The Drug Enforcement Administration's recent decision to reclassify Vicodin and similar hydrocodone combination drugs to Schedule II controlled substances is a significant step in fighting the prescription-drug abuse epidemic, but I'm concerned the tighter controls may place undue burdens on patients who need these medications to alleviate chronic pain.
A prescription for Vicodin or similar drugs can no longer be refilled without a visit the doctor's office and cannot be phoned in to the pharmacy. Doctors can write multiple prescriptions, but only for 90 days' worth of medication. While this should help address “doctor shopping” for drugs, it could also make it more difficult for patients to get their medication. Technology can help make the rule change a success, but only if it is easy for prescribers and does not inconvenience patients with legitimate needs.
I recently treated two patients in the emergency department who illustrate this dynamic. One complained of chronic back pain and said things to warrant narcotic treatment upon discharge. However, after checking the state prescription monitoring program (PMP), we discerned that the patient had been to several hospitals recently, receiving more than 100 tablets of oxycodone and hydrocodone. The second patient was suffering from pain associated with end-stage pancreatic cancer. Adding long-term narcotics to her regimen was appropriate, but forcing her to return to her doctor's office to refill her prescriptions seemed unreasonable and unjust.
In the first case, we were able to catch the instance of abuse using technology, but a recent study shows that 50% of physicians never check the PMP when prescribing controlled substances and the other 50% check it only half the time. PMPs need to be easier to access and use if they are going to be successful.
In the second case, the ability to route prescriptions for narcotics directly to the pharmacy could minimize the burden on the patient, but to date, electronic prescribing of controlled substances is not widely adopted.
Physicians are willing to embrace technologies such as systems that allow electronic prescribing of controlled substances and state PMPs, but they must be designed to fit easily into clinical workflows and minimize disruption for patients. The DEA reclassification of Vicodin and other hydrocodone drugs to Schedule II is a necessary step to fighting drug diversion and prescription-drug abuse, but it also sends this message to hospital leadership: Give prescribers the tools to make this work.
Dr. Sean Kelly is an emergency physician at Beth Israel Deaconess Medical Center in Boston and chief medical officer at Imprivata, an information technology security company based in Lexington, Mass.
