Opioid Prescriptions Decrease After ePrescription Mandate

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The Backstory to the Opioid Crisis

Both prescription and illegal opioid overdose deaths have been an ongoing issue since the 1990s and can best be described as trending upward in three waves:

1) increased prescriptions in the 1990s

2) a spike in heroin-related deaths coinciding a wave beginning in 2010, and

3) deaths rising in 2013 accompanied by increased synthetic opioid use such as fentanyl.

Upon closer inspection, the National Institutes for Health found a significant upward trend in overdose deaths involving prescription opioids from 1999 to 2020. In 1999, the number of deaths totaled less than 5,000; by 2020, this number skyrocketed to 16,416 deaths. This begs the question: What regulatory actions can aid in combatting this epidemic from a prescription abuse standpoint? A recent study involving an ePrescription mandate may reveal one potential solution.

Controlled Substance Prescription Changes to Medicare Part D

Approximately one year ago, on January 1, 2021, Medicare Part D began requiring electronic prescriptions of controlled substances per mandates in the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. How does this change impact opioid prescription volume? It is still too early to know all the answers since the mandate went into effect just over one year ago. However, The Journal of Hand Surgery Global Online jumped on the opportunity and published data in January of this year. Their study, which was focused in Massachusetts, involved 428 patients with either a carpal tunnel release (CTR), ganglion excision, carpometacarpal (CMC) arthroplasty, or distal radius fracture open reduction internal fixation (DRF ORIF). The objective was answering: “Is there a change in the number of opioids prescribed after the institution of electronic opioid prescriptions in 4 common, yet diverse, outpatient hand surgeries?”

Insight into Opioid Prescription Volume After the Medicare Change

Here is a brief rundown of the retrospective study’s significant results:

• Decrease in total morphine milligram equivalents (MMEs) prescribed for ganglion excision and CMC arthroplasty
• Reduction in the number of tablets prescribed for the ganglion excision
• Decrease in the number of patients receiving any opioid prescription in the CTR and ganglion excision groups
• No conclusions can be made about the actual consumption of pills by patients, as this study focused on examining physician prescribing patterns and volumes

Exploring the “Why” Behind these Prescription Patterns

One reason for these decreases may have been that the improved documentation created transparency with physician and patient accountability. Another contributing factor could be that the ePrescriptions improved refill efficiency by decreasing excess prescribed pills.

Potential for Future Data Generation

Data across a broader spectrum of geography, surgeries, and medical conditions should be published to continue investigating the more widespread impact of ePrescription mandates on physician-prescribed opioid volume. But for now, this study provides some promising data on a potential successful regulation that could be applied nationwide to decrease prescription volume. Stay tuned for more research on this topic in the coming months.