Jun 3, 2008
By: Jeanine Benca
Valley Times
By next year, California health workers may be able to check any patient's prescription drug history with the click of a mouse.
There has been a four-year effort to create an online databank to crack down on doctor-shopping by narcotics abusers, and today, state Attorney General Jerry Brown is expected to announce his support at a news conference.
"The old horse-and-buggy system required faxing from the pharmacy to the state. What we've got here is a way to curb these illegal drugs," Brown said by phone Tuesday.
Although some raise concerns about patient privacy, supporters say they are eager for an online tracking system to give prescribers, pharmacists and some law enforcement instant access to medical records. If the online system begins, it would be the largest in the country. Other states with Web-based drug-monitoring include Kentucky, Maine, Ohio, North Carolina, Tennessee, West Virginia, Illinois and Virginia.
It will cost about $3 million to develop and operate the program for three years, according to a 2007 feasibility study paid for in part by Kaiser Permanente. Funds have not yet been identified, but supporters are hopeful health care providers and insurers will foot the bill.
Nationally, prescription drug fraud costs insurers as much as $72 billion a year, according to a 2007 study by the Coalition Against Insurance Fraud.
"Our pharmacy leadership has been very involved in helping to develop the database.
We expect to continue partnering" to get the database up and running, Kaiser spokeswoman Kathleen McKenna said Tuesday.
The feasibility study calls for "the highest available state-of-the-art security technology" for the system. Once users' identity is verified by the Department of Justice, they would be issued a unique, encrypted password allowing access to patients' records. For added security, all passwords would expire periodically, the study says.
California was one of the first states to start monitoring controlled drugs in 1940. Narcotics prescribers, who are required to mail or fax weekly patient reports to the state Department of Justice, can also request patient records. But the process sometimes takes weeks.
An automated system would cut down on doctor shopping, raise prescriber accountability and help save lives, supporters say. They point to high-profile accidental overdoses, such as those of former Playboy Playmate Anna Nicole Smith and actor Heath Ledger.
"You've got a very broken system," said Bob Pack, a Danville computer entrepreneur who has pushed for online drug monitoring. He and his wife, Carmen, co-funded the $40,000 feasibility study with Kaiser and the Department of Justice last year. The couple vowed to help pay for the system.
In 2003, the Packs' children, Troy, 10, and Alana, 8, were killed by a driver who abused prescription drugs. Weeks before Jimena Barreto's car jumped a curb and hit the children, she had received Vicodin from multiple doctors who said they didn't know others had also prescribed it.
"I said, 'Hey, don't doctors share a file or something?' And that's when I found out they don't," Pack said.
But others say withholding narcotics from those who need them can also be deadly.
Siobhan Reynoldsof New Mexico said her husband died in 2006 of a cerebral hemorrhage resulting from years of "out-of-control pain," after doctors refused to prescribe large doses of opiates for his tissue disorder.
"It's inevitable that a cop is going to make a judgment about medicine, and that's what's got to stop," said Reynolds, founder of the Pain Relief Network.
Kathy Ellis of the Department of Justice said details about law enforcement access to California's system have yet to be worked out. Access likely will be granted on a case-by-case basis to prevent "fishing" in the system, she said. "They'd have to identify what their need is. I don't see a patrol officer having a direct need for that information."
It is important that enforcers not rely on numbers when looking at suspected abuse cases, said Sherry Green, executive director of the National Alliance for Model State Drug Laws.
"Even if something looks outside the traditional range, that doesn't in and of itself mean that something's wrong," said Green. "Prescription monitoring officials can't make those kinds of health determinations — all they can do is make a recommendation that something needs to be scrutinized more."
In Maine, civil libertarians fought the development of drug-monitoring. An online system, launched in 2006 in response to the state's OxyContin epidemic, has "an arm's-reach relationship with law enforcement," said program director Daniel Eccher. Investigators can't access records without a subpoena.
"I know there are concerns, but the benefits very much outweigh the risks here," said Sadiqa Reynolds, inspector general in Kentucky's Cabinet for Health and Family Services. In 2005, the state was the first to launch an online program.
Kentucky's system, accessible to law enforcement only during investigations, received 362,000 requests in 2007. Misuse is a felony, but officials say only one security breach has led to prosecution.
Fifteen states had drug-tracking programs before 2002, now 29 now have some form of drug-tracking. Five more are expected to launch programs by 2009.
Online systems are the wave of the future for doctors hoping to cut addiction off at the pass, said Green. "When you look at it from an early intervention perspective, you want a real-time system," she said.
