E-prescribing controlled substances

Technology Forum

As technology infiltrates the health care system, paper prescriptions may soon become a thing of the past. According to Surescripts’s National Progress Report, 58% of all eligible prescriptions in the United States were electronically prescribed in 2013.1 However, electronic prescriptions (e-prescriptions) for controlled substances continue to lag behind those of other drugs, even though such medications make up about 13% of the prescription market.

In the past, federal law required the issuance of a paper prescription for controlled substances. In 2010, the Drug Enforcement Administration’s (DEA) Interim Final Rule provided practitioners the option to issue e-prescriptions for controlled substances (EPCS) in lieu of paper prescriptions. Nonetheless, states throughout the nation have been reluctant to implement EPCS in fear of potential abuse in the absence of appropriate controls.

New protocols needed

DEA has begun to develop protocols for situations that are anticipated to cause some confusion or conflict. Currently, when a pharmacist receives paper and electronic copies of the same prescription, protocol dictates that one should be marked as void. When a pharmacist receives a paper prescription that was originally transmitted electronically to another pharmacy, the pharmacist must contact the original pharmacy that received the prescription to confirm the receipt and whether or not the prescription was dispensed. If the prescription has not yet been dispensed, the pharmacy must mark the electronic version as void. If the original e-prescription has been dispensed, however, the paper prescription must be cancelled.

This scenario assumes that the pharmacist knows the hard copy is a duplicate of a previously e-prescribed medication. If a pharmacist does not know whether the medication has been previously e-prescribed, however, a patient could potentially get one medication filled twice: once using the e-prescription and once with the hard copy if the patient pays in cash. Although e-prescribing for most medications may not be harmful, it could pose potential risks if a patient filled a hard copy prescription for a previously e-prescribed controlled substance and obtained more than the intended supply.

In addition, no protocol has yet been developed for instances in which an e-prescription is transmitted to a pharmacy that may not have the controlled substance in stock. Because new prescriptions cannot be transferred between pharmacies, the patient would need to contact the physician to receive the medication at another pharmacy. If the second pharmacy was also missing the prescription medication in stock, the process would have to continue until the prescription reached a pharmacy where it could be filled.

It is clear that such a situation would be a nuisance for everyone involved, especially the patient, who may be in a great deal of pain. While certain barriers still exist to the complete implementation of e-prescriptions, EPCS is a promising tool for improving public safety and health. 

Potential impact of new legislation

Use of e-prescriptions is a fairly new practice, and while its future seems promising, obstacles remain. E-prescribing has a number of confirmed benefits, including enhanced patient safety, reduced drug costs, and improved pharmacy workflow. Although e-prescribing eliminates certain errors, it also potentiates new errors and sources of conflict, such as those previously mentioned.

Prior to mandating e-prescribing of all medications, including controlled substances, clear protocols need to be developed to help prevent misuse or abuse. Pharmacists can help eliminate errors by anticipating problems that can arise and staying engaged in the process of developing related policy and protocols. In addition, use of state registries can help pharmacists and prescribers work together to prevent medication misuse and abuse as well as potentially decrease overdose deaths in any community.

It is anticipated that, with continued technological advances, the benefits of e-prescribing for controlled substances will outweigh its potential risks.

1. http://surescripts.com/docs/default-source/national-progress-reports/surescripts_2013_national_progress_report.pdf?sfvrsn=2