Prescription drug policy will be examined in this paper. Prescription drug policy is a highly relevant topic dealing with both clinical practice and public health. This type of policy deals with various factors regarding prescription drugs such as methods of prescribing, cost, and the recent opioid crisis which ties into it. The topic is significant due to the high rate of usage of prescribed medication by physicians and the population for health management, requiring regulation. The key question will be on how can prescription drugs be regulated through policy so that health benefits are achieved and how to limit unnecessary prescriptions that can lead to abuse and addictions.
Background
The abuse of prescription drugs has reached epidemic levels in recent years. The National Survey on Drug Use and Health (NSDUH) estimates that more than 16.7 million people in the United States abused prescription drugs, with 2.6 million meetings the criteria for substance abuse levels, an increase of over 250% over two decades (McHugh, Nielsen, & Weiss, 2015). Prescription drug abuse skyrocketed, being only second to marijuana in prevalence for illicit use or drug use disorders.
The legally prescribed opioids were the largest contributor to the issue alongside stimulants and tranquilizers. Prescription drug abuse is directly correlated with physician prescriptions of these medications in the U.S. This type of substance abuse has profound health impacts on the population ranging from addiction and possible transition to other illicit substances to increased risks of HIV and other infectious diseases as well as physical, psychological, and social deterioration in individuals and families.
Current U.S. policy targeting drug prescription and the opioid epidemic is multifaceted but not specifically focused. In October of 2017, President Trump declared the opioid epidemic a national emergency. As a result, various federal agencies implemented various responses. The CMS proposes restrictions for opioids amounts for Medicare beneficiaries to reduce oversupply.
The Comprehensive Addiction and Recovery Act (CARA) signed back in 2016 authorizes $181 million annually to fight the epidemic through the 6 pillars of coordinated response including prevention, treatment, recovery, enforcement, overdose, and criminal justice reform. Other reforms have been implemented such as helping the DEA detect fraudulent prescriptions, education for opioid prescribers, and improved safety for drug disposal (Gross & Gordon, 2018).
The strength of the current policy approach is that it is taking various routes to address the numerous issues in drug prescription, which may be viable considering the complexity of the problem and overall industry. However, the weakness is that there is a strong straightforward solution or even policy on the subject requiring immediate attention and solution, resulting in disorganization in a concept that involved numerous stakeholders. The key stakeholders affected by drug policy include patients, health care professionals who prescribe medicine, drug manufacturer companies, government health agencies, and by extent the general population and family members of those who suffer from substance abuse.
Analysis
The key objective is to reduce prescription drug usage and disrupt the cycle of addiction in the context of the opioid epidemic. There are multiple policy alternatives to achieve this. One is a change to the health system prescription model, by implementing electronic national systems for prescribing controlled substances, significant changes can be made. The system would keep track of all prescriptions by physicians and to patients, creating alerts for patients who are at risk or potentially manipulating the system. Furthermore, the electronic system would use direct e-prescribing methods sending recipes to pharmacies and electronic prior authorization would be required (McKesson, n.d.).
Another policy alternative would be to develop, fund, and implement public education and community-based intervention program meant to spread awareness regarding opioid usage and address various misuse situations, working with populations at risk. Finally, another policy alternative would be to greatly increase regulation of the pharmaceutical market and limit the number of opioids that can be produced and distributed on the market as well as increased limitations to the influence of the pharmaceutical industries over healthcare systems (McIver, 2017).
The most effective policy alternative can be evaluated based on its practicality and effectiveness. Such broad policy contexts will require political and economic support, therefore must be bipartisan and practical. The impact on the issue and overall long-term solution to the benefit of the stakeholders and healthcare system is also important. The electronic system is beneficial to the healthcare system as it integrates well with the current transition to digital healthcare, improves efficiency, and reduces medication error. However, it is highly expensive and complex, something that will require years to implement, although highly beneficial in the long-term.
The education and intervention program directly works with patients and potential at-risk individuals, it is an immediate and universally supported type of policy commonly. Nevertheless, it lacks the impact as the opioid epidemic is so widespread (all types of communities are impacted) and addictions are notoriously difficult to resolve through education alone. Stronger regulation of the pharmaceutical industry can be effective, but it does not resolve the issue at this point as a significant amount of damage has been done through the high-pressure push for opioid prescriptions. Furthermore, it is highly unlikely this would receive broad political support.
Recommendations
In the long-term and most competent solution, implementing a health system national electronic prescription system among prescribers and pharmacies would be most effective. State-level mandates introducing e-prescriptions on a limited basis have seen decreased rates of opioid prescriptions, and in turn, addictions. There was much greater transparency and data collection available. The efficiency of the system provides a safe and verified method of transmitting controlled substance prescriptions (Danovich et al., 2019). Strategies to implement such policy would require developing a system by the Department of Health and Human Services.
A bill would have to be passed by Congress and signed into law by the president for such a broad national system. The mandates would then go into developing the universal systems through private contractors and public oversight. Barriers to implementing this system may be high costs, pushback from healthcare systems due to significant changes, and numerous technological considerations that would need to be addressed. Policy implementation can be evaluated through the collection of data in the system analyzing prescription trends and patterns, as well as rates of opioid abuse cases, comparing data from before and after the system implementation.
Discussion
The proposed recommendation helps to regulate the drug prescription market and process through changes to the clinical practice and overall modification to the health system. The e-prescription policy allows the regulation flow of drug prescriptions while monitoring for abuses in the system and helps prevention measures for patients. Limitations to this analysis include a lack of comprehensive data to support which changes would be best and a lack of understanding of the political nuances and barriers that may arise.
Also, costs are not considered in detail, which may affect practicality. However, discussing broad options is healthy and beneficial to clinical practice where a significant amount of drug prescription issues arise, as well as broad effects on population health and the healthcare market.
Conclusion
Drug prescriptions are a sensitive and critical issue in the United States, particularly in the context of the opioid epidemic and drug abuse. Current policy is multifaceted and addresses the issue with small actions without a comprehensive approach. It is recommended to implement an electronic system of prescribing helping to limit opioid prescriptions, prevent abuse of the system, and track at-risk patients. In future policy analysis, it would be important to address the questions of whether the e-prescribing system can see similar failures to the current system as well as what are the core roots of the issue regarding overprescription of drugs in the U.S. health system, and how it affects patients,
References
Danovich, D., Greenstein, J., Chacko, J., Hahn, B., Ardolic, B., Ilyaguyev, B., & Berwald, N. (2019). Effect of New York State electronic prescribing mandate on opioid prescribing patterns. The Journal of Emergency Medicine, 57(2), 156-161. Web.
Gross, J., & Gordon, D. B. (2018). The strengths and weaknesses of current US policy to address pain. American Journal of Public Health, 109(1), e1–e7. Web.
McHugh, R. K., Nielsen, S., & Weiss, R. D. (2015). Prescription drug abuse: From epidemiology to public policy. Journal of Substance Abuse Treatment, 48(1), 1-7. Web.
McIver J. S. (2017). Seeking solutions to the opioid crisis. P&T, 42(7), 478.
McKesson. (n.d.). Call to action: Execute solutions today to combat the opioid crisis. Web.