How e-prescribing can help address the opioid crisis

An estimated 12,800 Canadians died from an opioid-related overdose between January 2016 and March 2019.

Unfortunately, the COVID-19 pandemic has only worsened the opioid crisis with a large surge in opioid related overdoses across Canada in the past few months.

However, despite the heightened awareness of overdose and drug-related deaths, as clinicians, we still struggle with challenges related to medication management, particularly for controlled substances, when we prescribe them for legitimate reasons.

This group of medications includes opioids, benzodiazepines and stimulants. These drugs all have therapeutic value, but can also lead to harm.

They are highly addictive, have value in the illicit market and cause serious harm to individuals, families and communities when used inappropriately.

Yet, traditionally we have not had robust mechanisms in place to track the journey of these medications, from the time they are prescribed to when they are dispensed by the pharmacy.

This has left the door open for forged prescriptions feeding the black market, with subsequent harm to people who access these medications.

The pandemic accelerated the appreciation for digital prescribing, especially early on during the state of emergency, when stay-at-home orders disrupted the normal functioning of clinical care.

For controlled medications, prescribing by phone is not acceptable, so an e-prescribing system can help ensure secure transmission of these prescriptions directly from a prescriber’s computer to the patient’s pharmacy of choice.

Most developed nations are already using such a service.

In Canada, PrescribeIT, from Canada Health Infoway (a federally-funded not for profit), is a secure, fully electronic system that enables physicians to create, renew and cancel prescriptions directly from their electronic medical record (EMR). The pharmacy management system (PMS) receives the prescriptions directly, reducing the chance of the prescription being lost, manipulated or diverted elsewhere.

Pharmacists receive notification that a prescription has been received and can also send a notification to physicians when it has been dispensed.

These tools help ensure better communication within the patient’s circle of care, and enhance medication management that is particularly important when prescribing controlled substances.

e-Prescribing also facilitates the prescribing of smaller quantities of a medication. This can be especially helpful when prescribing controlled substances, potentially limiting the opportunity for accidental overdoses or diversion of large amounts of medication.

This is a significant advantage over printed prescriptions, where the patient walks away with a script printed on regular paper that can be tampered with or copied or not filled at all, with no notification to the prescriber.

If we want to make a real difference in safe, modern management of controlled medications and all medications we prescribe and refill, we need to think differently, act differently and make bold changes to the way we prescribe, monitor and communicate about these medications. e-Prescribing through PrescribeIT is a good start.

Dr. Peter Selby is a senior medical consultant and a clinical scientist at Toronto’s Centre for Addiction and Mental Health and a professor of family and community medicine and psychiatry and public health at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviours and their comorbidities.