SB 1071 (CURES) update: Purdue Pharma Offers $1 Million to Help Fund Florida's Prescription Drug Monitoring Program

Posted by Joan Borsten on April 02, 2011

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. Senator DeSaulnier photo.jpg

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.  Oxycontin.gif

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.

 

Drug Makers Infiltrating a College Curriculum?

Posted by Pat Olsen on January 14, 2011

Occasionally drug makers have been devious in their advertising. Several times the government has made them change or pull their ads for making false claims. Or we’ve learned that they’ve funded studies and then neglected to mention, covered up, or glossed over, the negative results when reporting on the research. In December a Canadian news site, CBC News, revealed something similarly outlandish: a drug company that funded a book on managing chronic pain was able to get it in front of medical students in a pain management course.pills.jpg

The culprit? Purdue Pharma, the company that manufactures the painkiller OxyContin.

The book wasn’t actually required reading and it wasn’t distributed by the University of Toronto Medical School. But an unpaid guest lecturer linked to the drug company brought not one book, but several, into the Centre for the Study of Pain, which gave the pain class. The pain curriculum is “a 20-hour course jointly taught to medical, dental, pharmacy and nursing students,” according to the article.

A student and two doctors on the faculty complained after the student alerted the doctors about the book, and the school conducted an informal investigation. (What’s especially sad is that Dr. Rick Glazier, one of the doctors, experienced the tragedy of prescription pill misuse firsthand—his 18-year-old son succumbed to an accidental overdose of OxyContin.) Luckily, their voices were heard:  Lorraine Ferris, associate vice-provost in the department of Health Sciences Policy and Strategy, who headed the investigation advised that the curriculum be revamped to include balanced information and suggested it be done poste-haste.

The other faculty member, Dr. Phillip Berger, said about the inquiry: "She's raised very serious issues of conflict of interest and made what I think is an absolutely correct statement that not only the academic community but the public more generally would find making a copyrighted and owned drug-company textbook available to students objectionable, regardless of how its assessed quality is.” Not only that, but Ferris recommended that the development and accountability for the course be moved out of the Centre that gives the course. Smart idea!

An article on the CTV website, another Canadian news site, noted that the dean of dentistry at the university identified the lecturer as Dr. Roman Jovey, who co-authored the book. Jovey is paid by Purdue to lecture.

This article quoted Dr. Irfan Dhalla, a doctor at a Canadian hospital who also lectures at the University. He had significant concerns about the book. For one, it suggests that it’s fairly safe to prescribe opioids for chronic non-cancer pain, which he believes is untrue. The evidence indicates that it’s appropriate for cancer pain or other severe acute pain, but not non-cancer pain, and it’s a strong drug—twice as strong as morphine, and it is not the moderate one the authors suggest, Dhalla added.

The book also holds that the addiction rate is low for non-cancer pain sufferers—also not true, Dhalla said, and it glosses over the possibility of dying from an overdose. Finally, the doctor raises the issue of medical students being influenced by the misinformation put forth in the book when they become doctors prescribing pain medications. He’s concerned that younger doctors are more liberal with opioids than their predecessors, which points us again to the misinformation in the book.

Jovey said he wasn’t embarrassed or ashamed about what he did.  Imagine.

National Coalition Against Prescription Drug Abuse (NCAPDA)

Posted by Taylor Armstrong on December 14, 2010

One non-profit that’s high on my list is the National Coalition Against Prescription Drug Abuse. It was started, as so many organizations are, because of one family’s tragic loss. Last year, Arizona State University student Joey Rovero took a lethal dose of alcohol and prescription pills prescribed to him by Rowland Heights (California) osteopath Dr. Lisa Tseng.  He died one day before winter break. Here’s Joey's story.  Doesn’t it just make your heart break?april rovero and joey.jpg

His parents (see photo of Joey with mom April on left) started NCAPDA to raise awareness of the dangers of prescription drug abuse, and another family with a similar story has lent their voice as well. They have also enlisted several groups to help them, as well as reporters Lisa Girion and Scott Glover, who have documented for Los Angeles Times readers the ongoing legal investigation of Dr. Tseng by the U.S. Drug Enforcement Administration and the State Board of Osteopathic Medicine.  Not only Joey but at least seven others recently died from narcotics prescribed by Dr. Tseng. Thumbnail image for Thumbnail image for april rovero at SB 1071 hearings.jpg.


 

Take a look at some of these findings from the Office of National Drug Control Policy:

  • After marijuana, prescription drugs are the most abused illegal drug among young people. 
  • Teens are turning away from street drugs and using prescription drugs to get high. New users of prescription drugs have caught up with new users of marijuana.
  • Next to marijuana, the most common illegal drugs teens are using to get high are prescription medications.
  • Teens are abusing prescription drugs because they believe the myth that these drugs provide a medically safe high.
  • The majority of teens get prescription drugs easily and for free, often from friends or relatives.
  • Girls are more likely than boys to intentionally abuse prescription drugs to get high.
  • Pain relievers such as OxyContin and Vicodin are the most commonly abused prescription drugs by teens.
  • Adolescents are more likely than young adults to become dependent on prescription medication.

 

A video contest on the NCAPDA site is a way to further increase awareness. It’s for people ages 12-23 in the San Francisco area. You might also be interested to know that this group gives talks at schools and arranges panel discussions. There is also a page that allows you to enter your zip code and find a local pharmacy where you can safely dispose of old prescription drugs.

 

We need all the help we can get in trying to create awareness and avoid the senseless deaths from prescription drugs abuse. There are too many Joeys, and too many parents losing their children. My hat is off to his parents and those working with them.

 

NOTE:  Here is a link to April Rovero's testimony in Sacramento in favor of having the pharmaceutical companies provide funding for CURES, California's real time online database that helps doctors quickly discover if clients seeking prescriptions for narcotics are doctor shopping or pharmacy hopping.

 

Addiction by Prescription: The Purdue Pharma-OxyContin Saga Continues

Posted by Joan Borsten on October 02, 2010

A mom called the other night from Simi Valley, one of L.A.’s bedroom communities.  She was crying, begging for help.  She had been up the previous night with her 22 year old son – we’ll call him Bill.  He was so addicted to OxyContin and Xanax that she would check on him several times each night to make sure he was still breathing.    The night before he was so sick, she was sure he was going to die.Thumbnail image for march flyer.jpg

Her son, she said, has been getting prescriptions from half a dozen local doctors for the past 3 years.  He would show them two folders of medical records he compiled from accidents that occurred several years ago.  They would give him 150- thirty milligram pills per month.

He was crushing and snorting at least five OxyContin each day – more if he could get them.  He once smoked pulverized pills for a short period of time; he had never actually swallowed one.  He did swallow his Xanax – at least 60 each month, all prescribed by the same doctors.  OxyContin and Xanax, by the way, were key ingredients in the lethal cocktail that killed actor Heath Ledger in 2008.

Bill doesn’t drink or use street drugs.  He insists he did not know OxyContin was highly addictive, that the doctors never told him.  Once he understood he started trying to get off prescription drugs by going “cold turkey” because the family did not have enough money to pay for a medically-supervised detox.  He ended up having seizures and putting his parents into panic mode.

Hard to believe that just three years ago U.S. Attorney John Brownlee won a major legal battle in Virginia against Purdue, the privately owned pharmaceutical which manufactures OxyContin. 

“Despite knowing that OxyContin contained high concentrations of oxycodone, had an abuse potential similar to that of morphine, and was at least as addictive as other pain medications on the market, Purdue, beginning in January of 1996, with the intent to defraud and mislead, marketed and promoted OxyContin as less addictive, less subject to abuse and diversion, and less likely to cause tolerance and withdrawal than other pain medications,” Brownlee told PBS Newshour in May 2007.  “Of the $600 million Purdue will pay, $130 million will be used to resolve civil suits brought by patients who say they became addicted to the drug…Over the years, OxyContin has legitimately helped many patients cope with pain, but its criminal abuse has been widespread. The drug has been connected with hundreds of deaths and arrests.”

Dr. Sidney Wolfe of the Public Citizen Health Research Group spoke during the same PBS Newshour.  He said:  “…Someone in the company, it wasn't robots, designed this program to mislead doctors into thinking that this drug was much safer than it was and get them to prescribe it preferentially over other drugs.”

What has changed since then?  Not much.

Bill’s mom earns $10/hour.  Her husband, a chef, is on disability.  He was injured serving relief workers during Katrina.  She told me she could raise enough money to pay something for a doctor, but that was all.  Someone had given her the name of Malibu Beach Recovery Center.   I don’t know why because we are small, boutique and expensive.  Not a good fit.   

Together with our marketer, I called frantically around to find a free or almost free facility where Bill could get detoxed.  He wanted help, but as everyone in this industry knows, an addict’s “window of willingness” is very short.  I told his mom – “We have to move fast.” There was nowhere cheap enough to go except American Hospital in Pomona, which has a 4-7 day waiting list.  

It was getting late.  The mom was calling every few minutes.  She was very frightened.  She was also on Day 22 of a forty day march.  Every evening she walks from one side of Simi Valley to the other -- 10 miles -- to raise awareness for Bill’s plight and that of virtually all of his friends, friends he has had since kindergarten.  They are all, she says, severely addicted to OxyContin -- if they aren’t already dead.  With 28 more days of marching still to go, she had organized a 100 mom “Not One More” Promise Walk for October 9, 2010.  The goal?  Make the mayor and city council members aware of what is happening right under their noses.

It was a just cause.  We’ve already had several young clients from Simi Valley and adjacent Moorpark.  The parents all say the same thing:  They moved to these “Leave It to Beaver” communities from the San Fernando Valley to give their kids better lives.  Instead they became OxyContin addicts. 

We found a way to take Bill in for 7 days and get him detoxed.  Our plan was to then transfer him to one of the long term free treatment programs that do exceptional work but do not provide medically supervised detox services.  Once detoxed he chose instead to move in with a sober friend and work in construction.  He just called to report he is hiking and rock climbing alot; he assured me that when he feels cravings for OxyContin he does some of the yoga breath work he learned from our lead exercise instructor Oleg Yevseyev.  I told him to call if he ever needs help again.

The OxyContin epidemic is not unique to Simi Valley and Moorpark.  Last May I travelled to Sacramento with some of our alumni to support passage of a funding bill for CURES (California’s real time online narcotic prescription data base). The parents who spoke at the press conference were all from one Northern California Senate District, that of Senator Mark DeSaulnier who authored the bill.  All of their children had died from OxyContin overdoses (one of them, April Rovero, went on to found the National Coalition Against Prescription Drug Abuse).

Nine months earlier I had several conversations with Lynette Ropp, a mom who lives in El Dorado County, yet another area of California where young people are dying from their addiction to this powerful drug which many parents describe as nothing more than synthetic heroin.  Matt’s presence at Malibu Beach Recovery Center made me think of her, and her efforts to get Purdue Pharma to pay the costs of getting her son detoxed and treated.

“I continue to watch my son battle with OxyContin addiction. I am totally exhausted,” she wrote to the head of Purdue Pharma. “This past year has been very sad and stressful, checking constantly to make sure he is still breathing...Seeing him with dark circles under his eyes, watching him mumble his words unable to articulate himself clearly at times. So worried he will die.  I called 911 at one point and he was taken by ambulance to the hospital for overdose.  The rehab the doctor referred him to was closed for misappropriation of funds.  He had been attending a outpatient program but slowly that tapered off...A couple weeks ago at a softball game (he plays in a league with long time childhood friends) he was unable to throw a softball 15 feet.  My sister attended the game with her children and reports that he struggled to spit out a piece of gum.  Stumbling and cussing, humiliating himself in front of friends and family.  It is painful to watch my child who was such a talented, vibrant young man be totally depressed and sick...He needs professional medical help.  I believe I have found the appropriate facility.  Unfortunately everything comes down to money. So I find myself again contacting your office asking for help…”

Purdue never did provide the funds Lynette’s son needed to get professional treatment.  Instead he went to jail for 9 months because of multiple legal charges related to his OxyContin habit.  He is now clean and sober thanks to the largesse of California tax payers.

So here’s my question.  We did our part.  But what about the doctors who by now know that OxyContin is highly addictive?   Shouldn’t they have to detox these kids for free?  And what is the responsibility of Purdue Pharma, which manufactures OxyContin and still allows it to be prescribed in such lethal quantities?    Why haven't they set aside a very large fund to help Bill, and Lynette Roup's son, and OxyContin addicts across the country get their lives back?