Atty. Gen. Kamala Harris urges funding for prescription tracking
by Lisa Girion and Scott Glover, Los Angeles Times
Calling prescription drug abuse an urgent public health problem, California Atty. Gen. Kamala D. Harris is pushing lawmakers to fund an effort to identify physicians who recklessly prescribe addictive medications.
Harris said in an interview that she wanted to use a state database of prescriptions, known as CURES, to draw a bead on doctors who abuse their prescribing powers, a controversial step discussed for years but never adopted.
CURES, diminished by years of budget cuts, is now used mostly to identify "doctor-shopping" addicts, who feed their habit by obtaining multiple prescriptions from different doctors. Even that type of identification is done on a very limited basis because of the system’s technical shortcomings and bare-bones budget.
Harris, whose office operates CURES, called for upgrading the database and establishing two criminal enforcement teams to investigate suspicious patterns of prescribing. State Senate President Pro Tem Darrell Steinberg (D-Sacramento) and state Sen. Mark DeSaulnier (D-Concord) have introduced legislation to carry out the changes, which would cost an estimated $9.6 million.
Under the proposal, CURES would automatically alert authorities to prescribing that appears "questionable or excessive" so "we can look into it," Harris told The Times. Doctors who write large numbers of prescriptions for narcotic painkillers, for instance, or for drug combinations popular among addicts could come under scrutiny.
"Any legislator who questions the relevance or necessity of this should check with their local police chief," Harris said. "They’ll tell them what’s going on on the street."
Harris, a career prosecutor who was elected attorney general in 2010, has been outspoken on issues such as guns, gangs and gay marriage but comparatively quiet on the state’s prescription drug abuse problem.
A Times article published in December showed how the state’s failure to tap information in CURES had allowed incompetent or corrupt doctors to overprescribe narcotics for years before authorities learned about their conduct through other means.
The federal Centers for Disease Control and Prevention has urged states to use prescription monitoring programs to look for signs of reckless behavior by doctors, and at least six states do.
CURES ‘ formally the Controlled Substance Utilization Review and Evaluation System ‘ contains detailed information from pharmacies on the prescriptions they fill, including the names of patients and their doctors. The system has existed in various forms since 1939 and was once a model for other states.
Currently, it is "on life support," in the words of a Harris aide. It has a budget of $400,000 a year and is overseen by a single employee in the attorney general’s office. Doctors who have contacted the office with questions about CURES, or have sought help gaining access to the database to check on patients, have received email responses stating: "Unfortunately, due to budget restrictions, there is no staff to accept or respond to your communication."
Under the improvements envisioned by Harris, CURES would be transformed into a robust database capable of smoothly handling queries from up to 200,000 healthcare professionals.
Once the system was capable of handling the load, doctors and pharmacists would ‘ for the first time ‘ be required to check patients’ histories to look for any signs of narcotics abuse. The system is now voluntary.
The kinds of prescriptions tracked by CURES ‘ primarily for narcotic painkillers ‘ cause or contribute to more deaths than heroin and cocaine combined. Law enforcement and public health officials long have responded to the problem by focusing on illicit sources of prescription drugs, such as pharmacy robberies and teenagers stealing from home medicine cabinets.
But a Times investigation of more than 3,700 prescription drug deaths in Southern California found that nearly half of the decedents had doctors’ prescriptions for one or more of the medications that caused or contributed to their deaths.
The cost of upgrading the prescription database to the level sought by Harris is $3.8 million. That would be paid for by one-time assessments on health insurance plans and workers compensation insurers.
The bill seeks an additional $1.6 million annually to maintain the database by increasing license fees on doctors, pharmacists, dentists and other prescribers. It also would tax drug manufacturers to support two enforcement teams at an estimated annual cost of $4.2 million.
Because the bill raises fees, it requires approval of two-thirds of lawmakers. DeSaulnier said he believes that the bill has a better chance than previous attempts to upgrade CURES because of heightened awareness of the prescription drug epidemic and because it has the support of the state’s top law enforcer.
"It becomes much more of a public safety issue," he said.
Bob Pack, a technology entrepreneur who has championed improvements to CURES since a woman driving under the influence of painkillers struck and killed his two children in 2003, said another key difference is that the bill seeks funding from various sources, as opposed to singling out the pharmaceutical industry.
Pack said pharmaceutical companies have not been totally opposed to providing money for CURES improvements but have said they should not bear the cost alone.
"They’ve said there needs to be other parties involved. Now there are other parties involved," Pack said. "So, we’ll see."
A spokesman for the California Pharmacists Assn. said the group supports the $2-a-year fee increase on its members to pay for the CURES upgrade but is not convinced that pharmacists should be required to check the database before filling prescriptions if doctors have already done so.
The California Medical Assn. supports the CURES upgrade but opposes raising physician license fees by the proposed $9 a year.
A spokeswoman for the Pharmaceutical Research and Manufacturers of America said the trade group was reviewing the bill but did not have a position.