Consultant: State should e-prescribe to combat opioid epidemic

To combat a nationwide opioid epidemic, Arkansas should encourage or require e-prescribing of controlled substances, legislators were told Wednesday.

Rory Rickett with The Stephen Group consulting firm told the Health Reform Legislative Task Force that the United States, with 5% of the world’s population, is responsible for 90% of the world’s use of hydrocodone, 80% of the world’s use of oxycodone, and 65% of the world’s use of hydromorphone.

Rickett said the epidemic started with a brief story in a professional journal that found that short-term use of opioids among patients in a Boston hospital was not addictive. The medical community mistakenly determined that longer term use is also not addictive.

Rickett said that 90% of deaths related to opioids occur among prescriptions, though that is slowly shifting toward heroin and illicit drugs.

“There’s too many opioids sitting in people’s medicine cabinets that people, friends, family, everybody can get access to,” he said.

All states allow e-prescribing where a computer sends a prescription, but only three states require opioids to be e-prescribed rather than through paper pads, and he recommended Arkansas encourage or require that. Some states, meanwhile, limit initial supplies of the drug – just enough for a week. He said most states allow the use of Naloxone, which can quickly counteract the effects of opioids. All but eight states have made it available and granted immunity to those who administer it in good faith.

“Arkansas is right at the forefront of that,” he said.

Rickett said the Arkansas Medicaid program has been decreasing the amount of narcotics prescribed without causing a pushback from patients. The pharmacy management team has done a good job of monitoring patients so they don’t stockpile narcotics by refilling their prescriptions before they run out. He said the state has had a successful drug takeback program and should expand it.

Rickett said health-related government agencies are becoming involved in the epidemic. The Centers for Disease Control recently released 12 recommendations for prescribers to consider when treating chronic non-malignant pain. The FDA has approved six tamper-resistant drugs that can’t be consumed after they are crushed through snorting or injecting. The Drug Enforcement Agency has encouraged local drug takeback programs.

Rep. Joe Farrer, R-Austin, asked how other countries handle pain. Rickett said they use acetaminophen or aspirin.

“We start with the big guns,” Rickett said.

Dr. Greg Bledsoe, the state’s surgeon general, said that while practicing overseas, he saw that, “in international populations, they don’t have this false sense that they should have zero pain during their illness.” He blamed short-sighted policies that pushed medical providers to prescribe those addictive medicines. He said he recently co-authored a paper saying that patient satisfaction scores are contributing to the problem by encouraging doctors to prescribe lest they receive a low score.