Tuesday, March 12, 2013

Support SB 809 - The Cure for CURES

“There are many people who benefit from the status quo who are well-funded and well-established in (the Capitol),” Sen. Mark DeSaulnier, D-Walnut Creek, said to a crowd of about 50 members of the National Coalition Against Prescription Drug Abuse and a handful of media on the north steps of the Capitol on Monday about his bill, SB 809.

DeSaulnier is more concerned with funding CURES rather than expanding access.

First things first in other words.

Funding California's prescription drug monitoring systen is paramount to the state in order to get a handle on its share of the prescription drug abuse dilemma. Once its operations are assured then access can be expanded so that workers' compensation participants can use the system in due course, if that's even necessary.

SB 809, introduced last month for legislative debate, would require the Medical Board, Dental Board, State Board of Pharmacy, Veterinary Medical Board, Board of Registered Nursing, Physician Assistant Committee, Osteopathic Medical Board, State Board of Optometry and the Board of Podiatric Medicine to increase licensure, certification and renewal fees charged to practitioners authorized to dispense or prescribe controlled substances by up to 1.16%. The bill would also require the State Board of Pharmacy to increase fees charged to wholesalers and veterinary food-animal drug retailers by up to 1.16%.

Additionally, the bill would require health care practitioners and pharmacists licensed to dispense controlled substances to apply to the state Justice Department for access to CURES and to consult with the database before prescribing or dispensing Schedule II, Schedule III or Schedule IV controlled substances. Currently, enrollment in CURES is voluntary.

Finally, the bill would impose an annual tax on drug manufacturers and a one-time tax on insurers – including workers’ compensation carriers – to fund CURES. The bill does not propose an amount for the tax.

The bill would provide $5 million to upgrade the CURES system and $3 million annually to keep it running according to DeSaulnier.

The debate, in California, is that access to CURES, and any attempt to control outcomes, is tempered by two existing laws: the Intractable Pain Law and the Pain Patient’s Bill of Rights.

The Intractable Pain Law says a physician or surgeon shall not be subject to disciplinary action for prescribing or administering controlled substances to treat a patient for whom “the generally accepted course of medical practice” has not relieved or cured the cause of the pain.

The Pain Patient’s Bill of Rights says a patient suffering from severe, chronic, intractable pain has the option to request or reject the use of any or all possible treatments. While a physician can refuse to prescribe opioids, he must inform his patient that there are physicians who specialize in pain treatment with methods that do include the use of opioids.

Of course the issue with these laws is that pain is largely a subjective factor, so most of the determination of how much pain a patient has, or doesn't have, is based on patient self-reporting which can be notoriously unreliable.

Still, having at least one level of checks and balances should prevent the wholesale abuse of prescription drugs - i.e. the distribution of pills into the black market and thus onto the streets. Being able to monitor just how much drug is dispensed to a person over a certain course of time will alert professionals to potential diversion of drugs.

DeSaulnier's office knows how difficult it is going to be to get this bill passed as the opposition is well funded and well connected. Keeping it simple reduces the chances of objection.

The job of society can't be to protect every single individual - as laudable as that might be, it is next to impossible. Neigh the job is to protect as many in society as efficiently and efficaciously as possible and consistent funding of CURES helps do this.

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