As mounting evidence and support shows, if California lawmakers want to help end the prescription drug epidemic, they should mandate that doctors use the state's online prescription drug database. The latest evidence in support
is a new study from two San Diego doctors.
The study examined all of the 254 prescription-related overdose deaths in San Diego County in 2013, most of which involved the use of prescription painkillers. In 73% of the fatalities, people took drugs that were in California’s Controlled Substance Utilization Review and Evaluation System (CURES) drug monitoring program database (PDMP). The results, according to Dr. Roneet Lev, emergency medicine physician at Scripps Mercy Hospital, and Dr. Jonathan Lucas, San Diego County deputy medical examiner, suggest that if physicians use CURES to see if a patient is doctor-shopping for dangerous drugs, they will help prevent overdose deaths.
The bill would require physicians to check the CURES when prescribing Schedule II or III drugs like oxycontin to a patient for the first time, and annually thereafter if the treatment continues. The bill passed the state Senate last year and now is in the Assembly.
According to the new study, there were 186 patients of the 254 prescription-related deaths in 2013 in San Diego that had PDMP data. Some of those PDMP reports were "death diaries" that told a prescription story one year before death. The data provided had some red flags on many patients that included multiple prescriptions, multiple pharmacies, multiple providers, and drug interactions. Retrospectively, one can identify areas for potential intervention and prevention by providers, pharmacies, law enforcement, and health plans.
The medical community would like to think that if patients take medications strictly as prescribed and not mix them with alcohol or illicit drugs, they should be safe, according to the authors. Although this is true the majority of the time, this study showed a potential of deaths with matching toxicology reports, PDMP data, no alcohol or illicit use, and no doctor shopping. However, improvements can occur by using PDMP data, communication between providers, using special care with methadone prescribing, establishing a standard such as one provider and one pharmacy for chronic prescriptions, and minimizing opioid and benzodiazepine combinations, the report said.
Opioid overdose deaths, including both opioid pain relievers and heroin, have become a national epidemic, hitting record levels in 2014, with an alarming 14 percent increase in just one year,
according to the Centers for Disease Control and Prevention. From 2000 to 2014 nearly half a million Americans died from drug overdoses. The most commonly prescribed opioid pain relievers, those classified as natural or semi-synthetic opioids such as oxycodone and hydrocodone, continue to be involved in more overdose deaths than any other opioid type. These deaths increased by 9 percent (813 more deaths in 2014 than 2013), the CDC reported.
In January, the California Attorney General’s office announced that CURES 2.0, a two-year $1.9 million upgrade to the CURES database, was open to all physicians and pharmacists. Every health care provider licensed to prescribe or dispense medications must register to access the database by July 1, 2016.
Recently, a number of presidential candidates have spoken publicly about fighting the scourge of overprescribing, and
President Obama has proposed another $1.2 billion in federal funding to raise the ante in the fight against opioid abuse, including funds to expand the use of state prescription drug databases, such as CURES.
In addition,
a recent survey published by the American Medical Association found a majority (87%) of 2,130 physicians agreed PDMPs can be useful for staying informed about patients’ prescription histories and identifying when patients are receiving multiple prescriptions. This was a positive consensus, considering 61% of the surveyed doctors reported prescribing opioids on a daily basis, commonly in primary care settings for noncancer chronic pain conditions.
With the surge in both support and evidence, lawmakers should stand with patient advocates and pass SB 482.
