Opioid painkillers are dangerous? Thanks New York Times. Now tell us something we don’t know.

Dr. Sean Kelly
Mar 17, 2016

Yesterday, in an article on the release of new CDC guidelines for prescribing painkillers, which recommend that doctors first try ibuprofen and aspirin to treat pain, then prescribe only a three-day course of the highly addictive opioids, New York Times reporter Sabrina Tavernise wrote, “the recommendations are meant for primary care doctors, who prescribe about half of all opioids but often have little training in how to use them.”

If there are any doctors out there who didn’t learn about the dangers of painkillers in a decade of medical school and training, they surely have come to this realization through years of clinical practice, and I know this from experience. As I wrote in response to a NYT op-ed on the role of doctors in the addiction crisis, we doctors recognize that some of the most powerful medications we prescribe also have the most potential for abuse, addiction, and patient harm. But it isn’t a lack of training or education that prevents us from effectively combatting the addition crisis. It’s a lack of technology, outdated paper-based systems, lack of data, incomplete records, partial information, inaccurate information, and even intentional dis-information.

While the CDC’s guidelines are well intentioned, we at Imprivata believe that they miss the best way to address this crisis upstream and successfully: electronic prescribing for controlled substances (EPCS). Electronic prescribing is safe, legal, and is an effective tool against prescription drug abuse. It reduces the risk of altered, stolen, and fraudulent prescriptions, and the potential for drug diversion of controlled substances. EPCS can also be implemented alongside strengthened prescription drug monitoring (PMP) programs, allowing providers to check on a patient’s prescription drug history and thus help prevent “doctor shopping”. When PMPs are used with electronic prescribing and require real time reporting, they serve as a very effective tool to prevent prescription drug abuse.

In today’s world of modern medicine and cutting-edge tools for ascertaining precise diagnoses, we still measure pain using a rudimentary “1 to 10 scale” that is entirely based on the patient’s individual tolerance. In turn, prescribing powerful narcotics to treat pain is highly subjective, and physicians must make a judgment call as to whether the patient is in true need of medication or whether they are doctor shopping.  

As providers, we want to do the best for our patients, and we don’t want to deny anyone proper treatment. But it is a difficult balancing act, and it is our duty after all to do no harm. We certainly don’t want to inappropriately contribute to a cycle of escalating addiction. I think the vast majority of prescribers are actually trying to do the right thing and would welcome the tools to help them do so. Most want better technology that allows for efficiency, transparency, and accountability. And EPCS is a very effective deterrent for anyone trying to abuse the system.

Our hometown paper, The Boston Globe, got this right. Last year, Globe reporter Priyanka McCluskey reported on the EPCS rollout at Cambridge Health Alliance (CHA). CHA made the step to stop issuing paper prescriptions for addictive painkillers following a year where opioid drug abuse killed more than 1,200 people in Massachusetts. According to doctors interviewed by the Globe, the role that EPCS technology plays in “eliminating the paper trail for painkiller prescriptions” is “especially important given the nation’s severe ongoing opioid epidemic.”

The prescription drug crisis is a serious epidemic throughout this country. Though the CDC means well, the new guidelines alone won’t be sufficient to alter prescribing patterns. Electronic prescribing offers an easy technological solution that can be incorporated into healthcare settings today. EPCS helps prevent fraudulent prescriptions and drug diversion, but does not restrict access to opioids for patients who have a legitimate need for pain medication. EPCS is the solution -- and should be more widely implemented. 

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