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As the recently appointed chief medical officer of Purdue Pharma — a maker of prescription opioid medications — I am deeply concerned about the opioid crisis. As a clinician who focused on patients with headaches and other forms of pain, I profoundly empathize with the suffering of those with chronic pain. As a scientist, I am convinced that the benefits of pain medications of any class can be fully achieved only when appropriate medications are prescribed to proper patients in accordance with high-quality medical guidelines.
I have published on the consequences of misusing opioids, and I also know firsthand what opioids, when appropriately prescribed and used, can do to help patients coping with debilitating pain when other treatment options are insufficient. As so, I am encouraged that Congress and the states are considering a multitude of policies, programs, laws and regulations to address the opioid crisis through prevention, access to treatment for people with opioid addiction, judicious prescribing of opioids for the treatment of pain, and tools to prevent diversion of pain medications for illicit use.
Electronic prescribing of controlled substances is one such tool designed to improve efficiency, promote patient safety and reduce diversion. Electronic prescriptions may reduce diversion because unlike traditional paper prescriptions, they cannot be copied or stolen, and they are more difficult to alter or forge.
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In addition, e-prescribing can reduce medication errors caused by illegible handwriting or oral miscommunication. EPCS software can also be programmed to prompt doctors about appropriate dosing according to accepted guidelines, in order to help ensure patients are not prescribed more medication than needed.
Finally, EPCS can be easily mapped to electronic health records and to regulatory databases, offering an enhanced tool for research and epidemiological surveillance.
Since June 2010, the Drug Enforcement Administration has permitted EPCS, giving prescribers the option of e-prescribing, and allowing pharmacies to receive, dispense and archive e-prescriptions for controlled substances. Currently, more than 90 percent of pharmacies are equipped to handle electronic prescriptions for controlled substances. Adoption of the technology is expanding in medical practices, but is still underutilized, with only about one-quarter of all practices using e-prescribing for controlled substances.
Some states are speeding the adoption of EPCS technology by requiring all prescriptions for controlled substances to be transmitted electronically. Minnesota, New York and Connecticut require EPCS, while Maine requires e-prescribing for opioids but not for other controlled substances. Six states (New Jersey, North Carolina, Arizona, Oklahoma, Tennessee and Virginia) have passed laws requiring EPCS beginning in 2019 or later. States that require EPCS generally have higher numbers of medical practices that are EPCS-enabled, with New York leading at 76 percent, and Maine (55 percent) and Connecticut (51 percent) following.
Legislation currently under consideration in Congress would require the use of EPCS in the federal Medicare Part D program, carrying potential for enormous positive impact. Controlled substances are widely prescribed in the Medicare Part D program, where one out of every three beneficiaries (14.4 million of 43.6 million total) received at least one opioid prescription in 2016. Medicare paid for nearly 80 million prescriptions for opioids in 2016.
The “Every Prescription Conveyed Securely Act,” as currently drafted, will help to accelerate the adoption of EPCS in medical practices that serve people with Medicare coverage, but still allows for appropriate exceptions in certain circumstances. This bipartisan, bicameral legislation, if enacted, would be effective beginning in 2020. We hope this proposed bill is adopted, as part of a package of opioid-related bills currently being considered by Congress.
Technology can play a role in helping to reduce the risks associated with prescription opioids, and EPCS represents one such technology. Another important technology or tool, prescription drug monitoring programs, can integrate with EPCS and be used to support appropriate clinical decision-making, reducing “doctor shopping” and preventing prescription drug abuse and diversion.
Although PDMP systems, electronic databases that track controlled substance prescriptions in a state, have been available for many years, their utility was somewhat limited until we began connecting them to EHRs and pharmacy dispensing programs. Connecting these technologies enables health care professionals to access data on a specific patient in real time – as they are making prescribing decisions. High-quality, up-to-date data will be a powerful tool to assess impact of health interventions supporting proper use of opioids and treating addiction.
At Purdue, we understand that no one solution will end the crisis, and we believe that multiple, overlapping efforts will drive positive change. I strongly believe that EPCS and PDMPs can help reduce the incidence of prescription opioid analgesics being diverted for misuse and abuse. Purdue encourages prescribers to use both EPCS and PDMPs and to support the “Every Prescription Conveyed Securely Act.”
Marcelo E. Bigal, MD, Ph.D., is chief medical officer at Purdue Pharma.
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