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A bottle of OxyContin, one of the most widely abused prescription drugs in California.
This is a story about what can happen when no one is looking. For the patients at Universal Pain Management, a medical clinic in northern Los Angeles County, Dr. Francis Riegler is always looking.
On a recent Thursday afternoon, Dr. Riegler huddles with the clinic's nurse practitioner, Trudy Roberts, over a computer print out. The one-page report from the state's drug tracking system shows that the patient was on the hunt for more Vicodin, a powerful pain reliever that he was already getting from Dr. Riegler's clinic. "So he was here in November and got a prescription for our meds," Dr. Riegler whispers to Roberts. "And then he saw another local doc on December 1st and December 15th and got a prescription for what?" Roberts laughs quietly. "The same medication," says Dr. Riegler. "Busted."
More Californians die from overdosing on prescription drugs than from illegal street drugs. To root out pill-shopping patients and unscrupulous doctors, dozens of states, including California, electronically track the prescriptions for powerful narcotics like Vicodin and OxyContin. Now, California's unrelenting budget cuts are threatening to close the system down.
California has the oldest continuous prescription drug monitoring program in the United States dating back to 1939. It used to rely on carbon copies: one for the pharmacy, one for the doctor and one to be mailed, and later faxed, to the state's Department of Justice in Sacramento. It wasn't until the system went online in 1998 though that its full power was realized. Now, physicians can log-in and see which prescriptions their patients have filled anywhere in California.
"I think it's fair to say," says Dr. Riegler, "that we were able to weed out a significant number of people who were either abusing or diverting their medications or hoarding them where we simply had no idea."
So alarm bells went off among doctors and law enforcement when Governor Jerry Brown announced last year that, for budget reasons, he was eliminating the bureau within the Department of Justice that was in charge of narcotics enforcement. That bureau had long managed the prescription drug monitoring program. Dr. Scott Fishman, Chief of Pain Medicine at the University of California, Davis, and author of "Responsible Opioid Prescribing: A Physician's Guide" is one of those who is fearful that if California's system closes down the Golden State could attract pill pushers from around the country. "The rest of the country is developing prescription monitoring programs," says Dr. Fishman, not abandoning them."
Nonetheless, in January, the state laid off or transferred the nine people who operated the prescription database, and now there's one lone civil servant at the Department of Justice keeping it from going dark. Can one person really keep a massive system, with 200 million entries, going?
Mike Small, program manager for the Law Enforcement Support Program insists his one-man operation and the measures he has put in place are working for now. "It's not going to become unusable," says Small. "The electronic system has not faltered. It's been operating this entire time."
Small says there was a backlog, but he was able to catch up and several physicians confirmed that the database is up to date. Fear of the system's demise was premature, says Small, but not unfounded. Now that the Department of Justice, known as D.O.J., doesn't have the money for the program, it relies solely on year-to-year grants. Small agrees that without a permanent source of funding, the future of California's prescription drug monitoring program is indeed unclear. "Grant funding is an iffy thing," says Small. "It doesn’t promise a rock solid future and continuity and that might perhaps be what some of the end using clients might be fearful of. It's not DOJ and the program itself, but rather the state's commitment to funding this program."
The possibility that the nation's most populous state might stop tracking the sale of prescription drugs has not gone unnoticed by the U.S. Drug Enforcement Administration."It's something we're looking very, very closely at," says Mary McElderry, Assistant Special Agent in Charge at the DEA's Los Angeles Field Division. She says agents rely on state-run monitoring programs to catch criminals who peddle OxyContin, Vicodin and Xanax, among others. "We have 48 states that have laws that are governing prescription drug monitoring," says McElderry. "We have 37 states that have systems in place. California is unfortunately probably the only right now that's in danger of losing their drug monitoring system which would be devastating to us."
And devastating for U.S. Attorneys who rely on the database for evidence in criminal prosecutions. McElderry recounts the case of an Orange County doctor who ran a cash-for-prescriptions business out of the local Starbucks. The doctor has been indicted on charges of drug distribution, and the database records are key to the prosecution's case.
Indeed, in the Obama Administration's recently released plan to curb prescription drug abuse, electronic monitoring at pharmacies is a top priority, and drug policymakers say what is ultimately needed is a national database which would prevent sophisticated criminal networks that pay patients to hand over their prescriptions from simply moving across state lines to evade detection.
Back at Dr. Riegler's Los Angeles-county clinic, the veteran pain specialist is getting ready to confront one of his patients who has not evaded detection. Dr. Riegler holds a computer print out, clear evidence that the patient had filled multiple Vicodin prescriptions written by another doctor. "Maybe there's an explanation," Dr. Riegler says. Then he sighs, knocks on the exam room and goes looking for an answer. "Good afternoon. How you been doing? We're treating you for neck pain and arm pain? How’s that going?"'