By Marcelo E. Bigal, MD, PhD, Chief Medical Officer, Purdue Pharma

As a researcher, headache and pain specialist, and the chief medical officer of a company that manufactures prescription opioids, I recognize that technology has a supporting role to play in helping address the nation’s opioid crisis. At Purdue Pharma, we are deeply concerned about the toll the opioid crisis is having on individuals and communities across the nation. We believe that harnessing the power of technological innovation in combination with meaningful conversations between physicians and patients can drive solutions forward.

One important technological tool that already exists is the Prescription Drug Monitoring Program (PDMP). PDMPs enable prescribers to see prescription histories. Studies suggest that PDMPs can help reduce the number of prescriptions written for opioids and that PDMP use is associated with a reduction in pain medications received for nonmedical use from multiple doctors.[1],[2] Although PDMP systems have been available for many years, their utility was somewhat limited until they began to be connected to Electronic Health Records (EHR) and pharmacy dispensing programs. Connecting these technologies enables healthcare professionals to access data on a specific patient in real time – as they are making prescribing decisions. Purdue supports improved PDMP access and utility for clinicians, including enabling them to retrieve data across state line and integrating information into the clinical workflow. To aid in this effort, we provided funding to the National Association of Boards of Pharmacy to enable states to connect to a platform and share PDMP data with other states at no cost. We are also part of a public-private partnership working to improve PDMP usability by reducing the number of steps prescribers and pharmacists need to take to consult and use PDMP information when determining if it’s clinically appropriate to prescribe or dispense an opioid.[3]

There are other ways technology can play a role in helping to serve patients. We strongly believe that increased adoption of electronic prescribing of controlled substances (EPCS) can help protect patients by reducing medication errors caused by illegible prescriptions or oral miscommunication.[4] It may also reduce diversion by making forging or altering prescriptions difficult and reduce theft of written prescriptions and prescription blanks. Unlike traditional paper prescriptions, electronic prescriptions cannot be copied or stolen, and they are more difficult to alter or forge.[5],[6] Finally, EPCS can be easily mapped to electronic health records and to regulatory databases, offering an enhanced tool for research and epidemiological surveillance.[7] Since June 2010, the Drug Enforcement Administration has permitted EPCS, giving prescribers the option of e-prescribing, and allowing pharmacies to receive, dispense and archive e-prescriptions for controlled substances. Currently, more than 90 percent of pharmacies are equipped to handle electronic prescriptions for controlled substances. Adoption of the technology is expanding in medical practices, but is still underutilized, with only about one-quarter of all practices using e-prescribing for controlled substances.[8] We support continued utilization of this important prescribing technology.

Technology also has a role to play in supporting proper therapy and in reminding patients about healthy habits. Purdue partnered with an innovative health services organization on a study designed to demonstrate how the use of wearable health technology by chronic pain patients treated at a specialty clinic may improve both patient and healthcare system outcomes. The wearable device measured physical activity, sleep quality, and heart rate as well as self-reported pain levels, medication use, and non-pharmaceutical alternative therapies (stretching, mindfulness, and hot/cold therapy), in the hopes of guiding the patient toward optimal multi-modal therapy. Data have shown that 96 percent of patients recorded use of alternative therapy for pain control, with many applying various modalities multiple times per day.[9] We look forward to continuing this study to learn more about how this technology can be most impactful in sparing opioid use.

Technology provides useful complements to the critical conversation between health care practitioners and patients, but there is no substitute for the essential interaction between patients and their doctors when making medical decisions. Technology empowers physicians and patients, and if used in the context of humanistic and thoughtful care, might prove to be a powerful resource.

While no single intervention alone will solve the opioid crisis, we call on the medical community and the public to ensure they are making the most of the tools that already exist. In addition, there are untold ways technological innovation could help address the crisis. We stand ready to work with the tech community, alongside other partners in the government and medical community, to work toward meaningful solutions.

[1] Bao Y, Pan Y, Taylor A. Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Affairs (Project Hope). 35(2016)1045–1051. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336205/.
[2] Ali MM, Dowd W, Classen T. Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: evidence from the National Survey of Drug Use and Health. Addictive Behaviors. 69(2017)65–77.
[3] Purdue Pharma. Purdue Pharma and Commonwealth of Virginia Partner to Improve Utilization of Prescription Monitoring Program. Published January 26, 2017. Accessed December 2, 2018.
[4] Porterfield A, Engelbert, K, Coustasse, A. Electronic prescribing: Improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspect Health Inf Manag. 2014;11(Spring):1g. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995494/.
[5] DrFirst. The evolving EPCS landscape: A prescription for stopping opioid abuse. Retrieved from https://go.drfirst.com/hubfs/2016-03-24/2h8klr/8842/141586/EPCS_Whitepaper_DrFirst_3.2016.pdf. Published March 2016. Accessed September 15, 2018.
[6] Thomas CP, et al. Prescribers’ expectations and barriers to electronic prescribing of controlled substances. J Am Med Inform Assoc 2012;19:375e381. doi:10.1136/amiajnl-2011-000209. Retrieved from https://academic.oup.com/jamia/article/19/3/375/716591. Accessed November 20, 2018.
[7] Centers for Disease Control and Prevention. Meaningful Use. 2012. Retrieved from https://www.cdc.gov/ehrmeaningfuluse/introduction.html.
[8] Surescripts. 2017 National Progress Report. Retrieved from https://surescripts.com/news-center/national-progress-report-2017/#/better-healthcare-for-all. Published May 7, 2018. Accessed September 15, 2018.
[9] Han J, et al. Connecting patients to providers: Application of wearable health technology to a multidisciplinary pain program. (Poster #49) Presented at: 12th Annual PAINWeek® Conference; September 6, 2018.

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