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March 13, 2014
Another View: There is no quick fix for the epidemic of prescription drug abuse

prescriptions.JPG(March 13 - By Lee T. Snook Jr., Special to The Bee)

As a physician who focuses on pain medicine, no one is more concerned about the growing epidemic of prescription drug abuse. That's why my colleagues and I, and numerous health organizations, have championed reforms balancing patient access tomedication while aggressively reducing the risk of misuse and addiction.

But the suggestion by The Sacramento Bee's editorial board that this problem can be mitigated by mandating that physicians "check a database" betrays a misunderstanding of how practically unworkable that site currently is - and how dangerous that requirement, contained in a current ballot measure, would be for millions of patients legitimately needing prescription medication ("Our drug problem begins with glut of prescriptions," Editorials, March 11).

The so-called MICRA measure (Medical Injury Compensation Reform Act) puts all patient prescription drug access at the mercy of a government-run prescription monitoring computer system, which is not remotely close to being ready for prime time.

A database in which physicians could check patients' relevant drug histories sounds wonderful in theory, which is why California's physicians have supported, funded and fought to improve CURES (Controlled Substance Utilization Review and Evaluation System).

But in practice, according to a 2012 report by the Department of Justice, CURES cannot accommodate 200,000 new registrants who need to be added to the system to make it universally utilized.

What's more, the report indicated that the system is "slow and freezes," and requires a process that is "time intensive and highly manual."

Last year, Senate Bill 809 by Sen. Mark DeSaulnier allocated funding to improve CURES. But by any measure, such an information-technology upgrade of this complexity, involving millions of records of personal medical data and hundreds of thousands of users, will take years to implement. That's why SB 809 envisioned a deadline of 2016.

Enter the recent ballot measure, funded by trial attorneys and designed to increase medical malpractice lawsuits, which the proponents admit was written not by health professionals but by focus groups.

If passed this flawed measure would mandate by November 2014 all physicians and pharmacists to consult the CURES database, which won't even be fully functional by then, before every new prescription - causing, at a minimum, significant if not insurmountable delays for patients and flooding of already overcrowded emergency rooms.

A report by former California finance director Tim Gage said "the initiative would almost certainly result in a situation in which prescribing health providers would be legally required to use a database that was in practice not available."

This will put me and my colleagues in the unconscionable position of being forced to choose between denying needed medication to suffering patients and breaking the law.

Wishing a simple solution existed to end this epidemic won't make it so. But passing a ballot measure that is fundamentally unfeasible and certain to do great harm to patients is not the answer.

Dr. Lee T. Snook Jr. is a physician who practices in Sacramento and is a member of the American Academy of Pain Medicine.