It's not entirely clear what to do about what many have called America's "opioid epidemic." Several states have tightened regulations on prescribers and added new treatment programs for those struggling with addiction. Others have expanded access to naloxone, the antidote for opioid overdose, which is now sold over-the-counter at pharmacies in more than a dozen states. Last month, the Department of Health and Human Services also increased the amount of buprenorphine, an addiction medication, that doctors can legally prescribe. And in the private sector, companies like Massachusetts-based Imprivata are looking to plug the pipeline.
"We're crappy drivers. We're distracted, we're texting, we aren't better drivers than we were years ago. But it's no mistake that there are fewer deaths from auto accidents today," Sean Kelly, Imprivata's Chief Medical Officer, told VICE. "Standards and technology has increased our safety. Highways are now the same size, roads are up to a certain standards, guardrails are made in a certain way, and cars have become so much more technologically advanced when it comes to safety. The auto industry has adapted to those safety features, and healthcare needs to do the same thing."
Imprivata has been building and selling security technology since 2002. In the past they've sold products to banks, nuclear power plants, and even the Vatican. But about five years ago, they shifted their focus towards the medical industry. Today, some of Imprivata's flagship products aim to streamline doctors' ability to prescribe controlled substances electronically, instead of the conventional pen-and-pad route.
Electronic prescriptions are still fairly new: In the past, DEA restrictions prevented doctors from distributing controlled substances with a computer system, but those regulations were relaxed in 2010. Earlier this year, New York became the first state to flat-out require all prescriptions to be filled electronically. The hope is that these measures will cut down on the fraud, errors, and disorganization that fills the demand for opioids.
"The large percentage of doctors and nurses are trying to do the right thing, and the large percentage of patients are trying to do the right thing," Kelly told VICE. "What you want is to make it easier for people who are legitimately prescribing for people who need it, but you also want to make it really hard for people who are misbehaving."
The problem is that many hospitals and pharmacies haven't embraced electronic prescriptions for controlled substances (colloquially known as EPCS), in part because the process is complicated. The DEA (*1) requires two-factor authentication—meaning the doctor has to verify his or her identity in two different ways—before prescribing a controlled substance. The DEA requires two of the following factors: something you know (like a password), something you have (like a USB drive or chip stored separately from the computer), and something you are (biometric information, like fingerprints).
Those requirements can deter hospitals and pharmacies from adopting electronic prescribing. At the same time, "upwards of ten percent of [health care providers] report having their DEA number stolen," Kelly told VICE. "When I write a [paper] prescription of Percocet, my DEA number is on it. So someone can take that and create a fake prescription, sign it with my crappy signature, and put my DEA number, and go to the pharmacy. Sometimes it works! And with [electronic prescribing] that stops right away."
So last year, Imprivata introduced "Confirm ID," an IT security system designed to fit into the DEA's controlled substances policy. The system offers a number of simple registration platforms, like fingerprint scanners, one-time passwords sent via SMS or a mobile app, or a security token like a bluetooth connection from a phone, all of which make the two-step authentication process easy and intuitive without compromising security.
"The technology is easy to implement—it's integrated into your workflow within a day," said Art Ream, Chief Information Security Officer at Cambridge Health Alliance, a healthcare provider near Boston and an early adopter of Imprivata Confirm ID. "It also offers a huge turnaround to your providers and your patients. It returns time to your providers over the course of a day, and for patients, [the use of EPCS] means you don't have to take off work to get your maintenance drugs and see your doctor to refill your prescription."
Currently, Imprivata has 60 customers using Confirm ID. If the rest of the country follows in New York's footsteps and requires controlled substances to be prescribed electronically, they expect the number to increase—and, by consequence, for the number of opioids on the streets to reduce significantly. At the same time, the 2.1 million addicted Americans are still around. Confirm ID might help plug the pipeline, but the problem won't just disappear.
"The question is: If it's harder to get pain management medication from a legitimate source, what happens to the person who's caught in a dependence or addiction cycle?" Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, told VICE. "We know that a certain percentage go to an illicit drug like heroin, or illicit street drugs like fentanyl products that have come in from China. Ultimately, as the supply lessens, individuals may go to underground markets."
For a case study: When Florida started shutting down many of the state's "pill mills" in 2010, users simply transitioned to heroin. (*2) Between 2013 and 2014, deaths from heroin in the state doubled.
Parrino recommends broader, nation-wide education on the warning signs for opioid addiction and good, comprehensive, state-integrated treatment systems to keep addicted Americans from turning to the streets. Medical fraud is certainly part of the problem, he said, and electronic prescriptions seem like a great first step. But opioid abuse has festered for decades. It's escalated into an epidemic, and lives will be at stake for a long, long
