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E-prescribing triggers more prescription of controlled substances

Posted: September 8th, 2009 | Author: | Filed under: Controlled Substances | 1 Comment »

A shift from handwritten to computer-generated prescriptions was associated with a substantial increase in the proportion of controlled substances prescribed out in a New York hospital.

The removal of an impediment to prescription writing was linked to the rise in Schedule II opioids and benzodiazepines prescriptions at the emergency department of the Good Samaritan Hospital Medical Center in New York, researchers claimed.

“Simple regulatory changes and lifting of barriers, such as the utilization of electronic prescriptions, can make significant changes to practice patterns and may change the way patients are treated,” the authors wrote in a study published recently by the Academy Emergency Medicine journal.

The study compared the changes in opioid and benzodiazepine prescriptions before and after the New York State implemented the “Official Prescription Program,” which was designed to reduce the amount of drugs diverted from legitimate medical use by preventing alterations, forgeries and counterfeiting of prescriptions.

The new system, implemented on April 19th, 2006, required all prescriptions to be computer-generated from the doctors’ stations and printed via a dedicated printer onto standardized prescription forms.

Before this, the hospital’s emergency department staff stored a specialized prescription form in a locked cabinet, and physicians had to handwrite and stamp the prescription.

A year before the program was enacted, a little over 2 percent of almost 27,000 charts reviewed in the study were for Schedule II controlled opioids, such as oxycodone. A year after regulatory changes were made, prescription for the same class of drugs increased to 13.6 percent. The same pattern was observed in benzodiazepines, which increased from 1.4 percent to 3.9 percent.

Meanwhile, the corresponding percentages for Schedule III-V opioids, which include hydrocodone and codeine, dropped from 29.9 percent to 18.1 percent during the same period, results showed.

Researchers said the change was attributed from a shift in the prescribing of hydrocodone to oxycodone. Both drugs have similar side effects but oxycodone is associated with less constipation than hydrocodone, giving patients better relief, they added.

“We have demonstrated that clinical practice may be significantly associated with the ease and convenience of prescribing medications,” the authors wrote.

Interestingly, the shift was observed as the result of technological improvements instituted to comply with a state regulation, rather than as a measure to directly address pain management, they said.

“As more EDs shift to electronic medical charting with linked prescription writing, a similar unanticipated change in prescribing patterns could occur,” they concluded.

For more information:

McGerald G, Dvorkin R, Levy D, Lovell-Rose S & Sharma A. (2009). “Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions.” Acad Emerg Med. Jun;16(6):508-12. Read abstract


One Comment on “E-prescribing triggers more prescription of controlled substances”

  1. 1 Penny Hendrix said at 3:29 pm on February 22nd, 2010:

    George,
    I was doing some research to see where the DEA stands on its final rule with regard to e-scripts for controlled substances, and I found your site. I’m reading “E-prescribing triggers more prescription of controlled substances”. One question … in light of the other article, “Stakeholders await final DEA rule to lift e-prescription ban for controlled substances”, how is it possible that e-prescribing could trigger more prescriptions for controlled substances? Do you know if Good Samaritan Hospital Medical Center has/had some sort of special waiver from DEA to be able to do controlled substance prescriptions electronically? I would be interested to know if they did …


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