In an emotional ceremony held in the East Room of the White House on October 26, 2017, President Donald Trump directed the Department of Health and Human Services (HHS) to declare the opioid crisis a public health emergency. With over 64,000 reported cases of overdose deaths in 2016 alone, there is no disputing the fatal toll that drugs are taking on American lives. Mr. Trump’s actions have been criticized, however, for not taking more dramatic steps to ensure the opioid crisis receives the funding required to fight the epidemic. Eric D. Hargan, the acting health secretary formally made the public health emergency declaration which through grant money will provide resources to hire personnel, reduce some bureaucracy and allow access to telemedicine services, particularly in rural areas. In theory, there are funds allocated to address public health emergencies, but currently those coffers are dry. Congress will have to replenish the fund for there to be viable financial support behind efforts to combat the crisis. Mr. Trump stopped short of declaring a national emergency, which would have provided for the rapid allocation of federal funding required to properly address the issue.
On November 1, 2017, the President’s Commission on Combatting Drug Addiction and the Opioid Crisis released its draft final report which lays out 56 recommendations. The recommendations are categorized by federal funding and programs; opioid addiction prevention; opioid addiction treatment, overdose reversal, and recovery; and research and development. One of the strategies outlined under prevention is the enhancement of prescription drug monitoring programs, which includes integrating electronic prescribing of controlled substances (EPCS) into provider workflows.
Although there is currently no federal mandate for providers to utilize EPCS, both the American Medical Association and the American College of Physicians have recognized and recommended it as a key tactic to combat opioid abuse. It is approved for use in all 50 states by the Drug Enforcement Agency (DEA). Several states have led the way with legislation and are already demonstrating success in keeping controlled substance prescriptions out of the wrong hands. EPCS removes the need for paper prescriptions and mitigates the risks of lost, stolen, altered, and diverted scripts while also protecting against the fraudulent use of DEA numbers. This closed system between the provider and the pharmacy also provides safer care for the patient by reducing prescription errors and automating allergy and drug interactions.
States have been taking the charge in implementing EPCS with six currently having legislation in place. New York state has been a leader in requiring EPCS as part of it’s I-STOP system, making it mandatorily effective March 27, 2016. Maine became the second state to mandate EPCS which went into effect in January of this year. Virginia has followed suit requiring statewide adoption in 2020, and North Carolina recently enacted the Strengthen Opioid Misuse Prevention Act which mandates e-prescribing of specific controlled substances including opioids. While Minnesota has technically mandated EPCS since 2012, their compliance rates are much lower due to lack of enforcement (penalties). There are lessons to be learned here about the creating effective legislation to achieve the desired results. Both New York and Maine have instituted measures to track and enforce submission of EPCS making it difficult for providers to be non-compliant. Surescripts reported on New York’s success with the program, noting that they are No. 1 in EPCS with 91.9% of all controlled substances prescribed electronically. In Minnesota where there are no enforcement measures or penalties associated with the mandate, EPCS compliance rates are much lower. The Minnesota Department of Health readily notes that while there is no penalty associated with non-compliance, there is an expectation for parties to conform to the rules.
Physicians have been reluctant to voluntary employ EPCS into their practices, but carefully crafted legislation and knowledgeable software vendors can help to ease the burden of change. The Office of the National Coordinator for Health Information Technology (ONC) reported that in 2014, every state had at least 40% of all physicians e-prescribing, and 28 states had at least 70% of providers e-prescribing. While e-prescribing for non-controlled substances has flourished, prescriber readiness for EPCS has wide variability from only 3% of providers in Mississippi to 72.1% in New York. Those numbers have steadily increased, but states considering mandatory implementation must account for the time and resource involved for the practitioner or health care organization to prepare for EPCS. New York and Virginia, for example, provided a three-year window for providers and pharmacies to ramp up their IT systems. EPCS requires a two-factor authentication process that verifies a provider’s credentials before sending a script, and requires the use of a third-party certified electronic prescribing application.
With the early success of programs like New York States legislators have taken notice. Representative Katherine Clark of Massachusetts introduced a bill in the House in July that would require electronic prescribing of all controlled substances covered under Part D Medicare. The Every Prescription Conveyed Securely Act (H.R. 3528) is gaining traction among lawmakers after Mr. Trump’s announcement, and the National Associate of Chain Drug Stores has endorsed the bill citing the improved ability to track, control and monitor opioids. Enhanced abilities to monitor controlled substances will also have a direct impact on the integrity of the data found in state’s prescription drug monitoring programs further preventing abusers from doctor shopping.
Whether it is initiated at the state or federal level, EPCS is one proven tactic in fighting the opioid crisis that will only continue to gain traction. Technology can serve as a powerful intervention for removing fraudulent, unnecessary opioids from the streets. Now it is up to legislators to act.
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