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Local Oversight of Prescription Medications Is Far More Focused Than State, Federal Controls

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Local Oversight of Prescription Medications Is Far More Focused Than State, Federal Controls

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This article was written by Noozhawk Staff Writer Giana Magnoli as part of Day 5 in Noozhawk's 12-day, six-week special investigative series. Related links are below.

The Noozhawk's Prescription for Abuse series is a special project exploring the misuse and abuse of prescription medications in Santa Barbara County. Our series is a result of an exciting and unique partnership with USC's Annenberg School for Communication & Journalism, which awarded Noozhawk a California Endowment Health Journalism Fellowship to undertake this important work.

Through our reporting and presentation, we will establish an independent baseline of where our community is with respect to the misuse and abuse of prescription medications; how the problem is affecting health care, education, law enforcement, criminal justice, addiction and treatment, and our culture and society; what we as a community can do to educate ourselves about prevention and controls; and how we can perhaps reverse what appears to be a very troubling trend.

Noozhawk staff writers Lara Cooper and Giana Magnoli are the lead reporters on the project, and they've been assisted by managing editor Michelle Nelson; reporters Alex Kacik and Sonia Fernandez; interns Kristin Crosier, Jessica Ferguson, Tim Fucci, Kristen Gowdy, Jessica Haro, Daniel Langhorne, Alexa Shapiro, Sam Skopp, Erin Stone and Sarah Webb; photographers Garrett Geyer and Nick St.Oegger; content producer Cliff Redding; and Web development staffers Will Macfadyen and Edgar Oliveira.

Ashley Almada, Garrett Geyer, Hailey Sestak and Billy Spencer of the Santa Barbara Teen News Network filmed more than two dozen public-service videos featuring many of our story sources.

The project is sponsored by the Santa Barbara Foundation in partnership with KEYT, sbTNN and Zona Seca. The Annenberg School is assisted by the Renaissance Journalism Center at San Francisco State University.


Day One:

» Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

» After Losing It All, Former Drug Addict Looking Forward to Renewed Life

» USC, California Endowment Unite to Support Health Journalism at the Source

» Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities

Day Two:

» Local, National Statistics Reveal Alarming Jumps in Misuse and Abuse of Medications

» Marijuana Use Trends Higher, Especially Among Young Adults, Sparking Public Health Concerns

» Alcohol Plays a Role All Its Own in Setting the Stage for Local Abuse, Overdoses

Day Three:

» Understanding Addiction Key to Dealing With Prescription Drug Abuse

» Donna Genera Has Seen the Price and Perils of Drug Addiction from All Sides

» Rich Detty Bears Burden of Not Knowing Extent of Dead Son's Drug Use

Day Four:

» Escalation of Drug Overdose Deaths Includes Increased Presence of Prescription Medications

» Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series

» Dr. Chris Lambert Sounds Warning on Mixing Prescription Drugs with Alcohol

Day Five:

» Local Oversight of Prescription Medications Is Far More Focused Than State, Federal Controls

» Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs

» Second-Generation Pharmacist Peter Caldwell Fills a Vital Role with Patient Health Care

Day Six:

» Early Education for Parents and Youth Emerges as Critical Tactic to Thwart Drug Use

» Student Highs Can Lead to Tragic Woes with Addiction's Hook Just One Fateful Step Away

» From an Early Age, Shereen Khatapoush Saw the Horrors of Substance Abuse

» As a Parent Herself, Prosecutor Von Nguyen Brings Empathy to Job in Juvenile Justice

Day Seven:

» Law Enforcement Fights Battle Against Prescription Drug Abuse from Outside and Inside

» Sheriff Bill Brown a Strong Supporter of Re-Entry, Drug Abuse Treatment Efforts

» Speaking from Experience, Zona Seca's Kevin Smith Keeps Drug Abusers on Road to Recovery

Day Eight:

» Prescription Drug System Is Rife with Loopholes, Fraud and Lack of Oversight

» For Clinical Psychologist Neil Rocklin, Addiction Education Can't Begin Soon Enough

Day Nine:

» Drug Abuse Treatment Programs, Expertise Are Plentiful on South Coast

» Dr. David Agnew Sees Pain as Pathway to Abuse But Cautions Against Overreaction

Day Ten:

» Awareness, Disposal Key Elements to Reversing Tide of Prescription Drug Abuse

» Dr. Joe Blum Keeps Focus on His Veteran Patients Despite Health-Care System's Restraints

Day Eleven:

» Operation Medicine Cabinet Gets the Drop on Prescription Drug Disposal

» Lacey Johnson Gives UCSB Students an Education in Dealing with Drug Abuse and Addiction

Day Twelve:

» Santa Barbara County Officials Look for Solutions in Battle Against Prescription Drug Abuse

» Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series

» Annenberg Fellowships Take a Diverse Approach to Community Health Journalism

» Dr. Nancy Leffert Champions Antioch University's Role in Fight Against Substance Abuse

» Professionals Working in Addiction Field Often Share Roots at Antioch University Santa Barbara

Hospitals and clinics on the front lines develop their own systems to monitor abuse, suspicious activity
Sunday, September 25, 2011

Prescribing controlled substances is a highly regulated process, especially as abuse and addiction become more prevalent, but oversight is fractured between agencies with the burden falling on local health-care providers.

Local facilities are more proactive in efforts to prevent or intervene in drug-seeking behavior, while state and federal oversight is mostly driven by those local providers reporting violations.

The federal Drug Enforcement Administration usually will only get involved if there’s a strong possibility of interstate actions, but can send in tactical division squads for an investigation or enforcement, said Ashley Schapitl, press secretary for Rep. Lois Capps, D-Santa Barbara.

Congressional legislation established two grant programs for creating or enhancing drug-monitoring systems, one of which is still funded with a $5.6 million budget in 2011, but running these databases and any subsequent investigations fall to state agencies. California is one of 35 states with such a program in place.

California’s database — called CURES, which stands for Controlled Substance Utilization Review and Evaluation System — was established in 2009 by then-Attorney General Jerry Brown. It is intended to lower health-care provider and insurance costs while reducing drug trafficking and the high number of drug-related medical emergencies from overdoses.

As of Jan. 1, any health-care provider who dispenses controlled substances is required to report that information weekly to the state Department of Justice. (The DEA classifies controlled substances in five categories, or schedules, depending on their accepted medical use in treatment and their relative abuse potential and likelihood of causing dependence.)

Medical professionals, law enforcement and regulatory boards have instant access to patient records, instead of submitting a request via mail or fax. Before CURES, the Attorney General’s Office received more than 60,000 requests every year and had a slower turnaround time, officials say.

Records include the drug name, quantity and strength of pills, pharmacy information and physician information, so access is limited as a result of patient privacy concerns.

Bureau of Narcotic Enforcement specialists monitor and analyze the data and can refer potential abuses — by overprescribing doctors or drug-seeking patients — to regional offices.

The Bureau of Narcotic Enforcement is involved in the Santa Barbara Regional Narcotic Enforcement Team, but neither the Santa Barbara County Sheriff’s Department nor the District Attorney’s Office monitor the CURES program for investigations, officials say.

Instead, local health-care providers are the most vigilant in looking for potential abuses.

As medical administrative systems make the switch to electronic health records and monitoring patient records becomes easier, South Coast providers have responded to the problem of abuse with programs and protocols of their own.

“A stumbling block all along has been the lack of a common database,” said Dr. Chris Lambert, a Cottage Health System emergency physician.

With electronic records, a patient’s full prescription history can be gleaned with a glance and steps can be taken if overuse, abuse or addiction is suspected, he said.

Sansum Clinic is in the process of implementing a comprehensive record-keeping system, known as the Wave, which will maintain health data on file for each Sansum patient so the clinic can minimize duplications or bad drug interactions, Dr. Marjorie Newman, Sansum’s assistant medical director, told Noozhawk in an email.

The installation will be complete in early 2012, according to Sansum marketing director Jill Fonte, who said the system is much more than a prescription database. Sansum caregivers will be able to quickly see a patient’s records to review medications, allergies, test results, alerts and treatments received.

“Having that information readily available can enhance the care patients receive, and could make a big difference in an emergency, when time matters most,” she said.
A secure web portal will enable patients to access information such as educational materials, visit details, lab results and immunization records, Fonte added.

Sansum’s clinics also have “opiate contracts” that outline “rules” for long-term pain medication management and are signed by patients and the physician, Newman said.

The clinics can use prescription history to look for misuse, abuse or dependence and prompt a frank discussion with the patient, she said. Patients can be referred to a specialist or reported to CURES.

Cottage Health System has the only three emergency rooms on the South Coast — at its hospitals in Santa Barbara, the Goleta Valley and the Santa Ynez Valley — and has implemented a Frequent Opiate User Program, which is run by Lambert.

An increase in prescription drug abuse has been documented mostly through emergency department admission records, and hospitals can be a target for abusers and “doctor shoppers” who visit multiple physicians to get medication, officials say.

Any physician can alert Lambert if they suspect a pattern of abuse through frequent visits, and he can then access patient records and contact the primary-care physician. Once a month, the hospitals’ department heads, physicians and pharmacists review the records to determine if patient interventions are required, with three options: do nothing, put a patient on a watch list, or place him or her on a restriction list.

When patients are placed on a restriction list, they cannot be prescribed a specific drug in the emergency department unless they bring a formal letter from their primary-care physician, Lambert said. About 10 people are restricted per month, half of whom are “cruising through town,” he said, referring to out-of-town patients whose behavior implies they are here seeking drugs.

It’s not about punishment or judgment, Lambert said. Doctors are trying to refer someone with a pain management or substance abuse problem to get help, he explained.

“These drugs are very good and very effective,” he said. “People can get hooked before they know it.”

Painkillers are the biggest concern since they’re the No. 1 drugs of abuse, and practitioners have to balance patient care with the reality of addiction potential.

The Medical Board of California has clinical guidelines for prescribing controlled substances for pain but all health-care providers struggle with how to provide medication to the right patients for the intended purpose when abuse is so prevalent, said Dr. Alfredo Bimbela of the Santa Barbara Neighborhood Clinics.

“We certainly do not want fear to guide our prescription practices, but we do make every effort to use sound judgment in prescribing medications to patients,” he said.

“What we do know is these medications change peoples’ lives, allow them to function and allow them to not be suffering.”

While it’s inevitable that some people will come into the clinics with all the right answers to acquire drugs on false pretenses, Bimbela said, close relationships with patients and pharmacies can help prevent or identify a problem.

Lambert agreed, saying that pain management is delivered early and appropriately in the emergency department.

“Until it’s a clearly flagrant example that I’m getting worked, so to speak, I treat them,” he said.

Cottage Health System’s emergency department doesn’t prescribe more than 30 pills at a time, since any ongoing pain issues should be dealt with by a primary-care doctor, he said.

Patient education for drugs — and spotting abuse — also falls to physicians and pharmacists.

Both Sansum Clinic and the Santa Barbara Neighborhood Clinics have their own contracts outlining the understanding between patient and physician about the possible consequences of taking opiates or other drugs with abuse potential.

Pharmacists have their parts to play in oversight, too, and Bimbela said they are an invaluable resource in monitoring patients to make sure medication is taken appropriately.

Chain pharmacy stores like CVS and Vons have information-sharing databases so pharmacists can tell if one person attempts to get the same prescription filled at two locations or tries to get an early refill, Bimbela said.

Allan Cohen, pharmacy director of Cottage Health System, has a largely automated system as most hospitals do, but personal checks are in place to “look for weirdness,” he said.

“It’s too easy to divert drugs if you don’t have some kind of automation,” Cohen said.

Cohen’s staff is very aware of the abuse potential for certain drugs, especially strong painkillers, and acts accordingly, he said.

“If you know they refilled eight days ago, you may want to talk to them,” he said.

“It’s easy enough for people who may not even think of themselves slipping into addiction to slip into addiction,” he said. “They make rationalizations all the time about what’s happening but are not aware of it.”

Noozhawk staff writer Giana Magnoli can be reached at Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.