California needs to do more to combat prescription drug deaths than just relaunch drug database
The California Department of Justice program that gives physicians online access to a database of controlled substance prescriptions recently sent an e-mail blast to California physicians about a much-needed database upgrade. Billing the upgrade as “CURES 2.0,” the DOJ promises a slow rollout of new features including “performance improvements and added functionality.”
CURES stands for “Controlled Substance Utilization Review and Evaluation System,” and access to the improved database is limited to a select few doctors at first — the same way an independent movie is cautiously released — before the statewide rollout, which has been delayed until 2016. Given the current catastrophe of prescription drug deaths and the urgent need for CURES to work as well as possible for all doctors, this seems to be a woefully unhurried timeline.
CURES, as a tool, can be invaluable. Working in an urgent care center and faced with patients quick to ask for a Vicodin or Percocet “refill,” we doctors could check the database to ensure that such patients hadn’t just gotten three such “refills” in the last week from other doctors. I didn’t have my own login, but could ask the other doctors to log in and check up on patients before writing risky prescriptions. CURES probably had something to do with the California Medical Board’s probation of one of the urgent care doctors, whose unusual speed turned out to be due to blithely dashed-off charts that did little to justify his robust prescribing of controlled substances to anyone with a pulse.
Then, I took a job at a community health clinic that isolated me from other doctors during the day. Needing my own access to CURES, I dutifully filled out forms, got the paperwork notarized, and sent everything to the Department of Justice. I got a confirmation of receipt. Then … nothing. No access. I tried to call to get the matter sorted out, only to hear a recorded message that said budget cuts had led to the layoffs of staff who could answer questions. Unable to break the layer of bureaucracy, I crossed my fingers and hoped that Mr. Black on the chronic morphine was really, actually, in pain.
An NBC investigation revealed that relatively few doctors were even signed up with CURES, that everyone found it clunky and slow (a complete deterrent to actual use when you’re trying to blitz through 30 patients), and that I wasn’t the only doctor having difficulty with the signup process. Funding for CURES was cut in 2011, courtesy of Gov. Jerry Brown.
In the last few years, prescription drug deaths have almost tripled. And heroin has surged in popularity, because it’s made of the same stuff as prescription painkillers.
I've seen how slow our government’s response has been to address this epidemic, and I’m not surprised, based on my frustrating experience. The state of California, rather than allocating funds to CURES from existing public health money, is funding CURES 2.0 by fees tacked on to doctors’ medical licensing fees. While not a deterrent, this feels like a bit of a punishment for being a doctor, and raises the question of why California does not fund opiate abuse prevention in the same way as it funds prevention efforts for heart disease or diabetes.
The DOJ says that every practice will have access to CURES 2.0 by January 2016. How many people have to die before then? How many physicians never got access to the database and practice in the dark? How many graduating medical trainees don’t even know the database exists? We certainly had no knowledge of the database at our training hospital, despite the steady parade of addicts and chronic pain patients.
California and the DOJ should pursue a reduction in prescription drug deaths aggressively — with support for CURES, with education of young physicians and trainees, and with incentives for physicians to check the database. Access may be required for non-physician staff members, as most doctors simply won’t interrupt their workflow to check CURES when administrators are demanding ever more “patient encounters” per day. In the event of technical failure, there should be telephone backup so that a doctor or assistant can call to check on the prescription record of a particularly worrisome patient.
Our prescription pads are the problem, and we need information about risky patients to be available quickly, accurately, and easily. Physicians want to help stem the staggering numbers of overdoses and deaths, but we need support to do it.
[Photo by frankieleon via Flickr.]