Though 2022 has introduced on a larger sense of normalcy, the previous few years have distracted us from one of the crucial neglected epidemics plaguing healthcare: prescription drug abuse.
Earlier than Covid-19 diverted consideration away from this drawback, President Trump signed on to the SUPPORT for Patients and Communities Act of 2018, instating sweeping laws for initiatives to deal with the opioid epidemic. The invoice, amongst different initiatives, requires digital prescriptions for managed substances (EPCS) for any lined half D drug. Though the official begin of the mandate was delayed two years to January 1, 2023, the significance of this federal intervention can’t be emphasised sufficient as we plan for the yr forward.
The rise of substance use problems: An epidemic
In 2021, there have been 107,622 lives misplaced to drug overdoses – an enormous bounce from 2020’s already staggering 91,799 deaths. However what’s particularly stunning about many of those deaths is how so many people developed substance use problems to start with. If we glance again at opioid abuse alone, nearly 80% of heroin users reported utilizing a prescription opioid earlier than heroin. This statistic is only one instance of how managed substances – if not fastidiously monitored and prescribed – can result in misuse and dependancy. To completely perceive how we’ve gotten so far, it’s vital to contemplate the problems that include paper prescriptions.
The paper script drawback
The pharmaceutical panorama has modified dramatically over the previous a number of many years. Round 30 or 40 years in the past, prescription blanks (the pads of Rx paper designated for hand-writing prescriptions) have been in every single place – stuffed in desk drawers, in pockets, on counter tops, laying on a nurse’s station. There was zero safety. If somebody stole a prescription pad, it might be onerous to overlook. Again then, drug diversion – the theft of treatment meant for sufferers inside a healthcare setting – wasn’t extensively mentioned.
However certain sufficient, there have been pink flags in every single place. Pharmacists began to choose up on the way in which diverters would have a look at a prescription clean not noted within the open – which primarily served as a clean test for medication. Ultimately we talked to physicians in regards to the significance of securing their blanks, however compliance was low. Within the years that adopted, there was an try and make paper prescribing safer, however the efforts weren’t sufficient to outsmart diverters. And admittedly, there have been hardly any rules to implement change.
It isn’t troublesome to think about the diversion that occurred throughout the nation and the next widespread penalties of dependancy which have since rippled by means of society. Right now, we’re nonetheless cleansing up this mess. However with federal rules in our line of sight, there’s actually hope.
Combatting dependancy with EPCS
Recognizing the depth of this drawback over a decade in the past, many native governments began implementing state mandates for EPCS. The largest change this posed for well being methods was the transition away from paper to a larger reliance on know-how. Nevertheless, this variation paved the way in which for prescribers to ship prescriptions on to pharmacies electronically, in flip establishing IT infrastructure that may now be required on a federal stage. Round ten years in the past, there have been restricted applied sciences in the marketplace to do that. Nevertheless, extra developments and merchandise have come out since, and the healthcare trade now has many choices to seamlessly facilitate electronically prescribing.
Right now, 35 states have handed e-prescribing mandates, with the intention of the mandates to cut back the danger of stolen or cast prescriptions and to stop sufferers from ‘physician buying’ between states. As of 2021, 74% of e-prescribers within the U.S. are enabled for EPCS. Nevertheless, the issue nonetheless exists on a nationwide stage, with many states nonetheless writing paper prescriptions for managed substances. Alabama, for instance, has no state mandates in place and simply 37% of prescribers are enabled for EPCS.
Whereas change on this scale all the time requires an adjustment, well being methods which have carried out EPCS have skilled important advantages. There’s now a lot better visibility into the physician-specific patterns of prescribing managed substances, due to the digital medical file (EMR). The info and auditing capabilities are far more sturdy, permitting well being methods to establish diversion and act or remediate sooner.
Above all, EPCS enhances accountability and creates room for enchancment in prescribing. Suppliers could make higher knowledgeable choices for sufferers when they can have a look at all the info on what number of managed substances an oncologist prescribes, for instance, in contrast with how a lot a psychiatrist prescribes and whether or not further opioids are medically needed or applicable. Up to now, prescribing was about treating and controlling ache. Right now, it’s extra about treating the precise drawback and lowering the amount of medicine which might be prescribed. If we’re capable of prescribe much less, there’s a lowered likelihood of dependancy.
What to anticipate in 2023
Presently, the legislation solely requires EPCS for prescriptions for Medicare half D sufferers. Nevertheless, most states that have already got mandates require digital prescribing for all managed substances no matter payer standing – and it’s not far off to imagine this pattern would possibly evolve for brand new states complying with federal EPCS. Additional, a brand new federal invoice launched in 2023, the EPCS 2.0 Act, if handed, would successfully require all managed substances to be electronically prescribed.
Rural communities would possibly really feel probably the most strain from these modifications, as many nonetheless depend on paper scripts. Monetary constraints may additionally have an effect. However, sufferers can obtain their treatment quicker than ever earlier than with EPCS – no want to choose up paper from the physician after which drop it off at a pharmacy. Though any transition is difficult, we’ve all been primed for it with the pandemic (particularly healthcare). There could also be a protracted highway forward, however as overdoses climb and drug diversion persists, one factor is evident – it’s time for change.
Photograph: uchar, Getty Pictures