Well Duh! Combat Opioid Abuse by Tracking Prescriptions

Both houses of Congress have passed a bill to tackle opioid abuse. The bill funds training for emergency medical technicians and emergency room personnel and makes drugs to reverse the effects of opioids more readily available in an emergency. According to an article in Modern Healthcare, the legislation just passed should have taken advantage of existing safeguards to strengthen state drug monitoring programs to prevent opioid abuse enabled by doctor shopping. The bill does increase grants to states for drug monitoring programs. But the bill does not require states to ensure doctors actually check the state database.

All states now have drug monitoring programs. But only three-quarters of doctors are aware of the program and only about half use them. A way to get more doctors to use the state databases is to integrate them with mandatory electronic prescribing of controlled substances (e-prescribing). Rather than a doctor having to check the database, protocols incorporated into e-prescribing software automatically checks the database and flags patients whose opioid prescriptions are excessive.

Ironically, most doctors already prescribe most of their (non-narcotic) drugs electronically. But until recently federal regulations prevented e-prescribing of controlled substances due to the perceived risks of drug abuse. Implausibly, forcing a doctor to use a prescription pad and hand write a prescription was considered less prone to tampering. Electronic prescribing of controlled substances is now permitted in all 50 states. However, not all pharmacies — and even fewer physicians’ office – are equipped to prescribe opioids electronically in ways that meet rigid federal guidelines for electronic prescriptions for controlled substances.

About 1-in-8 drugs dispensed are narcotic pain relievers. Chronic pain effects an estimated 100 million Americans. Unfortunately, the line between well-managed chronic pain and slipping into addiction can be as simple as not monitoring the number of pain pills a patient takes. Until recently, many physicians were too lenient when prescribing opioids. Thinly veiled physician pain management practices — so-called pill mills — have been shut down in many states. But doctor shopping — that is, seeing multiple doctors for prescription opioids, is still common. This method fools many doctors because their patients are seemingly adhering to safe protocols. Doctor often do not realize their patients are seeing three, four or five other doctors in search of quantities of pills no one doctor would prescribe. Without proper management, legitimate patients experiencing significant pain can sometimes become addicted to their pain medications. Worse, many pain patients merely fake symptoms to get drugs.  The reality is prescription opioid drugs have become yet another product in the illicit drug trade.  For instance, $200 spend on Oxycodone at a retail pharmacy would cost $1,100 to $2,400 on the street.

Inadequate tracking of controlled substances drives up costs in other ways. An analysis found every $1 worth of drugs lost to fraud is associated with $41 in medical costs lost to abuse. Doctor shopping, the side effects of addiction, and unnecessary emergency room visits for intense pain where the addict hopes to get a narcotic pain reliever boosts the cost of drug abuse.

The way mandatory e-prescribing of controlled substances works is that when a patient sees their doctor and is prescribed 30 Oxycodone tablets for pain, the prescription is entered into a computer system that only a doctor could access. These systems require doctors to approve (or validate) the prescription — preventing a nurse or anyone else in the doctor’s office from ordering drugs for themselves or friends. When a patient visits his or her pharmacy, the pharmacy computer system would have to ping the physician computer system to validated the prescription and verify no other pharmacy had filled the prescription. The pharmacist and other prescribing doctors would be alerted if two, three or five other physicians also prescribed narcotic painkillers to the same patient. This system would also track customers who currently pay cash for their prescription to avoid tracking by their drug plan.

There are obstacles to a mandatory electronic prescribing of controlled substances. Software vendors need to consider physician workflow more than they currently do. There are also bottlenecks that slow the arrival of the prescription getting to the pharmacy — causing patients to make a second trip to the pharmacy or wait unnecessarily. If the pharmacy is out of a given drug, the prescription has to be cancelled and reissued to a different pharmacy. The current system of e-prescribing means patients need to shop for the best price before they inform their doctor which pharmacy they want their prescription sent to. However, these obstacles are not insurmountable. Doctors who have e-prescribed pain pills report the process is easier than they expected. It also lets them know if their patients are taking their medications — or too much medication.

Read more at E-Prescribing: A Commonsense Solution To Opioid Abuse that Is Being Ignored.

Comments (3)

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  1. Big Truck Joe says:

    Can be fixed in a month. Force pharmaceutical suppliers like Cardinal and McKesson to report to federal database which pharmacies they are selling their oxycodone to. Force pharmacies, many states already do, to what customers and how much oxycontins they are selling to including prescribing doctors NPI number and patient SSN, and you will immediately be able to flag patients who are Doctor shopping. why is that so difficult to enact. The tracking database foundation is already there in many states already.

    • Devon Herrick says:

      That precisely the point. Something like 49 states already have a database. But doctors don’t use it. Electronic prescriptions would in theory force the computer system to cross reference with the database.

  2. Big Truck Joe says:

    The U.S. Senate passed the Comprehensive Addiction and Recovery Act (CARA), which mandates the development of best practices for prescribing opioids. All they have to do is insert a government mandate that all physicians prescribing controlled substances have to keep a log of those RXs and report them monthly to the state board of pharmacy who will investigate patients guilty of Doctor shopping and put that orient on the CS over-prescribed watch list. Shouldn’t be that hard to develop.