Loosening Opioids’ Grip: Using Technology to Address Overprescribing

(I'm pleased to co-author this blog with Lee Ann Stember**)

The opioid crisis gripping the nation is one of our biggest public health challenges. In 2016 alone, an estimated 11.8 million people over the age of 12 misused opioids— 4.4% of our population.

From the White House to homes across the nation, people are asking how we can address this crisis. How can we reverse the trend and save lives?

While the opioid epidemic is a highly complex challenge that eludes easy fixes, that doesn’t mean it’s unsolvable. We need to address the problem at the front end – with patients, physicians and pharmacists – to effect real change.

One of the core causes of the opioid epidemic is overprescribing: too many prescriptions written for too many pills, at too strong a dosage, over too long a period. Every year, the U.S. Drug Enforcement Administration (DEA) is required by law to set a ceiling on the number of opioid pills manufactured in the U.S. Between 1993 and 2015, DEA substantially increased the ceilings (known as the aggregate production quotas) for oxycodone, hydrocodone and other opioids.

People are surprised to learn there isn’t widely used technology in place to help a pharmacist conveniently decide in real-time whether the prescription they are about to fill is problematic or not. For example, perhaps the patient is taking another medication that could conflict with the new one, or the patient just filled a similar opioid prescription in another store – or maybe another state – prescribed by another doctor.

What’s missing today is a simple “red flag” that tells the pharmacist to take a second look before the prescription is filled. It’s time to fill that gap with an innovative solution that would give pharmacists that information immediately and help them make an informed decision about the potentially addictive medication they are about to hand to a patient.

Today, most states (but not all) have technology in place that tracks controlled substance prescriptions, including opioids. Although these states have taken commendable and important steps to try and address this crisis, these state-by-state efforts have many shortcomings: they don’t provide immediate, real-time data and don’t all share information across state lines. Besides being data-deficient, they are generally not conveniently available to the pharmacist at the point of sale. Instead, they require the pharmacist to break their workflow, log into a separate database and then comb through patient history to make a clinical decision.

Relying on the patchwork quilt of state-level programs alone will not be enough. But there is technology available that would give pharmacists as well as prescribers that real-time patient information to intercept at-risk patients before they leave the pharmacy or medical office. Using a model conceived by the not-for-profit National Council for Prescription Drug Programs (NCPDP), the Rx Safety-Alert System (the System) would provide real-time, clinical alerts to pharmacists and prescribers when a patient comes to their pharmacy or office, helping them quickly and easily identify at-risk patients. Importantly, it would include all prescriptions – including those that were filled, attempted or abandoned – and cash payments.

Initially, the System would be launched for pharmacy use. Ultimately, it could be used by both prescribers and pharmacists filling orders.

Here’s how it would work: pharmacists would receive, in real-time, a ‘red flag’ when they are processing a prescription that may be problematic, encouraging them to take further steps before filling the prescription. Those additional steps could include checking for more details in their state-level database, calling the prescribing physician to confirm the legitimacy of the prescription and/or sharing information about the patient’s recent prescription activity. Together, the doctor and the pharmacist could decide the best course of action for the patient.

The technology exists today to develop this powerful tool which we believe could meaningfully help address the opioid epidemic. But before it can be launched, we need government action. We are calling on the Food and Drug Administration (FDA) to use its existing Risk Evaluation and Mitigation Strategy (REMS) authority to mandate the use of a prescription safety alert system -- while protecting patient privacy -- that would allow pharmacists to intercept at-risk patients earlier.

This is a clear first step to tackling the epidemic. This innovative tool would help give pharmacists – and eventually prescribers as well -- greater visibility into the full picture of opioid use by their patients. Furthermore, this public-private sector innovation will help ensure these medications make their way to those who truly need them—the 35-year old dying of cancer, or the 65-year old suffering after a hip replacement—while preventing others from abusing them.

Each participant in the drug supply chain can play an important part in combatting the opioid crisis. We can harness the power of technology and existing data to address the opioid overprescribing problem, alongside efforts to prevent addiction and support those who are suffering. As a leading for-profit healthcare company and a leading not-for-profit healthcare standards organization, we stand committed to working with the federal government to stand up this critical national alert system. We encourage the FDA to join us in this important undertaking.

** Lee Ann Stember is president and CEO of NCPDP, a not-for-profit multi-stakeholder forum for developing healthcare business solutions, including ANSI-accredited standards for electronic exchange of healthcare information.