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.
Riegler
huddles with the clinic's nurse practitioner over a computer printout. The
one-page report from the state's drug-tracking system shows that a patient was
on the hunt for more Vicodin, a powerful pain reliever that he was already
getting from Riegler's clinic.
California
has the oldest continuous prescription-drug monitoring program in the U.S.,
dating to 1939. It used to rely on carbon copies: one for the pharmacy, one for
the doctor and one to be sent to the state's Department of Justice. The system
went online in 1998, and that's when its full power was realized. Now, Riegler
and other physicians can log in and see which prescriptions their patients have
filled anywhere in California.
"I
think it's fair to say that we were able to weed out a significant number of
people who were either abusing or diverting their medications or hording them
where we simply had no idea," he says.
So
alarm bells went off among doctors and law enforcement when California Gov.
Jerry Brown announced last year that, for budget reasons, he was eliminating
the Bureau of Narcotic Enforcement, which had long managed the
prescription-drug monitoring program. Dr. Scott Fishman, chief of pain medicine
at the University of California, Davis, is among those 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, not abandoning
them," Fishman said.
Nonetheless,
in January, the state laid off or transferred the nine people who operated the
prescription database. Now there's a lone civil servant — Mike Small, program
manager for the Law Enforcement Support Program — at the Department of Justice
keeping it from going dark.
Can one
person really keep a massive system — with 200 million entries — going? Small
insists his one-man operation and the measures he has put in place are working
for now.
"It's
not going to become unusable," he says. "The system, 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; several physicians
confirmed that the database is up to date. But the program now relies solely on
year-to-year grants from the state's medical and pharmacy boards. Small agrees
that without a permanent source of funding, the future of California's
prescription-drug monitoring program is unclear.
"Grant
funding is an iffy thing," he says. "It doesn't promise a rock solid
future and continuity, and that might perhaps be what some clients might be
fearful of — is 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 federal Drug Enforcement
Administration.
Mary
McElderry, who oversees the federal government's prescription drug operations
for the Los Angeles Field Division, says agents around the country rely on
state-run monitoring programs to catch criminals who peddle OxyContin, Vicodin
and Xanax, among other drugs.
"We
have 48 states that have laws that are governing prescription drug
monitoring," she says. "We have 37 states that have systems in place.
"California,
unfortunately, probably is the only one right now that's in danger of losing
their drug-monitoring system, which would be devastating to us."
It
could also be devastating for U.S. attorneys who rely on the database for
evidence in criminal prosecutions. McElderry recounts the case of an Orange
County, Calif., 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,
drug policymakers say what is ultimately needed is a national database. That
would prevent sophisticated criminal networks that pay patients to get
prescriptions and hand them over from simply moving across state lines to evade
detection.
At
Riegler's L.A. County clinic, the veteran pain specialist is getting ready to
confront one of his patients who hasn't evaded detection. Riegler holds a
computer printout, clear evidence that the patient he's seeing filled multiple
Vicodin prescriptions written by another doctor.
Maybe
there's an explanation, Riegler says. Then he sighs, and goes looking for an
answer from his patient.
SARAH
VARNEY
npr.org
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