ePrescribing of Controlled Substances is Rising: While this Presents Challenges, it also Presents Opportunities to Curb Abuse

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A recent study in the American Journal of Managed Care[1] documented a dramatic increase in the amount of controlled substances that are ePrescribed, rising steadily since the Drug Enforcement Agency legalized the practice in 2010. The study looked at 18 months of transactional data depicting the Electronic Prescribing of Controlled Substances (EPCS) growth in both pharmacies and providers. It found that the total number of EPCS increased by nearly 3,000 prescriptions every month during the study period. The total number of EPCS-enabled pharmacies increased by nearly 700 pharmacies every month, while the growth of EPCS among physicians, physician assistants and nurse practitioners averaged nearly 300 new providers every month.

This is positive news, as electronic prescribing of controlled substances has the potential to reduce theft of controlled substances, reducing the potential of abuse in the process. This can benefit the entire healthcare system by reducing the cost from direct theft and the additional substance abuse treatment costs that may also be incurred from the theft. According to the HHS Inspector General, the Medicare Prescription Drug Program paid pharmacies $25 million for Schedule II drugs billed as refills in 2009. The problem is that “in no circumstances is Medicare supposed to pay for refills of these drugs.[2]” Using electronic prescribing technology, providers can now also closely track electronic prescriptions of controlled substances through a link to prescription drug monitoring programs (PDMP). By integrating program data into a comprehensive electronic record, a clinician has the ability to identify fraud and theft that might have gone unnoticed with paper prescriptions.

How PDMPs Work

PDMPs are state-run electronic databases that track the prescribing and dispensing of controlled prescription drugs to patients. They are currently operational in 47 U.S. states and territories[3]. Pharmacists, and some cases dispensing physicians, report to a PDMP each time a prescription is filled for a controlled substance medication. When available at the point of care, PDMP data can help clinicians distinguish between patients who legitimately need opioid medications for pain treatment and those who may be seeking to abuse the medication. It also provides clinicians with an opportunity to intervene if there are signs of drug misuse.

The challenge with PDMPs is clinician adoption. These databases have been time-consuming to access if they are outside of the normal workflow. To address this, the Office of the National Coordinator for Health Information (ONC) has launched new Standards and Interoperability (S&I) Framework Initiative focusing on PDMP and Health IT Integration. The new S&I Framework Initiative seeks to address the lack of common technical standards and vocabularies that would enable PDMPs to share information with health IT systems. The goal is a standardized approach to retrieve data stored in the PDMPs and deliver it to EHRs and HIEs.[4]

The ONC is also conducting several pilot projects as part of the Enhancing Access to PDMPs using Health IT project.  Pilots were conducted across the country to test various connections between state PDMPs and health IT systems including EHRs, HIEs, and pharmacy dispensing systems in a variety of health care settings, including emergency departments, pharmacies, opioid treatment programs, and clinician practices. These pilots worked to increase interoperability of data among states, improved real-time data reporting to a PDMP, and expanded the number of clinicians using these tools.[5]

These types of efforts are definitely needed. The CDC reports that the drug overdose death rate has more than doubled from 1999 through 2013[6]. By improving clinical integration to make PDMPs part of a comprehensive care record, opportunities for abuse can be minimized, hopefully in some cases before an addiction can spiral out of control.


[1] Meghan Hufstader Gabriel, PhD; Yi Yang, MD, PhD; Varun Vaidya, PhD; and Tricia Lee Wilkins, PharmD, PhD, “Adoption of Electronic Prescribing for Controlled Substances Among Providers and Pharmacies,” American Journal of Managed Care, (November, 17,2014), http://www.ajmc.com/publications/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies#sthash.dytIvc6y.dpuf

[2] Tricia Lee Wilkins, Pharm.D., Ph.D. and Meghan Gabriel, Ph.D., “The Electronic Prescribing of Controlled Substances is on the Rise,” HealthITBuzz, (December 31st, 2014), http://www.healthit.gov/buzz-blog/health-information-exchange-2/electronic-prescribing-controlled-substances-rise/

[3] Jennifer Frazier, “Health IT Helping to Fight the Prescription Drug Abuse Epidemic, “HealthITBuzz, (November 14, 2013), http://www.healthit.gov/buzz-blog/health-innovation/health-helping-fight-prescription-drug-abuse-epidemic/

[4] Jennifer Frazier, “Health IT Helping to Fight the Prescription Drug Abuse Epidemic, “HealthITBuzz, (November 14, 2013), http://www.healthit.gov/buzz-blog/health-innovation/health-helping-fight-prescription-drug-abuse-epidemic/

[5] Jennifer Frazier, “Health IT Helping to Fight the Prescription Drug Abuse Epidemic, “HealthITBuzz, (November 14, 2013), http://www.healthit.gov/buzz-blog/health-innovation/health-helping-fight-prescription-drug-abuse-epidemic/

[6] Centers for Disease Control and Prevention, National Vital Statistics System Mortality Data. (2015), http://www.cdc.gov/nchs/deaths.htm.

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