Online prescribing could help deter abuse of powerful drugs like the painkiller hydrocodone. (AP Photo/Toby Talbot)

In its effort to tackle the growing epidemic of prescription drug abuse, the federal government has taken a couple of major steps in the past few weeks. First, it put tighter restrictions on medications containing hydrocodone, a widely prescribed and highly addictive painkiller. Just earlier this week, the Obama administration issued new measures allowing people to return unused prescription drugs to hospitals, pharmacies and other places where they actually get drugs in the first place.

And new data suggest that another federal measure that could combat this epidemic through online tracking of powerful and potentially addictive drugs, like Percocet and OxyContin, is starting to gain some steam after launching four years ago. The initiative is Electronic Prescribing for Controlled Substances (EPCS), a March 2010 DEA rule allowing pharmacies and care providers to handle prescriptions for Schedule II-V controlled substances entirely online.

About 6.5 million Americans above the age of 12 used prescription drugs for non-medical purposes last year, according to a government survey released last week. As of 2011, prescription drugs accounted for more than half of about 41,300 deaths from unintentional drug overdoses.

Making prescriptions for these drugs electronic has some advantages that experts think could help deter prescription drug abuse and fraud. For starters, it reduces reliance on paper, which cuts down on the opportunity for forged prescriptions. It also creates a new wealth of information allowing prescribers and pharmacies to identify potential cases of misuse. When New York's new online system launched last summer, it reportedly helped identify 200 incidents of patients shopping around for doctors in search of these drugs in just the first three days.

As with any new IT initiative in health care, take-up of EPCS has been initially slow for a number of reasons. The prescribing networks need to be secure, states had to change their laws in response to the DEA rule, and several digital initiatives are competing for the industry's attention, like the meaningful use of electronic health records and the transition to a new medical coding system.

New data from DrFirst, a leading vendor of EPCS technology, shows that electronic prescriptions for controlled substances has taken off in the past year. The number of the company's EPCS transactions jumped from about 11,000 per month in January 2013 to 60,000 this past July.

A good sense of how many pharmacies are able to accept electronic prescriptions for controlled substances comes from Surescripts, which operates the biggest e-prescribing network and is plugged into 95 percent of the country's pharmacies. As of August, Surescripts found that 50 percent of pharmacies were enabled to electronically prescribe controlled substances — up from around 40 percent at the end of the year. Implementation of these electronic systems, though, has been uneven across the country, as the following map shows.


The top five states, according to Surescripts, include: Delaware (74 percent of pharmacies), Rhode Island (73 percent), Massachusetts and the District of Columbia (67 percent), and Oklahoma (65 percent). The bottom five: North Dakota (15 percent), Montana (18 percent), South Dakota (31 percent), Arkansas (33 percent) and Kentucky (36 percent).

The EPCS program is voluntary, but starting in March, New York will be the first state in the country requiring controlled substances to be prescribed electronically. That earned some praise from the director of the Centers for Disease Control and Prevention, who called it an "important step forward" in the fight against prescription drug abuse.

The New York e-prescribing law "is a real game-changer," said Peter Kaufman, DrFirst's chief medical officer. "This is one of the biggest things nationwide, and I think other states are waiting to see."

EPCS won't be a panacea for solving the nation's vast prescription drug abuse problem, and there are certainly other ongoing efforts to deter abuse of dangerous drugs. But it likely can play a larger part in the solution when there's widespread adoption of the technology.

"Is it two years? No," said Surescripts executive vice president David Yakimischak. "It is five years? Maybe. It is 10 years? Almost certainly."