Wednesday, January 23, 2013

CA & OK: Drug Monitoring Program Dichotomy

California's Attorney General, Kamela Harris, is involved in drafting and promoting legislation to get more money for the state's Controlled Substance Utilization Review and Evaluation System (CURES), a computer network intended to give doctors and pharmacists information about a patient's drug prescriptions.

The state's budget for the 2011-12 fiscal year cut funding for CURES, which has been criticized by users as complex, slow and non-responsive to the needs of its users. Harris wants to get more money to finance technological upgrades and staff members to operate the drug-monitoring program.

She would do this through surcharges to physician and pharmacists licensing fees.

In 2010, Sen. Mark DeSaulnier, D-Walnut Creek, authored SB 1071, which would have imposed on every manufacturer and importer of a Schedule II, Schedule II or Schedule IV controlled substance a tax of 0.0025 cents per pill sold. The Senate Committee on Health refused to pass the bill, and DeSaulnier withdrew the measure from consideration.

According to the article, doctors aren't necessarily opposed to this, though it would be preferred if the funding came from the General Fund. But there needs to be increased usability of the system and better technological capabilities before they will adopt the system for wide-spread use.

For instance, current protocol requires that a physician register to use the system by submitting notarized documents to the Department of Justice. An example of state government departmental disconnect - why notarized documents? Why can't the physician or pharmacist be confirmed via communication with professional boards?

Other states don't seem to have such big problems with their computerized drug monitoring systems. Oklahoma is far ahead of tech savvy California (sarcasm here...).

Rep. Richard Morrissette, D - Oklahoma City, would have the Bureau of Narcotics and Dangerous Drugs Control notify doctors when possible problems − such as the use of multiple prescribers or large numbers of refills − are detected by the state's prescription drug-monitoring program.

Unlike some previous proposals, which would have required doctors to check the monitoring system before prescribing controlled drugs for a patient, Morrissette's House Bill 1419 would use a form of "unsolicited reporting," meaning that notices would be sent to practitioners automatically, without the doctor having to go to the monitoring system.

Since Jan. 1, 2012, all Oklahoma dispensers have been required to report the dispensing of prescription drugs within five minutes of the drugs being delivered to the customer, with that information going into the monitoring system. The information is then available online immediately to doctors and pharmacists.

Mark Woodward, spokesman for the narcotics bureau, told WorkCompCentral Tuesday that use of the prescription drug-monitoring system by physicians and pharmacists has grown steadily since it began operating in 2006. More people realize the value of the system and are using it, he said.

Currently, the system is responding to 26,000 to 30,000 calls for information each month, Woodward said.

Those calls represent approximately 70% of the individuals licensed to prescribe controlled drugs, Woodward said. Some physicians, such as pediatricians, would not be participants because they aren't prescribing drugs that fall within the system.

I guess what bugs me is that Oklahoma, a state with a total population the size of Los Angeles, is more able to effectively control prescription drugs within its borders than California, which has ten times the population and presumably ten times, or more, the resources, because Oklahoma's prescription drug monitoring system seems to actually work.


  1. David,
    I have no doubt as to the ability or capacity of California to produce a model system. What is missing in California (which is hardly unique in this area) is the desire of enough of the interested parties. I plead guilty to cynicism here, but it seems to me California's system is an accurate reflection of political and economic special interests. This is true of all jurisdictions, but California always seems to get more attention than most. Things just seem magnified out there. The most socially redeeming aspect though is that California keeps trying to get it right. Eventually it may catch up with Oklahoma.

  2. Great comment Sam, and coincidentally the basis of my post this morning about Washington. CA's outsized influence is just a product of its outsized economy and population - as I noted the population of all of OK would fit within the County of Los Angeles... Thanks for reading.