Earlier this year, California Governor, Jerry Brown, eliminated the Bureau of Narcotic Enforcement, the agency responsible for managing California’s Prescription Drug Monitoring Program (PDMP), effectively slashing $71 million from the program’s budget.
Which leaves the massive system of over 200 million entries in the care of one man–Mike Small.
Mr. Small, program manager for the Law Enforcement Support Program at the Department of Justice, says the measures he has put in place is keeping the system alive and running.
But without a permanent source of funding, the future of California’s prescription drug monitoring program is hazy. As one person said, “The ship is sinking and the captains don’t want to do anything about it.”
Here are the top five reasons I believe the California prescription drug monitoring program is a still valuable tool and is worth saving:
1. The PDMP system is a valuable tool.
The PDMP is a system that allows health care providers (pre-registered, licensed and eligible) to access the history of the patient’s medication information, specifically medications that are controlled substances.
The state’s database, known as Controlled Substance Utilization Review and Evaluation System (C.U.R.E.S) has over 200 million entries. Such a database is of invaluable aid for health care professionals to spot possible patterns of substance abuse–doctor shopping, for example.
Besides the healthcare community, the PDMP is used by other sectors of society, including
- Law enforcement
- Regulatory boards
- Educational researchers
2. Now is not the time for abandonment.
With the rise of prescription drug abuse, now is not the time to give up on the system that could be our best chance of controlling it.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) reported a 430% increase of treatment admissions for abuse of prescription pain relievers from 1999 to 2009.
- In 2010, 2 million people reported using prescription painkillers non-medically for the first time.
- Overdose on prescription drugs are now the number 1 cause of accidental deaths in the US, surpassing motor vehicle accidents as well as overdose deaths from heroin and cocaine combined.
- According to the Center for Disease Control and Prevention, nearly 11 people die every day from prescription drug overdoses in the state.
- According to the Drug Enforcement Administration, California pharmacies dispensed 69 tons of oxycodone and 42 tons of hydrocodone in 2011.
3. Enrollment can be improved.
Perhaps the biggest flaw of the system is that enrollment is optional, not mandatory. This severely reduces the number of users, which in turn undermines the whole purpose of the system.
According to the data, slightly over 1,000 pharmacists use it. Of the 165,000 prescribers, only 6,755 are registered. In the Bay Area, just 86 of the 30,000 doctors and pharmacists are participating.
However, the accuracy of the numbers may be questioned. Dr. Andrew Fenton, the President-Elect of California Chapter of the American College of Emergency Physicians, wrote in response to a recent article on the issue: “I know many of my emergency physician colleagues statewide are actively enrolled in the system and we encourage all physicians to do the same. I question the reliability of the data suggesting few health care providers use the system.”
Then, of course, there is the obvious solution: just make it mandatory.
4. It has the Potential to Make a Difference.
The program is not working as it should be, there's no doubt about that.
Doctors who used the system call it “slow and cumbersome,” “not the high-tech information technology system it could be” and “lacking the capability to analyze data systematically.”
But when it operates as it should, the PDMP can be a powerful tool. According to the National Drug Control Policy, studies show that PDMPs are effective when fully utilized.
Take Wyoming’s program for example. From 2008 to 2009, the state reported a decrease in the number of patients reaching or exceeding the maximum number of allowed prescriptions. Conversely, there was an increase in prescriptions requested by the prescriber.
This suggests that fewer patients met the criteria for doctor shopping and that prescribers are using the PDMP for its intended purpose.
Even in Northern California, the system might just be worth saving. Dr. Andrew Fenton, the President-Elect of California Chapter of the American College of emergency Physicians, wrote, “While some might find initial challenges with enrollment, and in navigating through the CURES database program, the reporting information physicians obtain is invaluable.”
5. Worth the Costs
Repairs are at an estimated $1.2 million. But the biggest cost is the cost of addiction. Each year, people spend thousands of dollars to satisfy their cravings, and thousands more for rehab.
John Eadie, the executive director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Massachusetts said,
“If California does not fix its system, it will pay a huge price in terms of people who end up dying whose lives could have been saved, of people overdosing and going into hospitals, or nursing homes, or ultimately on disability. The health care costs are massive.”
The ship may be sinking, but it’s not too late to save it.