E-System Aims to Reduce Fake Painkiller Prescriptions

A new electronic prescription system holds the potential to drastically cut the number of fake prescriptions written for opioid painkillers. The new approach is attracting a lot of attention because prescriptions for dangerous and addictive substances are often written on paper by hand, making it much easier to falsify them. It’s estimated that 120 people in the U.S. die each day from drug overdose, and over half of these deaths are related to pharmaceutical medicines. The question is: does this strategy have the potential to significantly reduce this number, or does it miss such key elements of the problem as doctor shopping?

Opioids in the U.S.

The rate of death from drug overdoses more than doubled from 1999 to 2013, and much of the problem comes down to opioid pharmaceuticals. Almost 52 percent of the deaths in 2013 were related to prescription drugs, and around 71 percent of these (over 16,200 deaths) were related to opioid medicines like OxyContin and Duragesic. In addition to the startling overdose rates, in 2011 around 1.4 million Americans visited emergency departments as a result of nonmedical use of pharmaceuticals, with over 420,000 of these relating to opioid medicines. In 2012, enough opioid painkiller prescriptions were written to give every adult in America a bottle of pills.

It’s a problem that’s hard to overstate. Ultimately it comes down to the fact that opioid medicines have a lot in common with heroin, effectively interacting with the brain in the same way. That means that long-term users of opiate drugs are at risk for developing an addiction—either requiring them to attempt to mislead doctors into continually providing large doses of a medicine, forging prescriptions or switching to heroin itself.

Paper Prescriptions vs. Electronic System

Although most drugs are prescribed electronically, controlled substances are primarily prescribed using the old-fashioned pen-and-paper approach. The reason for this is that in order to comply with Drug Enforcement Administration regulations, electronic prescriptions of controlled substances must be accompanied by a series of checks, including thumbprint identification or electronic tokens. The problem is that most healthcare providers don’t have sufficient security systems to comply with these rules, so paper prescriptions are less time-consuming. However, a paper prescription includes the physician’s signature and prescribing number, thus giving addicts access to everything they need to forge prescriptions.

Imprivata has a solution to the problem in the form of Confirm ID, which handles the prescriptions for controlled substances but sends sensitive information that could be used to forge prescriptions directly from doctors to pharmacies, without the patient seeing it. The system requires either fingerprint scanning or the use of a one-time password for security, and integrates into many systems already in use by healthcare providers.

Initial trials of Confirm ID have been positive, but the setup is reportedly fairly time-consuming, because every doctor must have his or her credentials verified. However, among the benefits of the system is that it will make it easier to identify doctors who overprescribe prescription painkillers, especially reducing the practice of physicians writing large prescriptions in order to avoid having to write additional ones. One of the directors of a medical group who was involved in a trial of the approach pointed out that “the volume of pills being prescribed is insane,” telling the story of a patient who received 360 OxyContin pills after surgery but needed to use only 60 of them. By making prescription-writing simpler and easier, “bulk” prescribing should be reduced.

Pairing Approach With Drug Monitoring Programs

There are criticisms of the approach, including that it won’t help with issues like doctor shopping, where patients visit multiple physicians to obtain prescriptions. However, the use of prescription drug monitoring programs can help with this as they provide a statewide centralized database that records the patients who receive prescriptions for controlled substances, enabling easy identification of those attempting to obtain multiple prescriptions. Both systems working in concert would tackle both issues. However, more valid criticisms of the approach do exist, in particular that improving access to treatment is vital and that strategies like this can’t work unless they are part of a more wide-ranging, multifaceted strategy.

A Step in the Right Direction

Any one approach to tackling the problem of prescription drug abuse is bound to have its flaws, but the strengths of Confirm ID and similar approaches can be bolstered by improved education and access to treatment. It isn’t going to single-handedly curb prescription drug overdoses or make overprescribing a thing of the past, but it’s one of many tools developed in recent years that—if used correctly and alongside other approaches—could play an instrumental part in bringing down rates of prescription drug abuse, overdose and addiction.

Posted on August 28th, 2015
Posted in News

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