Most doctors don’t use e-prescribing for opioids
Aim is to boost safety, efficiency and prevent abuse over paper orders All states allow e-prescribing yet only 7% of doctors do so.
Electronic prescribing of controlled substances reduces fraud and prevents patients from getting multiple prescriptions for the same drug, but only three states require it and one doesn’t even enforce its law.
As much of the USA struggles with record overdose deaths, often from opioid painkillers, industry officials say this legislative lapse needs to be remedied as part of a broad drug policy.
Although paper prescriptions were once considered safer, all states now allow e-prescribing for drugs, including opioid painkillers and other controlled substances, yet only 7% of doctors do so, according to Surescripts, which links doctors with pharmacies for e-prescribing.
Between 3% and 9% of opioid abusers use forged prescriptions, says Paul Uhrig, Surescripts’ chief legal officer.
E-prescribing would prevent that and many of the overdose deaths caused by so-called doctor-shopping — people who get narcotic prescriptions from several physicians, he says.
Databases known as Prescription Drug Monitoring Programs (PDMP) show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to eprescribe, health IT experts agree.
That may change soon as there’s new pressure — including a push by insurer Cigna — for doctors to check state databases before they write prescriptions for controlled substances.
All states and Washington, D.C., have the drug monitoring databases, but fewer than five require their use. If these databases were fully used, Cigna CEO David Cordani says, about 97% of the people at high risk of addiction could have been identified.
Here’s what states are doing on e-prescribing. New York. The state’s 2012 e-prescribing law, which requires doctors to check the PDMP database before prescribing narcotics, went into effect March 27. Nearly half of doctors in the state now use electronic prescribing for controlled substances (EPCS), up from about 13% last year. Those who continue to use paper pads are subject to fines, jail time or both.
Maine. Drug overdose deaths were up 31% last year, the state’s attorney general’s office said in March. Most were for heroin, fentanyl or opioid painkillers. In April, the state became the third to require EPCS. After January 2017, physicians who don’t use electronic prescriptions also will be subject to fines, jail time or both.
Minnesota. New data from the Minnesota Department of Health show drug overdose deaths jumped 11% from 516 in 2014 to 572 last year.
The state was first to require eprescribing but the legislation doesn’t allow enforcement or penalties for doctors that don’t adhere.
Just 3.5% of doctors were using electronic prescribing for controlled substances this year, Surescripts says.
Marty LaVenture, director of the Minnesota office of health IT and e-health, says the health department will consider this summer which “policy levers could be used to encourage full adoption and use of e-prescribing capabilities,” including possible financial incentives.
Experts emphasize that e-prescribing can create problems and hardly solves all of them.
“It’s another tool to help make it harder to get some of these drugs, but the flip side is that if they have a hard time getting the prescription, that’s when many switch to heroin,” says Becky Vaughn, addiction services vice president at the National Council for Behavioral Health.
Caryl Brymialkiewicz, chief data officer for the Department of Health and Human Services’ inspector general, says she is “cautiously optimistic” about e-prescribing ’s potential, but says there still might be ways (people) are going to manipulate the system.”