Everybody Hurts: Bill tackling prescription drug abuse felled by cost concerns

A plan to make prescribing safer has been shot down in the California legislature because of cost concerns.

The mismatch between ambitious ideas on the legislative side and how-are-we-going-to-pay-for-this realities on the administrative side should be a red alert for patient safety advocates. Can they find a low-cost or even cost-neutral way to make health care safer? Here’s what happened.

Bob Pack, a software entrepreneur and the head of the Troy and Alana Pack Foundation, worked with Sen. Mark DeSaulnier, a Democratic state senator from Northern California, to put together Senate Bill 1258. Initially, the bill was poised to do many things:

1. Require that all narcotic prescriptions be limited to a 30-day supply. This is a central issue for Pack, whose children were killed when a woman high on painkillers ran them over.

2. Add so-called schedule 5 drugs to the state database set up to track heavy prescribers and heavy users of prescription drugs. Schedule 2, 3, and 4 drugs – which cover the most popular painkillers – are part of the tracking system. But right now, drugs like codeine cough syrup aren’t part of the system but can be highly addictive.

3. Make electronic prescribing mandatory for all doctors. This would have allowed better tracking of who is writing prescriptions, where they are being filled, and how often patients are going back for the same prescriptions.

Let’s face it. You don’t like being told how to do your job by anyone other than your boss and often you don’t like your boss’s advice, either. Doctors are no different. And when state legislatures start making demands about how doctors should practice medicine, state medical associations everywhere kick into high gear. The California Medical Association is one of the best at stopping legislation that will add red tape to health care processes, and if there is a clear added cost from a piece of proposed legislation, it makes it even easier to kill a bill.

The first thing doctors didn’t like about the bill was the 30-day limit. The bill did allow for exceptions. For example, if they could show that a patient had chronic, severe pain for cancer, a burn, or really any other cause, they could prescribe up to 90 days. The bill did require, though, that doctor note the reason in the prescription, which would then be noted on the pill bottle and that the reason for the 90-day supply be put in the patient’s file, too.

The bill would have put California among about a dozen states that now have narcotic prescribing limits.

Initially, SB 1258 had some momentum. It passed its first two committee hearings. But the costs ultimately sunk it.

Remember that the Controlled Substance Utilization Review and Evaluation System, or CURES, in California has limped along for years because of lack of funding. Just by adding schedule 5 drugs, the system would have cost more to run.

Making prescriptions electronic would have required an even more significant health care expense. State regulators would have had to upgrade their computer systems to accommodate the change, and doctors, hospitals and clinics would have had to upgrade their computer systems, too. That part of the bill was so unpalatable to physicians that DeSaulnier dropped it at the last minute.

It was too late. Once opposition has formed, it can be hard to alter course. Pack received a note from a legislative aide that said:

I am sorry to inform you that SB 1258 was held in Senate Appropriations today, effectively meaning the bill has died. The senator is very disappointed as this bill was a top priority for him and he amended the bill to remove the most expensive section of the bill (the e-prescribing mandate). Thank you for your support and I hope that California will prioritize passing legislation to prevent prescription drug abuse soon.

I asked DeSaulnier about the demise of the bill, and he sent me this comment:

I have been proud to carry legislation throughout my time in the Capitol to fight prescription drug abuse. SB 809, a 2013 bill signed into law, was instrumental in saving and strengthening the CURES system. We cannot continue to ignore the urgency of the prescription drug abuse epidemic.

Voters will have a chance in November to make a different set of changes to the way California regulates drugs and doctors. Pack succeeded in getting enough signatures for the Troy and Alana Pack Act, which requires random drug testing for doctors and raises the amount patients can win in a malpractice lawsuit.

Photo by Guian Bolisay via Flickr.