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

Despite the walls put up by regulators to limit prescription drug abuse, those barriers are often just porous enough for a steady supply of opiates to end up on the street.

Lisa W., a former drug addict who recently completed treatment at the Santa Barbara Rescue Mission’s Bethel House, says she visited dozens of practitioners to get the prescriptions needed to fill her habit.

“(My husband and I) went from my main doctor to a pain management doctor to a psychiatrist for things like the ativans and the ‘benzos,’ and then shopped to another pain management doctor, to every ER in Santa Barbara County to every Urgent Care in Santa Barbara County,” she told Noozhawk on condition of anonymity.

“As long as I looked presentable, I never had any problems.”

When that option is exhausted, said all of the addicts Noozhawk interviewed for this Prescription for Abuse series, they were able to sustain their drug habits by finding and purchasing prescription medications on the street.

Among them was Alicia, a former drug abuser now living in Los Alamos, who asked that her last name not be used. She told Noozhawk she purchased her drug of choice, Tramadol, from an online pharmacy that shipped from the East Coast after her local doctor stopped writing her more prescriptions.

A quick online search yields hundreds of such suppliers. The first Web site that comes up after a search for “Tramadol” requests that purchasers fill out a medical questionnaire and provide a credit-card number. Buyers are then asked to agree to the site’s terms and conditions, one of which states that the purchaser has undergone an exam by a physician and has a prescription for the drug being ordered. Once Alicia began ordering online, she said no one from the supplier ever checked with her doctor about the authenticity of the prescription.

“There’s no way for them to track whether you’re getting a refill,” she said of the Web site operators. “They give you a bottle of 100, which should last two months, and it ends up lasting two weeks, and no one asks any questions.”

Tracking down doctors who overprescribe is a challenge, which Noozhawk discovered firsthand while investigating this series. Multiple sources — ranging from pharmacists, emergency-room doctors and law enforcement — pointed out one general practitioner who operates out of a Lower Eastside Santa Barbara storefront. According to these sources, the doctor consistently overprescribes pain medication.

Santa Barbara County civil court documents reveal a medical malpractice case and another case of negligence, both of which the physician settled. The Medical Board of California doesn’t reveal complaints against doctors or whether an investigation is ongoing, so records for the Santa Barbara doctor yielded nothing. Only formal actions taken by the medical board are reported on its Web site, leaving little information available to consumers.

But local sources know there is more to the doctor than the licensing board will reveal.

One source, who contacted Noozhawk after the Prescription for Abuse series started, has an adult child who has received OxyContin and morphine from the Santa Barbara doctor without a legitimate medical condition to warrant the prescriptions.

“Huge amounts” were prescribed to the family member, the source said, and at least 10 emergency room visits have resulted because of overdoses. The source contacted the state medical board, local hospitals and pharmacies, and even federal authorities, but the physician is still practicing.

“He’s ruined our lives,” the source said of the physician. “Somebody’s gotta stop this.”

The state medical board is under increasing scrutiny after a report was issued last month by Public Citizen, a nonprofit consumer advocacy organization, which called on Gov. Jerry Brown to take action by disciplining dangerous doctors. (Scroll down for the full Public Citizen report.)

Public Citizen reported that the medical board has failed to take action against 710 physicians, all of whom were disciplined for wrongdoing between 1990 and 2010 by California hospitals, health maintenance organizations, ambulatory surgical centers and other health-care organizations. Of the 710 doctors, none of whom were named, 102 of them were designated by peer reviewers as an “immediate threat to health or safety” of patients, the watchdog group says.

A last line of defense is often pharmacists, who have the ability to refuse to fill a doctor’s prescriptions if they believe he or she is overprescribing.

“We have the right to question a prescription,” according to Tim Connell, a CVS pharmacist in Lompoc. “We can lose our license and we are just as liable as anyone else.”

That’s exactly what happened to a Ventura pharmacy owner who kept filling prescriptions from a doctor who was overprescribing to patients, according to a report in the Los Angeles Times.

“There are definitely doctors that I won’t prescribe for,” said Connell, including three doctors in Santa Barbara County who have been blacklisted from CVS.

Pharmacy workers are wary of another two, he said.

Prescriptions from outside Santa Barbara County also raise warnings locally. A group of doctors from Reseda recently set off alarm bells for Connell when he noticed that several morphine-based prescriptions, like Opana, come in large doses. A co-worker filled one prescription, and within a couple of hours, the store started getting phone calls for more prescriptions to be filled from the area.

When asked how to solve some of the issues prescription medications present, Connell was reflective.

“It’s a tough one because people definitely have pain,” he said, but he added that there are alternatives.

There’s only so much relief a person can get with an opiate, and Connell said he believes other options, like chiropractic care, aren’t always pursued.

Prescribing anti-inflammatory drugs for pain instead of opiates is another route, he said. Doctors will sometimes prescribe Xanax as a muscle relaxer, but “there are so many muscle relaxers out there,” he said. “Why use one with addictive qualities and a high street value?”

“I think a lot of times they’ll just listen to what the patient wants,” said Connell, adding that vigilance by pharmacies is also important.

“Doctor shopping” is also a way to get multiple prescriptions, and communication between physicians and hospital networks is almost nonexistent, Noozhawk found.

Although a state database monitors prescription drugs dispensed in California, people who are doctor-shopping for medications are still able to slip through. The Controlled Substance Utilization Review and Evaluation System, or CURES, allows a patient’s treating physician to check prescription records if a problem is suspected. But that database isn’t available to everyone, and authorities and health-care officials say the system has had limited success in the county as a gatekeeping measure.

Cottage Health System has its own database that is used by all three of its hospitals to track what is prescribed and when, according to Dr. Chris Lambert, director of its Frequent Opiate User Program. Lambert can see which patients have been flagged for frequent use and review records to see who needs to be placed on a restriction list. About 10 people per month are restricted, about half of whom aren’t locals, he said.

The goal over the next year is to improve communications between health-care organizations. Efforts for a shared database were under way about a decade ago, but Lambert said worries about exchanging proprietary and confidential information hindered the move.

“We don’t necessarily talk to each other as well as we could,” Lambert said. “A stumbling block all along has been the lack of a common database.”

Sansum Clinic also has its own database to track prescriptions, but it is specific only to the clinic’s network, according to Sansum marketing director Jill Fonte.

“Due to HIPAA (Health Insurance Portability and Accountability Act of 1996), it would not be appropriate for us to share this type of information with any other entity, especially if they were not involved in the care of the patient,” she said.

— Noozhawk staff writer Lara Cooper can be reached at lcooper@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews. Connect with Noozhawk on Facebook.