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Q&A with Bob Pack: Holes in an RX Abuse Detection System

Q&A with Bob Pack: Holes in an RX Abuse Detection System

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Bob Pack is a technology entrepreneur and the CEO of Shop O’ Lot. Ten years ago, he lost his two children, Troy and Alana, when a woman ran over them in Danville, California. When he discovered that the driver had been abusing painkillers, Pack set out to create a system that might prevent something like that happening again.

Despite a lot of talk, some legislation, and promises made by the current California governor, 10 years later, Pack’s ideas have yet to be fully realized. He agreed to answer a few questions by email.

The first part of the interview addresses what Pack believes are flaws in California’s Controlled Substance Utilization, Review and Evaluation System (or CURES) and his attempts to improve it. CURES is a system that allows pre-registered users, such as licensed healthcare prescribers, pharmacists, law enforcement officials and regulatory boards to access controlled substance prescription histories for patients. The interview has been edited for space and clarity.

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Q: When did you first become awareof California’s Controlled Substance Utilization, Review and Evaluation System or CURES?

A: I first became aware of CURES after the deaths of my two children by a women who was a prescription drug abuser and "doctor shopper." In the police investigation, I learned that she had been obtaining thousands of narcotics from doctors all working for the same HMO. I contacted the Attorney General's office, where I was informed about the CURES program.

Q: What was your sense of how it was functioning as a prescription drug tracking system and as a public safety tool?

A: After reviewing the capabilities of the CURES program I was shocked and appalled at its limitations and lack of usefulness. Having a background in technology, I immediately realized that without providing doctors and pharmacists instant access to CURES, it was not a very effective program.

Q: What about the way CURES was being used appalled you?

A: To my astonishment, the system seemed archaic. Doctors were required to fill out a patient inquiry form and fax it into the state Department of Justice, where someone would then manually look up that patient's prescription history in the database and then fax back the requested information. This would often take anywhere from weeks to well over a month. By then, the patient already had taken the prescription and filled it at the pharmacy.

Q: How did you set about trying to improve this system?

A: I drafted a proposal to upgrade CURES to a real-time accessible system and approached former Senator Tom Torlakson to spearhead a Senate Bill for these needed changes.

Q: What were some of the essential ideas you proposed?

A: The key element of the proposal was to build a Web-based secure portal where doctors, pharmacists and authorized law enforcement could log in and instantly check a patient’s prescription history, especially prior to prescribing a narcotic or filling a prescription for a narcotic. The system would need to be “bank-level secure” to not breach federal privacy laws like HIPAA.

Q: Did Torlakson’s bill accomplish everything that you suggested? Or was it watered down in the process?

A: The bill contained all of the elements needed to gain authorization from the Legislature to move forward.

Q: It seems that you initially received a warm reception from state officials, including then Attorney General Jerry Brown. What was working with them like?

It actually took almost a year to get a meeting the attorney general, as he was new to the office. Once we met and the full impact of the CURES system potential was explained he was very excited to make it happen. The state officials were really helpful and great to work with. However I didn't realize how long and slow the government process would be.

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