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March 10, 2014
Editorial: Go after doctors who overprescribe painkillers

prescriptions.JPG(March 10 - By the Editorial Board)

The biggest drug problem in the United States is not the one we think we have: illegal drugs. It is drugs prescribed by doctors.

On Monday, U.S. Attorney General Eric Holder properly focused attention on the sharp rise in heroin deaths, noting that "addiction to heroin and other opiates, including certain prescription pain-killers, is impacting the lives of Americans in every state."

As it happens, more people die of prescription drug overdoses now than from traffic accidents. A new study by the Centers for Disease Control and Prevention found that doctors are key contributors to the crisis of addiction and overdose.

Some of it is irresponsible doctors, "problem prescribers." But part of it is doctors simply resorting to drug prescriptions when alternatives may be better.

Then there are patients who go "doctor shopping" to get prescriptions of painkillers like hydrocodone and oxycodone from different doctors.

This study follows a 2012 investigation by the Los Angeles Times, "Dying for Relief," which found a startling phenomenon: Nearly half of the prescription overdoses in Southern California were attributable to doctor's prescriptions, with one doctor alone linked to 16 dead patients.

How to deter prescription drug abuse, which the Centers for Disease Control is now calling an epidemic?

After a truck driver who had gotten multiple prescriptions for Vicodin and Flexeril fell asleep and killed his two young children, software entrepreneur Bob Pack pressed California to be the first state to set up a prescription drug database to prevent patients from doctor shopping and doctors from overprescribing. That is a big part of a solution.

But the Controlled Substance Utilization, Review and Evaluation System, or CURES, was hamstrung from the beginning by lack of funding for enforcement and resistance from doctors and pharmacists to any requirement to check the database before they write or fill prescriptions. So CURES so far hasn't been much of a deterrent.

California Attorney General Kamala Harris sponsored Senate Bill 809 last year seeking to help fix both problems.

What actually passed and was signed by Gov. Jerry Brown, however, was only a small improvement.

A $6 fee increase on doctors and pharmacists raises enough funds to operate the database effectively. But the drug lobby got a proposed fee on drug manufacturers removed, money that would have gone to enforcement. And the California Medical Association won removal of the proposed requirement that doctors check the database before writing a prescription.

So the task of finding the people trying to get multiple drugs from multiple doctors and the doctors prescribing too many drugs remains difficult.

The Legislature should get a backbone in this session to require doctors to check the database and require the drug industry to contribute to enforcement.

If it doesn't, Pack and the Santa Monica advocacy group, Consumer Watchdog, are proposing a ballot initiative with more onerous provisions. In addition to requiring doctors and pharmacists to check the database, his ballot measure would require random drug and alcohol testing of doctors, among other provisions.

Going after problem prescribers certainly is a necessary part of a solution. But we Americans have to confront ourselves. We consume 80 percent of the world's supply of painkillers. The problem is us and our inclination to treat problems with a pill.