As the opioid crisis rages across the country and in rural California, the California Department of Justice has not yet certified a database designed to prevent doctors from overprescribing the drugs, angering consumer and law enforcement groups that say it hurts efforts to prevent opioid abuse.
The current timeline means doctors will not have to check the database until at least January 2019.
“We’re disappointed to see that (Attorney General Xavier) Becerra hasn’t made it more of a priority to certify,” said Carmen Balber, executive director of Consumer Watchdog, a nonprofit consumer group. “Every day of delay has placed patients at risk of inappropriate and dangerous prescribing, and ensured that doctors will fail to identify and help some patients already addicted to these potent narcotics.”
Health officials say the database is key to preventing “doctor shopping” for addicts and others looking for dangerous narcotics. Thirty-nine states, including California, have mandates for doctors and others prescribing the drugs to check statewide prescription drug monitoring databases, according to the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University.
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At a legislative hearing on Tuesday, Virginia Herold, executive officer of the California Board of Pharmacy, told of one patient who obtained 636 prescriptions or 44,423 doses of more than 25 controlled substances from 116 prescribers over four years.
State officials said they need time to ensure the database can handle more users. At Tuesday’s hearing, officials from the state Attorney General’s Office said they hoped to finish certifying the prescription drug monitoring database for statewide use by July.
Legislation written by Sen. Ricardo Lara, D-Bell Gardens, in 2016 required doctors to check the Controlled Substance Utilization Review and Evaluation System (CURES) before prescribing opioids and other controlled substances to a patient for the first time and at least once every four months if drugs remain part of the treatment. The law, Senate Bill 482, takes effect six months after the state certifies the database is ready.
The Department of Justice, which maintains the CURES database, finished hiring enough people to certify the updated database last month, Tina Farales, manager of the CURES program, told lawmakers at the hearing. The database, which contains patient and prescription information, has been around since 1997, and an electronic, more user-friendly version debuted in 2009. The mandate to use it came with Lara’s bill in 2016.
The newest version, dubbed CURES 2.0, launched in 2016 and provides prescribers with alerts about patients who have, for example, received higher doses of painkillers or prescriptions from multiple providers during the past few months, Farales said.
According to an emailed statement from the Attorney General’s Office, the CURES database’s capacity for handling information “was half of what is needed in order to be certified” when SB 482 passed in 2016 and is now being tested to to ensure it can handle more users. “The last thing we want to do is have a mandatory system that can’t meet the influx of users,” the statement said.
The database receives about 1 million prescription entries each week, Farales said. In 2017, more than 128,000 prescribers and more than 40,000 pharmacists were registered in the CURES database, according to Farales.
Public health officials say CURES is key to preventing opioid-related deaths in California and has had success. Dr. Karen Smith, director of the California Department of Public Health, said during Tuesday’s hearing that deaths peaked in 2009 and had dropped 15 percent by 2016, to 1,925. California had 10.8 drug overdose-related deaths per 100,000 people in 2016, below the national average of 19.8 deaths per 100,000, added Dr. Kelly Pfeifer from the California Health Care Foundation.
However, opioid and heroin use continues to hit the state’s rural northern counties hard, with several counties having more opioid prescriptions than people in 2016. Pfeifer said these rural counties have opioid-related death rates similar to rates seen in opioid-ravaged states like Kentucky and West Virginia.
These numbers point to the need for a certified CURES database that all prescribers must use, said John Lovell, a lobbyist for the California Narcotics Officers Association, during Tuesday’s hearing. Law enforcement agents can access CURES records as well.
“Given the crisis that we’re facing, that delay is inexplicable,” Lovell said.
The California Medical Association, which represents 43,000 doctors in California, thinks the CURES database needs more work before the mandate kicks in. The CMA has been a vocal opponent of a mandate requiring doctors to check CURES, and helped defeat Proposition 46 in 2014, which would have established a mandate. The CMA also opposed SB 482.
While applauding the recent improvements to CURES, CMA board member Dr. Lee Snook Jr. said during Tuesday’s hearing that “mandating a system that may not be ready for prime time” unfairly impacts doctors. Snook said problems still exist with the system kicking off users as they try to update patient accounts or not allowing them to log in. A lag in data reporting also allows “doctor shoppers” to go undetected, he added.
“There’s a current seven-day requirement (to log the prescription in the database) that leaves a gap in which a true doctor shopper could obtain and fill multiple prescriptions before data would show up in the CURES database and alert the prescriber or the pharmacist,” Snook said.
The CMA also does not agree with the Department of Justice overseeing CURES, arguing that prescribers and medical professionals are better able to identify “red flags” when prescribing opioids.
“We prefer it be housed in a non-law enforcement entity, so that it serves its function for public health,” Snook said.