Operational Update: Electronic Prescriptions

I am writing to update you regarding the current requirement that Schedule II opioid prescriptions be transmitted electronically in Arizona. I understand that there has been a great deal of frustration. Please know that we are listening and we hear you.

We have been closely tracking the evolution of the law since its passage and were in communication with relevant regulatory bodies as January 1 approached. We do have a solution. In fact, the Epic practice management system we will begin to deploy in April will solve this issue.

In the meantime, we were presented with a dilemma. We were informed by numerous sources that a high percentage of dental practices and, in fact, medical practitioners generally, would not be in a position to comply with the new requirements. We were also informed that most pharmacies would continue to accept paper prescriptions until the issue could be solved more widely.  We were faced with a hurdle—­ our current practice management system is fragile, making integration with an Arizona-only e-script solution a significant risk (thus the massive investment in Epic). Stand-alone solutions that might work for smaller, solo practices were not suitable for our environment. Based on these numerous discussions, we believed that, at most, it would be an inconvenience if a BC, for example, had to call a back-up pharmacy on the occasion that an e-script was required by the first-choice pharmacy. Of course, we wished for you to have the easiest, most compliant solution on day one, but the risks of such a solution seemed unreasonable for the situation, especially with Epic being readied for deployment. Thus, we obtained waivers from these new requirements for each supported practice and kept working full steam on the permanent Epic solution. Which is where we find ourselves currently.

We humbly ask that clinicians consider alternatives before prescribing opioids. You may be aware that the #1 place where young people first encounter opioids is through their dental office. We attached the “Center for Opioid Research and Education: Dental Opioid Guidelines” for those with an interest who may not have it handy. In addition, studies, including one from Harvard in 2017 and one highlighted in JADA in 2018 showed that a combination of ibuprofen and acetaminophen are proven to be more effective, and safer, than opioids in treating acute dental pain.

We respect the role of clinicians in making their own clinical judgement on this matter, and we ask for your forgiveness if our suggestion in any way transgresses your notion of propriety.

Thank you for your understanding and patience as we all work together to overcome this unique challenge. We will keep you informed as we move forward.