KQED News, April Dembosky
Long plagued by technical problems, the state’s prescription drug database has finally been overhauled. State officials will fully launch the new system next Friday, Jan. 8, when all doctors will be automatically upgraded to the new system.
Health officials now refer to prescription drug addiction as an epidemic. More Americans die from prescription opioid overdose than in drunken-driving car crashes, according to data from the Centers for Disease Control and Prevention.
California regulators have been preoccupied for years with doctor shoppers.
“We had a single patient go to 116 prescribers over four years, and went to 58 pharmacies and got 45,000 dosage units of controlled substances worth at least $850,000 on the street,” said Virginia Herold, executive officer of the state Board of Pharmacy.
Pharmacists are required to report all drugs they dispense in the state’s prescription drug database, known as the Controlled Substance Utilization Review and Evaluation System, or CURES.
But neither pharmacists nor doctors are required to check the database before dispensing or writing new prescriptions.
“If any of those 58 pharmacies or 116 practitioners would have checked, they would have seen that the patient in front of them, that may have only been in there once every 30 days, was actually going to other places and to multiple prescribers to get the medication,” Herold said.
Pharmacists and doctors have complained for years that the reason they don’t use the system is because of a long history of technical glitches. In the past, for example, doctors had to submit paper registration materials to the Department of Justice just to get a login and password, a process that took as long as six months for some doctors.
“There’s been a huge backlog at the DOJ,” said Molly Weedn, spokeswoman for the California Medical Association. “People want it to be a usable system, but in the past few years, it’s been severely understaffed and underfunded.”
Funding for the database was slashed in 2009 when the economic recession hit, leaving the technical problems to linger. More cuts followed in 2012.
In 2013, the state Legislature passed SB809, which charged doctors a $6 annual fee when renewing their medical license to provide funds for database improvements. The state slowly began rolling out CURES 2.0 this past summer, and after fixing a Web browser compatibility problem, will do so universally in the new year.
“The new system is more user-friendly,” said Deputy Attorney General Robert Sumner, who oversees IT projects for the Department of Justice. “It’s faster, it’s more responsive, it’s more intuitive.”
It also allows doctors to delegate searches to nurses, so a nurse can cue up a patient’s prescription drug record for the doctor prior to a consultation, and includes a number of patient alerts.
“Physicians will automatically be told if, based on their prescription history, the algorithm has picked up that the patient might be at risk for doctor shopping,” Sumner said. “Whether or not you’ve gone to a number of different prescribers, whether or not you’ve been given a number of different prescriptions in volumes, and also the frequency at which you’ve been receiving prescriptions.”
"We had a single patient go to 116 prescribers over four years, and got 45,000 dosage units of controlled substances worth at least $850,000 on the street." -Virginia Herold, state Board of Pharmacy
Despite the improvements, safety advocate Bob Pack is still not satisfied. He says the only way the database will really work is if doctors are required to use it.
“I’ve been disappointed all along,” he said. “I’ve always believed it needed to be a mandatory requirement.”
In 2003, Pack’s two children were killed by a driver who was high on prescription drugs, which she had obtained from multiple doctors. Ever since, Pack has pushed for redevelopment of the database, convincing his local representatives to write various bills, including SB809, which provided the funding to update the database, and a pending bill, SB482, which would require doctors to consult a patient’s medical history before prescribing narcotics for the first time.
“I wanted this thing to be mandatory for the last nine years,” Pack said. “But the medical lobby keeps fighting this.”
The California Medical Association says it will wait to see how well the new system works before agreeing to any requirements.
“Before we make the system mandatory, let’s make sure it’s functional,” said Weedn.
While 49 states have a prescription drug database in one form or another, only about 10 states require doctors and pharmacists to check it before writing new prescriptions, including Kentucky and New York. Some studies show that the number of narcotic prescriptions written in those states went down after the mandate, and enrollment in addiction treatment went up, though it is unclear if some drug abusers may have turned to street drugs instead.
Congressman Mark DeSaulnier, D-California, who authored SB809 when he was a state assemblyman representing Walnut Creek, says he wants to bring some of these reforms to the national level, starting with incentivizing states to upgrade their systems.
“These can be wonderful drugs,” he said, “but they’re disastrous if not used right.”
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