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By Brian Bamberger, Life Sciences Practice Lead
There is a new war on drugs being waged by the federal government and states. This time, the focus is prescription opioid abuse and the battles are being fought electronically. New York is leading the way with its I-STOP legislation, which will create opportunities for pharmaceutical manufacturers with physicians.
Misuse and abuse of prescription opioids in the United States (US) constitute a public health crisis that has grown to epidemic proportions over the past decade. The Centers for Disease Control and Prevention (CDC) has identified prescription drug abuse and overdose as being among the top five health threats in 2014. According to the CDC, deaths by drug overdose (mostly from opioid abuse) have risen steadily over the past two decades to become the leading cause of injury death in the United States. Everyday, 120 people in the US die as a result of drug overdose and nearly 7,000 more end up in the emergency department due to misuse or abuse of drugs (again, mostly due to opioid abuse). More than 2.4 million Americans were considered opioid abusers in 2010, a number the CDC believes has since grown exponentially.
Recognizing the threat, New York took action with the I-STOP Program, which offers a multipronged approach. First, it requires electronic prescribing (ePrescribing) of all medications beginning March 27, 2015 (although that implementation date may be delayed). How will this help fight prescription opioid abuse? To start, it takes paper prescriptions out of patients’ hands. This will drastically eliminate a major opportunity for substance abusers to forge prescriptions on their computers or alter drug names and quantities on legitimately issued prescriptions. In addition, ePrescribing can help clinicians recognize substance abuse at the point of dispensing through medication history checks, which identify both controlled and noncontrolled medications that have been paid by a patient’s insurance. ePrescribing systems, as well as pharmacy systems, can also flag potentially deadly prescription errors and drug interactions related to opioid use, thus preventing accidental deaths and overdoses. Refill request monitoring can also be used to help flag abuse and diversion.
I-STOP’s second prong requires prescribers to electronically consult the state’s Prescription Drug Monitoring Program (PDMP) Registry when writing prescriptions for Schedule II, III and IV controlled substances. The PDMP Registry provides practitioners direct, secure access to view dispensed controlled substance prescription histories for their patients. This information will allow practitioners to better evaluate their patients’ treatment with controlled substances and determine whether there may be abuse or nonmedical use.
In addition, I-STOP requires the creation of the Prescription Pain Medication Awareness Program and a consumer program for the safe disposal of controlled substances.
The federal government, states and stakeholders (such as physician groups) are watching I-STOP with interest. Several states (including California, Illinois, Oklahoma, Texas and Utah) are considering similar legislation.
All of this activity will open doors for pharmaceutical manufacturers and their representatives as physicians scramble to implement I-STOP in New York. They will need assistance adopting ePrescribing systems over the first few months – either ePrescribing in general or for controlled substances. For example, I-STOP provides an avenue for Pharma companies to assist practices in creating efficiencies with ‘Favorites’ and reducing pharmacy calls with corrected prescriptions. Writing electronic prescriptions for non-tablet products, even familiar ones, can be confusing to new ePrescribers and pose a risk to patient safety. Practices need to understand how to use these unfamiliar systems for more difficult-to-prescribe products.
Learnings from the New York experience can help Pharma position itself in other states considering similar legislation. Going forward, it will be imperative that drug makers understand how to assist prescribers in adapting to the new technology.
The war on opioid abuse is far from over, but electronic tools show promise for fighting this deadly epidemic. Moreover, stakeholders are creating educational materials for physicians, which can be leveraged by sales reps as prescribers adopt systems that are not intuitive to them. Point-of-Care Partners (POCP) has allied with CVS Caremark to create a series of webinars and educational materials (available at http://info.caremark.com/istop) to help providers as the March 27 go-live date nears. Let POCP position your firm and sales reps to take advantage of this unprecedented opportunity to help physicians adapt to using electronic health records and ePrescribing.