Malibu Beach Recovery Center

We on the East Coast often look to California, the more progressive coast, as a bellwether. But the state has dropped the ball when it comes to its CURES prescription database.  Funding was pulled at the end of last year, which is a blow to anyone concerned with the epidemic of prescription pill abuse.

Joan wrote about CURES here, in March and here, earlier this month. It’s the program that replaced the Prescription Drug Monitoring Program (PDMP) and allows pharmacists to check a database to learn whether customers wanting a prescription were filling the same prescription at another pharmacy, called “pharmacy shopping.” Both doctors and pharmacists could access the database. It’s still accessible but with very little staff and few participants.

As a New York Times article explains, Governor Brown cut the state budget of the Department of Justice, leaving the program in the lurch. The writer notes, however, that there were problems from the start. The main one seems to be that entering prescriptions into the database is optional, unlike some states’ programs. (Joan noted that “even the 49th poorest state, Kentucky, had a functioning data base and requires all doctors and pharmacists to use it.”

Here’s a quote from the article, from the executive director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Mass.: [If California does not fix its system,] “it will pay a huge price in terms of people who end up dying whose lives could have been saved, of people overdosing and going into hospitals, or nursing homes, or ultimately on disability.”

Ira Freeman, owner of North Hollywood"s Key Pharmacy, is one CA pharmacist who cares (he made headlines in 2009 for refusing to fill Anna Nichole Smith's pain pill prescriptions). In March he attended a meeting with representatives in the Attorney General’s Sacramento office to talk about CURES. The situation couldn’t appear any bleaker. He had read an article in the Bay Citizen and learned that only 4% of pharmacists in the state had signed up. “My frustration is one, that not enough pharmacists have signed up and two, the system is antiquated. Even though it’s supposed to be realtime, it takes roughly six or seven minutes to get the data. That’s a long time when you have someone looking you straight in the eye on the other side of the counter,” he said.

The only time doctor shopping gets air play is when a celebrity dies, he noted. But unfortunately, everyday citizens are doing it as well. “We want to see that patients with legitimate needs see legitimate physicians and have access to their medications,” he said. “But those who doctor shop are raising the costs for everyone. The drugs and office visits are often covered through insurance, and everyone down the line pays the cost. Everyday citizens can’t say it doesn’t affect them, it does. It adds to insurance premiums,” he explained.

Freeman recommends that insurance companies provide funding because they would directly benefit if doctor shopping decreased. He believes that for every $1 spent on drugs, there is $43 in associated medical costs. “So,” he concluded, “it’s in their best interest to fund the program.”

According to a recent press release Purdue Pharma, the pharmaceutical company that manufactures OxyContin, will provide a $1 million grant to support the operation of a prescription drug monitoring program ("PDMP") in the state of Florida, to help combat the illegal diversion and abuse of prescription medications.  The Company also announced a $1 million grant to the National Association of Boards of Pharmacy to support that organization's program to help State PDMPs detect "doctor shopping" across state lines.

What about California?

On May 5, 2010 I took a group of alumni to Sacramento to lobby for passage of SB 1071, a bill aimed at providing continued funding for CURES, California’s online real time PDMP. The State of California was broke at the time  (still is) and was unable to continue underwriting CURES although it was being used by more and more doctors to quickly determine if a patient was doctor shopping or pharmacy hopping for drugs like oxycontin, vicodin, valium, fentanyl, and morphine.

At the urging of his constituent Bob Pack, whose children were killed by a woman driving under the influence of multiple vicodin prescriptions, State Senator Mark DeSaulnier (D-Concord) undertook the responsiblity of finding ongoing funding for CURES. Pack, a computer company owner, had already helped the Department of Justice modernize California's antiquated system.  

Senator DeSaulnier staff, working with Pack and the Office of Attorney General (now Governor) Jerry Brown, determined that the most likely sources of underwriting were the pharmaceutical companies that manufacture these highly addictive narcotics.  SB 1071 called for a tax of $0.0025 for each Schedule II, III and IV narcotic prescription filled in California -- less than 25 cents a prescription.

I spoke briefly during the hearing with Frederick H. Noteware, a lobbyist who represents the pharmaceutical industry in Sacramento. He had just testified against passage of the SB 1071.  He thought the purpose was “worthy,” but he insisted that the pharmaceutical companies which manufacture narcotics were not responsible for the irresponsiblity of doctors who over prescribe, and wrongly prescribe.  We did not agree, and neither did the many parents who testified that day about the children they had lost to OxyContin.

As Senator DeSaulnier said at the hearing:  “I differ with the pharmaceutical companies.  When they make a profit and there is a mitigation for the profit, they should participate.”

SB 1071 did not get enough "yes" votes from Senate Health Committee members to move to the Finance Committee.  Senator DeSaulnier found some interim funding to keep the database alive and continued his campaign to find permanent funding.  

On July 28, 2010 the Contra Costa Times, a newspaper in Senator DeSaulnier's district, published an article about OxyContin entitled "A Silent, Growing Problem Among Youths." Journalist John Simerman quoted an email from Libby Holman, a spokeswoman for Purdue Pharma.  She wrote that while the company opposed SB 1071 it supports "appropriately designed" prescription monitoring programs.  "Prescription drug abuse is a serious public health concern and Purdue is taking an active role in being a part of the solution to the problem."

Several days later, on August 3, 2010 Senator DeSaulnier wrote to John H. Stewart, President and CEO of Purdue Pharma, requesting that Purdue take an immediate and productive role to combat the problem of abuse and addiction to prescription painkillers in California.  

Senator DeSaulnier then met with Robert McElderry, the Regional Director of Purdue.  According to Indira MacDonald, the Senator’s legislative aide: “The Regional Director vowed to be supportive of the Senator’s efforts, but not the way he went about it in SB 1071.  In the meeting, Purdue would not commit funding without California first meeting higher marks in terms of what funding practitioners and pharmacist contribute to the CURES.”

On March 14, 2011, after Purdue Pharma officially announced they would provide funding to Florida’s online data base, Senator DeSaulnier again wrote to the President and CEO of Purdue Pharma.

'I write to continue our dialogue regarding your company’s commitment and support of California’s prescription drug monitoring program... As we begin a new legislative session, I am eager to work with your company in responding to the problem of abuse and addiction to prescription painkillers.

'While the launch of our state PDMP is a constructive step forward, we now face an enormous challenge to register more users. The sheer number of California practitioners and pharmacists eligible to prescribe and dispense prescription controlled substances makes this outreach effort an enormous one. Before even having the capability to register all potential users of the PDMP, we must first enhance the system’s capability (this includes: hardware, software, etc.) to withstand the volume of registered users and hits (requests for patient information), as well as provide the necessary staff to appropriately manage this registration process and upkeep the system.

'I applaud your company’s responsible economic support of the National All Schedules Prescription Electronic Reporting Program (NASPER) under the Department of Health and Human Services to support states in establishing PDMPs as well as your company’s recent grant award to combat the illegal diversion and abuse of prescription medications in the state of Florida.

'I would like to ask for your assistance to the California Department of Justice office of the Attorney General in providing CURES with the necessary resources to enhance the capacity of our PDMP as this is the obstacle we currently face to prevent and detect the diversion and abuse of pharmaceutical controlled substances. Without additional funds, achieving full usage of the PDMP cannot be met and therefore, our ability to fully protect the public is hindered.

'Without your company’s direct reinvestment into states’ efforts to combat the crisis before us, being an active part of the solution, we cannot win this fight. As a longtime business owner, I have always held that financial success should come by way of responsible business practices. Consumer’s safety and trust is greatest when businesses meet their moral obligations to mitigate negative effects. As a product steward, your reinvestment is appropriate and necessary. With your alliance and a public/private partnership we can make improvements to the responsible market of prescription controlled substances, ensure patient privacy and access to appropriate medical care, while also detecting the illegal diversion of controlled substances in order to save lives.

'I look forward to working with you and your company to support the operation, expansion and awareness of prescription drug monitoring programs. In particular, I look forward to hearing from you in regards to funding the CURES’s PDMP for the systems sustainability enhancement to increase registration and usage."

Great letter.  No response as yet from Purdue Pharma. 

Footnote:  Readers will hopefully remember the “Addiction by Prescription” article I wrote for this blog on October 02, 2010 article. 

It was about Bill, 22, a resident of Simi Valley, one of L.A.’s bedroom communities whose young people are being decimated by addiction to prescription drugs, especially OxyContin.  Bill’s mom had committed to walking from one side of Simi Valley to the other 40 times, carrying a sign that said “Not One More.” She wanted to dramatize the fact that many of the kids Bill grew up with were dying from overdoses of OxyContin or, when they could not afford prescription pills any longer, heroin.

She called us one day crying, begging for help.  Bill had taken so much OxyContin and Xanax the day before that she was sure he was going to die.  We took him in because Purdue Pharma has yet to establish a fund to pay for detoxing and treating dying kids whose families have no financial resources.

A week ago Bill, his mom, and his sister came to Malibu Beach Recovery Center to celebrate his six months of sobriety.  Bill is working full time, physically fit, and zealous about his new life. He truly inspired the clients currently in treatment at the Center. 

The only sad moment was when he told us he had recently attended the funerals of two more childhood friends, both dead from drug overdoses.

California State Senator Mark DeSaulnier is coming to visit the Malibu Beach Recovery Center at the end of July. We are honored and excited.

Senator DeSaulnier is a man after my own heart. Every year he holds a "There Ought to be a Law" contest," inviting members of his Northern California district to submit ideas for new state legislation. We got to know him this year because one of the 2009 winners was Danville resident Bob Pack, whose two children, Troy and Alana Pack, ages 10 and 7, were killed in 2003 when a woman high on prescription medication passed out while driving her car. The car crossed three lanes of traffic, killing Bob’s children and seriously injuring his wife. The driver had gotten 350 vicodin pills in the week before the accident from six different doctors, all of whom practiced at the same hospital. Each of them had no idea that she was getting medication from the others.

Working with the Department of Justice, Pack, an East Bay computer company owner, and advocate for curbing prescription drug abuse, turned the State's antiquated Controlled Substance Utilization Review and Evaluation System (CURES) into a real time online data base. Now doctors can have instant access to prescription drug histories of their patients- which helps prevent doctor shopping for highly addictive controlled substances such as oxycodone, xanax, vicodin, valium. Until now it took healthcare professionals weeks to obtain information on drug use by patients. That delay allowed patients like the driver who killed Pack's children to get large quantities of drugs from multiple doctors for personal use or sale.

With the State of California broke, Pack proposed the legislation that became SB 1071 (SB stands for Senate Bill). It was designed to make the CURES online database financially sustainable by taxing the pharmaceutical companies $0.0025 for each highly addictive narcotic prescribed in California. That’s less than 25 cents a prescription.

On May 5th I took some of our alumni to Sacramento, including prescription drug addicts now in recovery, to lobby for SB 1071.

To our surprise the bill did not get out of the Senate Health Committee. It lost by one vote. The Democrat who Senator DeSaulnier counted on to vote with him, voted against the bill because; according to his office staff, she was opposed to levying new taxes in the current economic climate. Given the amount of revenue the pharmaceutical industry reports each year (over $300 billion in 2007) this was surprising. Maybe not though, considering the number of lobbyists the pharmaceutical industry employs in Sacramento.

Senator DeSaulnier told me that he is committed to making sure the CURES system will remain funded so doctors can continue to find out in real time if their patients are doctor shopping and pharmacy hopping for narcotics. Can’t wait to hear what he has to say on his upcoming visit.