E-Prescribing and Opioids: A simple solution to a complex problem

Written by: Katherine Hill

Edited by: Sienna Schaeffer, Madeline Nicol

In 2016, Roger Winemiller of Blanchester, Ohio lost two children to opioid overdoses. The farmer’s only remaining son, Roger T. Winemiller, has also struggled with opioid addiction for years, at one point spending a year in jail on drug charges. Although Roger is currently in remission, his father worries about leaving him at home alone and is uncertain about his son’s future (1).

The Winemillers are far from alone in their struggle with addiction. In the United States, opioid overdoses were responsible for 30,000 deaths in 2015, a number that exceeds both annual deaths from motor vehicle accidents and from HIV/AIDS during the peak of the US epidemic (2).

Drug addiction is a large and complex problem that will not be solved overnight. Despite the complexity of this issue, surgeon and best-selling author Atul Gawande argues that one part of the solution may be relatively simple: electronic prescribing.

In an article published in the Annals of Surgery, Dr. Gawande wrote that surgeons have helped to fuel the opioid epidemic. Surgeons frequently give patients prescriptions for large numbers of pain pills, even after relatively minor surgeries and outpatient procedures. Overprescribing can be a problem for both patients and those around them. Patients often take too much medication for too long, putting themselves at risk for dependence, or funnel excess pills to friends and family members who already suffer from addiction.

Opioid prescriptions for large quantities of pills remain popular despite the risk for addiction because physicians are often more concerned about the harm that can come from too few pills than the harm that can come from too many. To understand why, it is necessary to know how most prescriptions work. Traditionally, a surgeon writes a physical prescription for opioids after the surgery and gives it to the patient. The patient then takes the prescription to a pharmacist and waits for the prescription to be filled before finally taking their medication home. It can be difficult or impossible for a patient to return to the doctor’s office for a second prescription, meaning that if the doctor miscalculates how much medication is necessary, the patient may have no choice but to suffer through the pain unaided.

Enter electronic prescribing. Electronic prescribing, or E-prescribing, allows doctors to send prescriptions to pharmacies electronically, eliminating the need for patients to ferry a paper copy from the doctor’s office to the pharmacy. E-prescriptions eliminate the wait between dropping off a prescription and having it filled by the pharmacist so that patients can receive their medication faster. Electronic prescriptions are also easier for pharmacists to read than handwritten prescriptions, which can reduce incidents of patients receiving either the wrong dose or the wrong drug entirely by mistake (3).

Crucially, E-prescribing also makes it much easier for doctors to send pharmacies an order for more medication if the patients run out early. This would allow surgeons to prescribe far fewer painkillers initially and then send refill requests for the 20% or 30% of patients who are still in pain after finishing their first prescription. By following this strategy, doctors could greatly reduce the number of excess opioids in circulation and hopefully prevent patients from taking too many pills or giving them to acquaintances.

E-prescribing by itself will not end opioid abuse, but it is a relatively simple, low-cost intervention that has the potential to help considerably. Unfortunately, physicians have not yet embraced electronic opioid prescriptions. Although over 90% of doctors have the capacity to e-prescribe opioids, only 8% actually utilize that capability.

Surgeons’ prescription writing practices inadvertently helped create the opioid epidemic that has touched the Winemillers and so many other families around the United States It is time surgeons begin utilizing E-prescribing to help correct the situation.

Sources

1. Healy, J. 2 of a Farmer’s 3 Children Overdosed. What of the Third — and the Land? The New York Times (2017).

2. Gawande, A. A. Itʼs Time to Adopt Electronic Prescriptions for Opioids: Annals of Surgery 265, 693–694 (2017)

3. U.S. Centers for Medicare &, Medicaid Services. Electronic Prescribing. Medicare.gov Available at: https://www.medicare.gov/manage-your-health/electronic-prescribing/electronic-prescribing.html. (Accessed: 20th March 2017)