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. 2020 Dec 1;3(12):e2027951.
doi: 10.1001/jamanetworkopen.2020.27951.

Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates

Jordan Everson  1   2 , Audrey K Cheng  1 , Stephen W Patrick  1 , Stacie B Dusetzina  1
Affiliations

Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates

Jordan Everson et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objective: To assess the association between use of EPCS and trends in opioid prescribing.

Design, setting, and participants: 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.

Main outcomes and measures: 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.

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Everson reports receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study, funding from the Robert Wood Johnson Foundation, and having received personal fees from the Office of the National Coordinator for Health Information Technology and the Urban Institute for work outside of this article. Dr Patrick reports receiving funding from the National Institute on Drug Abuse, the National Institute on Child Health and Human Development, the Robert Wood Johnson Foundation, the Boedecker Foundation, and the Centers for Medicare & Medicaid Services Innovation Center. Dr Dusetzina reports receiving grants from the Commonwealth Fund and personal fees from West Health, the National Academy of State Health Policy, and the Institute for Clinical and Economic Review outside the submitted work; serving on the National Academy of Sciences, Engineering, and Medicine Committee “Ensuring Patient Access to Affordable Drug Therapies”; and receiving funding from the Commonwealth Fund, the Leukemia and Lymphoma Society, the Robert Wood Johnson Foundation, and Arnold Ventures. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Opioid Prescribing, Morphine Milligram Equivalents (MME), and Electronic Prescribing of Controlled Substances (EPCS) Capability, 2010-2018
Figure 2.
Figure 2.. Change in Opioid Prescribing, Percent Morphine Milligram Equivalents (MME) of Prescribed Opioids, and Prescriber Electronic Prescribing of Controlled Substances (EPCS) Use, 2013-2018
See this image and copyright information in PMC

References

    1. Wide-ranging ONline Data for Epidemiologic Research (WONDER). Centers for Disease Control and Prevention. Accessed November 14, 2020. http://wonder.cdc.gov
    1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. doi:10.15585/mmwr.mm675152e1 - DOI - PMC - PubMed
    1. Danovich D, Greenstein J, Chacko J, et al. . Effect of New York state electronic prescribing mandate on opioid prescribing patterns. J Emerg Med. 2019;57(2):156-161. - PubMed
    1. Imprivata. Federal and state regulations. State EPCS legislation adoption. Accessed February 6, 2020. https://www.imprivata.com/state-epcs-legislation
    1. Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients an Communities Act or the SUPPORT for Patients and Communities Act. In: Vol 115-271. Library of Congress; 2018.

Publication types

MeSH terms

Substances