can create an electronic prescription that is sent directly to the pharmacy. You might think of it like email, but a type of email that’s extremely secure. Electronic prescriptions are sent and received on closed networks, which means that they’re not connected to the open web; instead, it’s a direct and near-instant connection between physicians and pharmacies.3 So they’re more reliable, safe and virtually tamper-proof compared to paper prescriptions.

Electronic Prescriptions vs. the Opioid Epidemic

There are a number of benefits to prescribing opioid painkillers electronically. First, patients can’t attempt to get duplicate prescriptions filled since electronic prescriptions go directly to the pharmacies, meaning they can’t be lost. Electronic prescriptions work really well with electronic file management systems, making the tracking of patients’ prescriptions extremely convenient and effective; in fact, it turns all of a provider’s prescriptions into a searchable database. And the implementation of electronic prescribing capabilities alongside prescription drug monitoring databases and patient file management systems provides on-demand access to a patient’s history, gives physicians a way to quickly check whether a patient is receiving medications from other providers, and assess whether a patient is a diversion risk.4 In short, electronic prescriptions would consolidate several important sets of data, making it quick and convenient to cross-reference the information.

Additionally, there are practical and logistical benefits to the electronic prescribing of controlled substances (EPCS). For instance, it reduces the potential for dosing errors. Electronic prescriptions are also faster and more efficient, which is important for high-volume practices that would otherwise be spending a lot of time writing, rewriting and verifying paper prescriptions.

Are There Drawbacks?

Although there aren’t many downsides to using electronic prescriptions, there’s one particular hurdle to mention. Electronic prescriptions aren’t quite as easy to implement as writing prescriptions on paper; a provider must have the technologies required to implement electronic prescriptions, but a number of providers don’t have the tools necessary to begin writing prescriptions electronically. While more than 88 percent of pharmacies are EPCS-enabled, only 20 percent of providers are able to begin writing electronic prescriptions.5 To gain electronic prescribing capabilities, there would surely be an initial expense as well as a learning curve.

Moreover, another problem with electronic prescriptions is the unavoidable fact that making corrections to electronic prescriptions would be a more involved process than tossing a slip of paper into the wastebin and simply writing another. It goes without saying that writing electronic prescriptions would save a lot of time, but the amount of time it would take to correct prescriptions that have already been submitted and are saved to databases should be considered; fortunately, it’s estimated that less than four percent of electronic prescriptions require intervention.6

Overall, the benefits of electronic prescriptions for opioids — and even for other drugs — are far more significant than the potential drawbacks. In fact, the states of Maine, New York and Minnesota require the use of electronic prescriptions for the very reasons mentioned above.7 Although most providers don’t currently rely on them, we’ll likely see more and more providers prescribing controlled substances electronically as we move forward.


Sources

1. http://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html
2. http://www.workcompwire.com/2016/03/nsc-poll-99-of-doctors-prescribe-opioids-longer-than-cdc-recommends/
3. http://www.learnabouteprescriptions.com/what-is-eprescription.aspx
4. http://journals.lww.com/annalsofsurgery/Fulltext/2017/04000/It_s_Time_to_Adopt_Electronic_Prescriptions_for.12.aspx
5. https://www.healthit.gov/opioids/epcs
6. https://www.uspharmacist.com/article/pros-and-cons-of-e-prescribing-in-community-pharmacies-42392
7. http://www.medscape.com/viewarticle/862378

Written by Dane O’Leary

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