According to the Canadian Institute for Health Information, hospitalization for opioid poisoning increased by 27 per cent between 2013 and 2017, with an average of 17 people hospitalized for opioid poisoning each day in 2017. Devastating, but the facts get worse — the Public Health Agency of Canada reported 10,300 people in Canada died from an apparent opioid-related overdose between January 2016 and September 2018. That is approximately 10 people who die due to opioids every day.
Finding a solution to the opioid crisis is not easy — there are many factors at play — and changes likely need to be made at every point across the continuum. Physicians, pharmacists, health systems, regulators, public health agencies and affected citizens themselves all have a role to play.
Canada Health Infoway recently held a stakeholder consultation with prescribers and patients with opioid experience, to understand their perspectives. What the exercise revealed was that 76 per cent of prescribers and 77 per cent of patients support e-prescribing as the sole/preferred option for prescribing opioids, believing it can help with Canada’s opioid crisis.
Historically, Canada’s prescribing system has been paper-based, with physicians providing prescriptions to patients to take into a pharmacy. PrescribeIT® is a national electronic prescribing service that offers prescribers, pharmacists and patients a safer and more patient-centric option that is part of a shift towards digital health offerings in Canada.
e-Prescribing makes it easier for physicians to give patients prescriptions for smaller quantities of opioids knowing that an additional supply can be ordered remotely if or when the patient needs it. This may sound simple, but it is significant. Currently, prescribers frequently order larger quantities of opioids after surgeries or procedures because of concern the patient may run out and be in pain. As a result, there are left-over opioids in medicine cabinets across the country, which can then be stolen, misused or sold.
A study of students in Ontario from grades seven to 12 found that 21 per cent admitted to taking opioid prescription drugs for non-medical reasons, and of those students, 72 per cent reported obtaining them from their homes. This is a significant concern that e-prescribing of smaller quantities of opioids can help to address. e-Prescribing also makes it easier to cancel a prescription when it is no longer needed, again reducing the potential for that medication to end up being misused.
e-Prescribing can also enhance the communications between the prescriber and the pharmacist. PrescribeIT® offers a secure two-way communication so a pharmacist can quickly address any concerns about dosages or potentially dangerous combinations. This is particularly important when opioids are unknowingly prescribed alongside benzodiazepines, medications that are commonly prescribed for anxiety, insomnia and epilepsy. This deadly combination was responsible for 50 of the 82 opioid-related deaths in New Brunswick in the past three years.
In addition to better supporting patient care and outcomes, e-prescribing can lead to a reduction in inadvertent errors, forgery and fraud. While this won’t eliminate the illicit use of opioids, it can be a step in a positive direction.
The consultation also underscored physicians’ and patients’ overwhelming support for e-prescribing services to offer evidence-based prompts to physicians when prescribing opioids. PrescribeIT® could be enhanced to display prompts that would inform prescribers if their opioid prescribing falls outside of recommendations in opioid prescribing guidelines.
We need new ideas and renewed commitments from all stakeholders to achieve significant change. And changing how opioids are prescribed, and in-turn supporting safer prescribing, is an excellent step forward.
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