2014: A critical year for opiate addiction policy

In January 2014, Vermont Governor Peter Shumlin dedicated his entire state-of-the-state address to what he called “a matter of great concern to our state’s future.” He spoke of a crisis so “complicated, controversial, and difficult to talk about,” it would take the full force of government, law enforcement, and the health care community to adequately address it.

Gov. Shumlin was speaking about a national public health crisis—opiate addiction and abuse, which is fueled by increasing prescription drug abuse. The number of deaths involving opioid painkillers like Vicodin and OxyContin is rising at an alarming rate, increasing nearly fourfold over the last decade.  His dramatic and admirable stance on the issue has been taken up by policymakers around the country who are also dealing with the addiction, crime, and death that stem from this epidemic. In March 2014, Massachusetts Governor Deval Patrick declared Massachusetts’ opiate epidemic a public health emergency, and in June, governors from 5 of the 6 New England states met at Brandeis University to develop a new, multi-state strategy to combat the region’s growing opioid abuse epidemic with a focus on both treatment and prevention.

As an emergency physician, I am aware of the emotional and physical toll that opiate abuse, particularly when prescription drugs are involved, takes on our society. As the Chief Medical Officer for Imprivata, I also understand the critical role that technology can play in enhancing security and preventing drug abuse, while simultaneously easing access for patients who legitimately need treatment with controlled substances, such as those diagnosed with acute painful conditions, chronic pain syndromes, cancer, seizures, mood disorders, or palliative care/hospice patients.

Throughout this past year, I have spent a great deal of time meeting with medical professionals, lawmakers, boards of pharmacy, and healthcare technology vendors. Together, we discussed ways we can collaboratively use technology to enhance patient safety and quality while preventing the morbidity and mortality that comes with abuse of these highly addictive medications. 

No doubt, prevention requires widespread education of youth, parents, guardians, and care providers who, with specialized training, can be better prepared to recognize early warning signs of addiction and intervene at its onset. In addition to these efforts, the health care community is partnering with the technology industry to help prescription drug abuse with innovative tools that combat drug diversion.

The DEA and many states are recommending, and increasingly enforcing, Prescription Monitoring Programs (PMP) and electronic prescribing of controlled substances (EPCS) to prevent the illegal diversion of drugs before they are prescribed, and ensure that patients with legitimate pain have convenient access to the medication they need. The state of New York is leading the way with its Internet System for Tracking Over-Prescribing (I-STOP) Act, a landmark law mandating that providers check PMPs and that all medications be electronically prescribed by March 27, 2015.

I-STOP has made New York care providers and pharmacies the default pioneers of technology-driven drug prescribing security, and has forced vendors to deliver technology that prescribers will embrace because it streamlines (rather than interferes with) their ability to care for patients.

Examples exist throughout the country of forward-thinking healthcare organizations implementing technology to help combat prescription drug addiction while also improving patient safety and convenience.  Northshore University Health System in Chicago and Methodist Health System in Omaha were early innovators. They both implemented EPCS projects in order to ensure that patients with legitimate pain have efficient access to the medications they need while those with harmful or illegal intentions are prevented from diverting medications into the wrong hands.  As this news clip featuring Methodist Health System demonstrates, leaders in healthcare have taken advantage of the opportunity to adopt the tools they need to meet these two goals. And for good reason: The regulatory environment regarding drug security continues to tighten and the political pressure and ethical momentum to address this public health epidemic continue to grow.

Today 49 states have PMPs that track and report on the prescribing patterns of patients. These programs provide doctors with the visibility they need to identify potential doctor shopping and abuse. EPCS regulations are also expected to expand from state to state for a variety of reasons, chief among them is the immediate need to stem drug diversion related to opiate abuse. In September 2014, the DEA reclassified “hydrocodone combination products” including Vicodin, from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access to this widely prescribed drug and make it more difficult to prescribe.

Much has happened since Governor Shumlin told his fellow Vermonters that stemming the opiate abuse epidemic would be his number-one policy priority. Just days after winning the election in November, Massachusetts Governor-elect Charlie Baker reiterated his campaign promise by vowing in a Boston Globe interview to work with the healthcare community to tackle Massachusetts’ opiate epidemic. In December, he traveled to Washington for a meeting with President Obama, at which he urged other states to collaborate in the fight against opiate addiction.

This level of public commitment is encouraging, as is the momentum that is visible across the healthcare industry: from prevention and education to treatment and recovery. Healthcare technology vendors who support prescribers and hospitals in adhering to prevention policies will play an even more critical role in 2015.