California has unveiled a Web-based tool to track use of dangerous drugs so that any doctor, pharmacist, midwife or registered nurse can instantly determine whether writing or filling another prescription for a patient would perpetuate addictive abuse.
The database, called CURES (Controlled Substance Utilization Review and Evaluation System), was announced this week by Attorney General Jerry Brown, in an effort to stop trafficking and abuse of Schedule II, III, and IV drugs, which include addictive painkillers or anxiety medicines such as Oxycontin, Valium or Vicodin. Some 100 million prescription entries are already logged in.
"With 7,500 pharmacies and 158,000 prescribers reporting prescription information annually, CURES is the largest online prescription-drug monitoring database in the United States," Brown said in a statement.
Brown wants to reduce the number of disabling and potentially lethal overdoses that send people to the hospital emergency room and unnecessarily add to health care costs. A 2005 study by the Drug Abuse Warning Network estimated that non-medical use of pharmaceuticals accounted for more than 500,000 emergency room visits in California, "an enormous drain on the state's healthcare system," the statement said.
He said the recent deaths of Anna Nicole Smith and Michael Jackson "have made it clear to the whole world just how dangerous prescription drug abuse can be."
"CURES has been available for some time," explains Brown spokeswoman Christine Gasparac. "But it used to be that if you are a doctor, and a new patient is coming in and you wanted to verify the drug history, you'd fax the request to our office, we would first verify that you were a doctor, and then we would send that patient activity report back to you in the mail. It could take a week."
Now care providers in those four specialties can register for access to the site, and view the entire history of Schedule II, III or IV drug usage for any patient within minutes.
"Under the new system, a pain-management physician examining a new patient complaining of chronic back pain would be able to instantly look up the patient's controlled-substance history to determine whether the patient legitimately needs medication or is a 'doctor shopper,'" who visits dozens of doctors to obtain multiple prescriptions," Brown's statement said.
Certain law enforcement officials and medical profession regulatory boards will be able to access the site as well.
The database does not have photographs of each person who filled a Schedule II, III or IV prescription, but it soon well.
With so many providers and others able to view potentially confidential information, there is concern about patient privacy violations. But Gasparac says that providers who register to use the site may do so only for patients under their care, and there are criminal penalties for abusing the database to violate a person's medical privacy.
Using it to snoop into records of people who are not that provider's patients could result in the loss of one's professional medical license, she says. She added that celebrities and public figures will have extra security attached to their drug records.
Gasparac adds that anyone who accesses the database will have to register, and the amount of time spent on the site, and which records were reviewed, are all recorded.
Another concern about such a system is that some providers may not want to use it because of the time it takes away from their clinical setting to log on and look up the patient's history. The practitioner may also not wish to turn down a potentially disruptive or violent patient.
But now that the system is available and relatively easy to access, practitioners who fail to use it may be legally liable if the patient or someone else—say an occupant of a vehicle who is struck by the patient—is harmed as a result of the use of that prescription drug.
Brown believes that the database's ability to prevent many of the deaths and accidental overdoses and other harmful or violent events caused by the abuse of such schedule drugs makes the system worth the risk.
Already the system has had success stories. Last year, Brown and the CURES team targeted 50 doctor shoppers who averaged more than 100 doctor and pharmacy visits to collect "massive quantities of addictive drugs like Valium, Vicodin, and Oxycontin."
The effort led to the arrest of dozens of suspects, including Frankie Greer, 53, who allegedly visited 183 doctors and 47 pharmacies to feed a prescription-drug habit. Greer was reportedly able to persuade emergency room doctors to prescribe her "more than 4,830 hydrocodone tablets, 2,210 oxycodone tablets, and 156 Oxycontin pills, along with a variety of additional addictive painkillers."
California is not the only state to have such a database, but it is the largest. Other states with online programs include Idaho, Illinois, Kentucky, Utah, Alabama, Arizona, Louisiana, North Carolina, North Dakota, South Carolina, Vermont, Colorado, Maine, Wyoming, Connecticut, Indiana, Iowa, Mississippi, Nevada, New Mexico, Ohio, Oklahoma, Tennessee, Virginia, and Michigan.
Gasparac says she does not know whether other providers in other states will have access to the California database, or whether California providers will see the other states' databases.