The war on drugs is being fought on many fronts -- including the bathroom medicine cabinet. In fact, that’s where the heaviest action is, because prescription drug abuse is the fastest-growing drug problem in the United States. The National Survey on Drug Use and Health has found that nearly one-third of people ages 12 and over who used drugs for the first time in 2009 began with prescription drugs. And more overdose deaths have involved prescription opioids than heroin and cocaine combined since 2003, according to the Centers for Disease Control and Prevention (CDC). In 2007, approximately 27,000 unintentional drug overdose deaths occurred in the U.S. For every such death, nine more people are admitted for substance abuse treatment.
The problem is most troubling among the military, where illicit prescription drug use increased from 5 to 12 percent among active duty service members over a three-year period from 2005 to 2008.
Abuse is also rampant among the young. One reason is the sheer number of addictive pills out there. Opioid prescriptions have jumped 48 percent between 2000 and 2009. The other is weak prescription drug monitoring programs (PDMP). Nearly every state has one, but most are not up to the task of tracking the epidemic. A big issue is technology. To that end, the federal government has set up pilot programs in Indiana and Ohio to improve real-time access to PDMP information for health-care providers. The Office of the National Coordinator for Health Information Technology (ONC) is managing the overall project in conjunction with the Substance Abuse and Mental Health Services Administration, CDC and Office of National Drug Control Policy.
Though PDMPs track potential abusers, doctors simply haven’t yet learned how best to utilize the information. “Forty-nine states have monitoring programs in place, but most of their providers and pharmacies are not accessing them regularly because it doesn’t fit in with their workflow,” says Kate Tipping, a policy analyst with the ONC. “We wanted to explore ways we could help get that information to providers in real time and see if it can be used to determine if a controlled substance should be prescribed.”
In Indiana, the ONC chose a health system with electronic health records (EHR) in place. Whenever a patient is admitted to, discharged or transferred from the emergency room, that order will trigger the Indiana Scheduled Prescription Electronic Collection and Tracking program (INSPECT) to upload information about the patient’s drug history to the EHR. “We’re working to demonstrate a deep technical integration with INSPECT,” says Tipping. “If we are successful there, other hospitals can connect with the health information exchange (HIE), and other HIEs can connect with INSPECT to add PDMP access to their capabilities.”
Ohio’s project is similar, but it is focusing on integrating a smaller, family practice-based EHR system with the Ohio Automated Rx Reporting System. Patients are given a numeric score using a software program that indicates their risk of abuse. If the score is over a certain threshold, the provider receives an alert on that patient’s EHR. If the pilot proves successful, practices without an EHR will still be able to access the data through a Web interface.
“We’re not building anything new, just connecting existing systems,” Tipping says. “This makes it easier for others to duplicate what we have done.” The pilots ended in September, and data is being analyzed to see if the information flowed as planned and if the number of abuse reports decreased. “Mainly, we want to see if this information is getting to providers in real time,” Tipping says. “The overall goal of all our pilot tests is to give health-care providers the data that they need to make the best prescribing decisions that they can.”