Malibu Beach Recovery Center

Until recently a doctor could instantly check CURES, California’s real time online data base, to see if the new patient sitting in front of him/her, seeking a prescription for pain medication, was “doctor shopping” --- going from doctor to doctor to get multiple prescriptions for  the same medications.  Such a pattern red flags addiction.  Pharmacists could check the same data base to discover if the patient was “pharmacy hopping” – filling the same prescriptions at another pharmacy, another red flag for addiction.

Based on my discussions with physicians and pharmacists, the data base which is run by the California Department of Justice, has helped them point out the obvious to addicts and convince some of them to seek treatment. 

Now no more.  CURES still exists; pharmacists still report the narcotics prescriptions they fill every six days and the CURES data base was recently used by law enforcement officials investigating Whitney Houston’s death.  But funding for CURES ended in 2011 and there is now no way for doctors and pharmacists to access the data base real time. 

As we reported in earlier stories about CURES, Bob Pack is the software engineer who in 2009 took responsibility for modernizing the state’s 70 year old antiquated Prescription Drug Monitoring Program (PDMP).  He convinced State Senator Mark DeSaulnier to author SB 1071 to fund CURES with a miniscule tax on some the nation's very large and profitable pharmaceutical companies.

It was envisioned that every time a prescription was filled in California for a Schedule II or Schedule III narcotic, the manufacturer would forward to the State coffers approximately 25 cents to keep CURES up and running.  The Controlled Substances Act (CSA) of 1970, which regulates manufacture, importation, possession, use and distribution of certain substances, has five drug schedules.  Here are the drugs included in Schedule II, and here are the drugs included in Schedule III.

On  May 5, 2010 I flew to Sacramento with alumni Krissie Bergo and Laurie Kelsoe.  Krissie and I both spoke at the State Senate Press Conference in support of SB 1071, and then Krissie, Laurie and I spoke at the State Senate Health Committee Hearing in support of SB  1071.  The bill failed because a single Committee member, a Democrat who had pledged to vote yes, suddenly voted no.   She was then running for a statewide office.  Perhaps not by chance just before she voted no she was observed on Senate’s closed circuit TV system having an impromptu tete a tete with a pharmaceutical industry lobbyist.

I cringe every time I read on the website of the National Coalition Against Prescription Drug Abuse reports about yet another state which got its PDMP up and running while California’s pioneering PDMP withers. 

The most recent state is Kentucky – ranked 47^th in median household income, 47^th in high school graduation rate and 48^th in percentage of the population below the poverty line.  Kentucky not only now has a functioning PDMP  but requires all doctors who prescribe federally controlled drugs to refer to the PDMP before writing prescriptions.  

How to remedy the situation?   An informal meeting was scheduled today between the Attorney General and Legislative Staff (from Senator De Saulnier’s Office) to discuss with lack of funding for CURES.  We don’t know the outcome yet. 

Pack, who estimates prescription drug abuse is costing California about $7 billion annually, is collecting signatures to put on the June ballot a measure to raise about $7 million per year to support the CURES program.  The ballot measure includes an educational component for doctors , pharmacists and consumers.

There Ought to Be a Law.

We propose that in addition to collecting funding from the nation's pharmaceutical companies, the Department of Justice impose a “CURES fine” on any California doctor convicted of over prescribing or wrongly prescribing. 

Dr. Daniel J. Healy of Duarte would have been an ideal donor.   In April 2010 Healy was sentenced to four years for “prescribing powerful and highly addictive pain killers to people who had no medical need for the drugs.”  Healy ordered more than 1 million tablets of hydrocodone (vicodin) in 2008 -- more than any other doctor and 10 times more than the average American pharmacy.   According to the Los Angeles Times Healy was making so much [illicit] money he kept an automatic money-counting machine in his office.

Dr. Nazar Al Bussam, “California’s top prescriber of narcotic painkillers”  also would have been an ideal donor.  In October 2011 he was sentenced to 7 years in prison.  According to the Los Angeles Times, over a two year period Al Bussam deposited $1.8 million in cash into multiple bank accounts. 

Dr. Lisa Tseng, of Roland Heights is still a potential donor.  She was arrested March 1, 2012 and charged with second degree murder after three of her patients died from prescription drug overdoses.  Some reports say that she and her physician husband paid $5 million in cash for their office building.

2011 may well be remembered as the year the nation finally ­­realized that it is not just celebrities who are dying from legally prescribed drugs, but tens of millions of ordinary folk – from children to adults to aging baby boomers, in every city and town.  Many of us already suspected what a recent analysis by the Los Angeles Times confirmed:  drug deaths now outnumber those killed in traffic accidents, and prescription drugs are largely to blame.

Law enforcement has begun to take note:  most daily on the organization’s facebook page, Members of the National Coalition Against Prescription Drug Abuse (“NCPDA”) post news about crack downs on local “pill mills” – doctors who make a living writing prescriptions for anyone who pays.  

Unscrupulous doctors operating out of store fronts, with cash counting machines, or via internet, create just part of the grisly statistics.  National and state legislators now need to regulate the practice of pain management – not just for those who specialize in this new field, but for the doctors who staff the Emergency Rooms and Urgent Cares, and also dentists.  Too many of these medical professionals write prescriptions for narcotics and benzodiazepines without a thought to the long-term consequences, or the history of the patient.

Earlier this year we interviewed Dr. Marc Mandel, MD, a Beverly Hills doctor who often serves as a medical expert in Workers' Comp cases involving pain.  Most often the doctors whose treatment he reviews are anesthesiologists. To become pain management specialists they study the pain management curriculum – there is no residency program -- and pass a board test which certifies them in the sub specialty.  

Treatment of pain, says Dr. Mandel, is often related to blocking different nerves, something anesthesiologists are quite adept at doing. 

Dr. Mandel goes on to say:  “The classical textbook on pain management was authored by Doctor Aronoff.  In the introductory chapter of the classic book, he states, 'too many visits to this office may be deleterious to your health'.  And what Doctor Aronoff was stating is that the goal of pain management is to help the patients cope with their pain.  It’s not to simply ply them with medications.  Because if you have an addictive personality, and probably 15 to 20 percent of us do, you’re gonna get hooked on the medications.  And consequently, you’re gonna need ever increasing amounts of drugs to allay the symptoms of pain.

“Now if someone has terminal cancer, I think it’s important to give them medications to make their life as comfortable as possible since the end is near.  But if you’re dealing with a young, adult otherwise healthy person, I think it’s not the best practice to ply them with an enormous number of addicting narcotics.”

Just last week a client, we will call her Lynda, had a very impacted wisdom tooth which needed to be pulled while she was still in treatment. Lynda was born addicted to cocaine. She has battled most of her young life with substance abuse, specifically opiates.  The dentist was told not to use narcotics and he did not, but a subsequent infection sent her to another dentist.  His staff was warned that Lynda was in early recovery when the appointment was made, and the counselor who accompanied her wrote a note to the dentist.  Nonetheless, he handed her a prescription for percoset, a Schedule II (controlled) narcotic whose main active ingredients include oxycodone -- basically synthetic morphine and highly addictive.   As an addict, Lynda was really tempted -- after all it was a dentist who wrote the prescription.  It took virtually the whole clinical team to talk her down.   Next morning I called the dentist, more to enlighten him then to complain.  I said that a Class II narcotic could “awake the sleeping dragon” in any addict and cause a relapse.  My comments were met with pure attitude.

A week before that Lynda’s roommate Anais managed a trip to the Emergency Room for “excruciating” back pain.   A chiropractor confirmed that years of living on the street had taken its toll and that now, off pain-numbing opiates, Anais was finally feeling the consequences.   He also said she could manage the pain with over the counter ibuprofen.  The paramedics told the ER staff Anais wa a patient at an alcohol and drug treatment center.  The counselor accompanying her told the doctor she was in early recovery.   Yet when Anais shooed the counselor out of the room, the ER doctor gave her a shot of morphine. 

Krissie Bergo, who we wrote about last June, came to us through Workers' Comp.  She spent 73 days at Malibu Beach Recovery Center and then 6  weeks at Oceanside Transitional Living.  It cost her insurance more than $100,000 to get her off $50,000/month of toxic opiates and benzodiazepines, all prescribed by a single Workers' Comp pain management doctor.  Incredibly the next Workers' Comp doctor she was assigned ordered her back on hydrocodone, another addictive Schedule II (controlled) narcotic.  She knew enough about addiction to refuse.  Then she went to the dentist and though she told him she was in recovery, he used a benzodiazepine to numb her gums.  I believe it was inadvertent, but warned that Krissie was an addict,  he need to be more vigilant.  She spiraled out of control and had to check back in to MBRC to avoid relapse.

Any addict looking for a quick fix, or a prescription on which to relapse, has to go no further than our local Urgent care.  The doctor told me he would rather give the patient demanding narcotics what he/she wants and out the front door than risk a bad internet write-up.  

ER doctors who want to do the right thing may be putting their jobs at risk said Douglas, a former drug and alcohol counselor who called in to the September 27, 2011 broadcast of “Talk of the Nation.” Douglas told Neil Conan, host of the award-winning  PBS news show, that two of his current clients are emergency room physicians,  He said doing the right thing is hard when you are graded on performance, which includes patient feedback.

Douglas (caller):  “So they'll get clients, patients coming in who are drug-addicted, on Oxycontin, other drugs like you've mentioned, and will press for the drugs...If they spend the time discouraging that patient, it ends up scoring negatively against them.”

In the United Kingdom doctors are being sued for creating prescription drug addicts amid claims they have failed to follow safety guidelines published more than 20 years ago.

Are frustrated Americans going to "occupy" the lobby of the AMA this year?  Stay tuned.