Abstract
The majority of US states have passed mandates requiring the use of electronic prescribing of controlled substances (EPCS) as a tool to reduce rates of opioid prescribing. It is not known whether increasing use of EPCS will have the intended effect. To assess the association between use of EPCS and trends in opioid prescribing. In this retrospective, longitudinal cohort study of all patients and prescribers in the 50 US states and the District of Columbia from 2010 to 2018, changes in state-level use of EPCS and concurrent changes in opioid prescribing in each state are described. Then the association between changes in the use of EPCS and opioid prescribing are estimated using state and year fixed-effects models that include covariates for policy change and state demographic change. Data Analysis was performed on May 5, 2020. The proportion of controlled substances in each state prescribed using EPCS based on opioid prescriptions per 100 persons and morphine milligram equivalents (MME) of opioids. In 2018, the population-weighted percent of opioids prescribed using EPCS was 27%, up from 0% as of 2013. National rates of opioid prescriptions decreased from 78 prescriptions per 100 persons in 2013 to 53 in 2018. Over the same period, there was a decrease from 64 071 MME per 100 persons in 2013 to 40 906 MME per 100 persons in 2018, representing 36% of the 2013 level. By 2018, EPCS increased to 69.4% in states with mandates for its use and 23.6% in states without mandates. In multivariable models, a 10 percentage-point increase in the use of EPCS was associated with an additional 2 prescriptions per 100 persons (95% CI, 1.3-2.8) and a 0.8% (95% CI, 0.06%-1.5%) increase in MME per 100 persons. These data suggest that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Opioid prescribing is associated with a variety of social and public health factors, and thus, despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing. Policy makers should consider levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
Highlights
IntroductionPrescription opioids are an important component of the opioid epidemic, contributing to 55% of the approximately 400 000 opioid-related overdose deaths that occurred between 1999 and 2017.1,2 Recently, electronic prescribing of controlled substances (EPCS) has been pursued as a means to “[decrease] rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to ‘doctor-shop’ and alter prescriptions.”3(p156) By February 2020, mandates for EPCS were in effect in states and passed in an additional states
These data suggest that an increased use of electronic prescribing of controlled substances (EPCS) was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing
Opioid prescribing is associated with a variety of social and public health factors, and despite the appeal, EPCS adoption alone may be insufficient to reduce opioid prescribing
Summary
Prescription opioids are an important component of the opioid epidemic, contributing to 55% of the approximately 400 000 opioid-related overdose deaths that occurred between 1999 and 2017.1,2 Recently, electronic prescribing of controlled substances (EPCS) has been pursued as a means to “[decrease] rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to ‘doctor-shop’ and alter prescriptions.”3(p156) By February 2020, mandates for EPCS were in effect in states and passed in an additional states. Enthusiasm for EPCS is due to its potential to detect and prevent opioid diversion by eliminating paper prescriptions,[6] enabling cross-referencing of prescription drug monitoring program (PDMP) databases[7] and facilitating electronic decision support tools.[8,9,10] Based on these potential advantages, the implementation and use of EPCS may curb “doctor shopping,” prescription fraud, and overprescribing, leading to improved opioid outcomes. These potential benefits may not be realized if EPCS systems do not effectively display the information needed to identify prior prescriptions or evidence of fraud in a way that is useful to clinicians at the point of prescribing. Like other sources of electronic clinical decision support, the success of EPCS is not assured and may depend on the crucial factors of its implementation.[11,12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
