Everybody Hurts: Budget Woes a Poor Excuse for Ignoring Drug Abuse

The picture that comes into your head is sad, really.

A lonely bureaucrat, perhaps in a basement office with no windows, surrounded by towering stacks of documents that need to be entered into a database that will tell pharmacists and doctors whether a patient is abusing prescription drugs. A knight hunched over his computer, fighting a losing battle against the dragons of painkiller abuse.

That’s the scenario presented by the state of California in response to questions about why its prescription drug tracking system isn’t working the way it was intended. Budget cuts have thinned the ranks. There’s no money to gather the necessary information or provide a usable website that people could check to see if patients had been doctor shopping to feed a painkiller addiction.

How much would it cost to make the system live up to its potential? The state says $3 million.

But that’s just the kick-start. To run the Controlled Substance Utilization Review and Evaluation System, or CURES, in a way that would regularly flag doctors prescribing too many drugs would cost $1.6 million.

I have never run a state agency, of course. But this seems crazy.

If the system works right, it should be making the connections and sending out red flags automatically. This does require software development. But does it require $3 million in software development?

It also requires some staff time for data entry and cleanup. But in the millions every year?

When I was at the Orange County Register, we set up a database of doctors who had been disciplined by the state. People could access it 24-hours-a-day. Two reporters contributed to it, and it took us about three hours every month to plug in new doctors’ names and details.

Even if two people at $30 an hour worked eight hours a day doing data entry with no vacations or holidays, it would take more than 12 years to rack up $1.6 million in costs.

At that rate, we both would be working well into our retirement before our work added up to $1.6 million.

Three hours a month.

And state workers shouldn’t have to do all the work. If doctors are required to log their prescriptions into a centralized system, there would be no reason for state staffers to spend a significant amount of time on data entry.

Here’s what Dr. Allen Frances, a professor emeritus of psychiatry at the Duke University School of Medicine and told Scott Glover and Lisa Girion at the Los Angeles Times: “… credit card companies monitor customers' purchases more closely than most states monitor prescribing of addictive medications. ‘This is life and death,’ Frances said. ‘If you can do it for a $100 credit card purchase, why can't you do it for prescriptions?’”

And credit card companies don’t have legions of young software engineers sitting in rooms watching every credit card purchase. They rely on the retailers who are swiping your credit card to feed them the information they need. They have software that flags purchases that are out of line with past practice. CURES could work the same way and should.

When Brown cut funding for the Bureau of Narcotics Enforcement in 2011 to help solve the state’s budget crisis, it effectively killed CURES.

Could CURES be funded some other way? The father of two children killed by a woman driving high on painkillers thinks so. Bob Pack joined forces with state Sen. Mark DeSaulnier (D-Concord) to start charging pharmaceutical companies a fee that would pay for the database. The bill died in committee.

So Pack tried to put the fee to a public vote by gathering enough signatures for a statewide initiative. He didn’t have enough volunteers, though, and ultimately gathered just 50,000 signatures out of a necessary 500,000. He told Shoshana Walter at the Bay Citizen:

“Unless you have an army at every Safeway for two months in a row, at every grocery store and drug store and so on in California — you have to be out there physically for hours at a time. And the signatures are just the first step. You have to spend like a million and a half on signatures and then you have to have money for the actual election … And you know the pharmaceutical companies are gonna outspend you like 10 to 1. So how can I possibly do it?”

There’s another question. How are other states doing it? I’ll talk about that in my next post.

Image by Mac Filko via Flickr