A 21st-century solution to the opioid crisis

A 21st-century solution to the opioid crisis
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The numbers are staggering: nearly 12 million people fell prey to opioid addiction in 2016 alone, contributing to 64,000 drug overdose deaths in the same year.

Awareness of this epidemic is on the rise, and widespread consensus exists among Democrats and Republicans alike on the need for swift action. But we have still come up short on real solutions that move us from talk to results.

This is where technology has a role to play.

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In a day and age when an Apple Watch can detect a heart arrhythmia and a doctor’s appointment can be scheduled with a few taps of a smartphone, we must similarly modernize our response to this pressing public health emergency.

 

We believe that starts with putting better information in the hands of the prescribers and pharmacists who are on the front lines of the fight against opioid misuse.

Pharmacists who dispense controlled substances have a responsibility not to dispense to patients who may be at risk for abuse of these drugs; however, their tools are limited.

The systems that clinicians rely on to detect improper opioid prescriptions – known as Prescription Drug Monitoring Programs (PDMPs) – hold great promise, but they operate as a patchwork of separate programs in each state, creating troubling blind spots that allow episodes of abuse and unintended misuse to fester.

In many states, data on a potential abuser may not be available in real time and do not include fill attempts, which encourages pharmacy shopping.

Worse, PDMP information is not in doctors’ or pharmacists’ workflow – meaning that clinicians must use a separate, cumbersome system to check patients’ opioid history. A study of Massachusetts’s PDMP found that this process took over four minutes and 53 mouse clicks, taking valuable time away from clinicians’ face-to-face interactions with the patient.

It’s no surprise, then, that a Pew study found the median rate of PDMP usage among prescribers to be 31.7 percent. When doctors know they are not getting the most accurate, comprehensive view of a patient’s opioid history anyway, it’s easy to see why some choose to forgo the program altogether.

This is why groups as diverse as Walgreens, Oracle, Centerstone, the National Alliance on Mental Illness, the Brain Injury Association of America, MedStar Health — as well as our respective organizations: Health IT Now and the National Council for Prescription Drug Programs (NCPDP) — have embraced a nationwide, interoperable, and real-time drug monitoring program to stop fraudulent prescriptions before they reach the patient’s hands.

We’ve called it the Prescription Safety Alert System, based off the NCPDP Standards-based Model for PDMP: An Interoperable Framework for Patient Safety, but the name is much less important to us than the policy.

First envisioned in a 2016 NCPDP white paper, our solution would function as a facilitator that is run by the private sector under a contract with the federal government.

Importantly, the technology to do this is already exists. More than 20 years ago, NCPDP first developed its SCRIPT standard that paved the way for doctors to electronically send prescriptions to your pharmacy in real-time. More recently, its telecommunication standard wrote the rules of the road for how pharmacies communicate with patients’ insurance to instantly adjudicate claims.

Now we need to employ these tools to stem the tide of abuse by allowing clinicians to identify at-risk patients while ensuring access for those with a valid medical need, and we know it’s possible. Medicare Part D is using a similar system today, known as the “TrOOP” facilitator, to track out-of-pocket costs, making this a time-tested concept.

Under our plan, an alert system would instantly capture data each time a physician sends an electronic prescription for a controlled substance and each time a pharmacist seeks to fill an opioid prescription.  

The private sector facilitator would use this information in conjunction with an algorithm to alert the prescriber or dispenser if a patient presents a risk — anything from a possible drug interaction to an individual who may have already filled a prescription moments ago at another pharmacy across the street.

The result? Clinicians have real-time information before prescribing a controlled substance. Moreover, the solution reduces the time clinicians spend trying to track down data and allows them to focus more time on patient care.

What’s more, with a recent study pegging the true economic cost of the opioid crisis at $500 billion a year, this solution can actually save taxpayer dollars, as physicians and pharmacists are empowered to catch problems before they become costly tragedies.

We have been hard at work championing this blueprint, and Washington is taking notice. Included in the White House’s new opioid plan released last week is a call for states to “transition to a nationally interoperable prescription drug monitoring program network” — a network like the Prescription Safety Alert System.

The administration realizes, as we do, that when prescribers and pharmacists lack a complete view of a patient’s history with powerful opioid medication, they can tragically become unwitting aids to an abuser’s destruction.

Conversely, when clinicians have the right information at the right time, they can thwart cases of abuse before it’s too late and precious lives can be saved. The Prescription Safety Alert System will help accomplish exactly that.

Joel White is the executive director of Health IT Now. Lee Ann Stember is the president and CEO of the National Council of Prescription Drug Programs (NCPDP).