California Physicians Must Consult Tracking System Before Prescribing Opioids
Back in 2003, in California, Carmen Pack set off with her two children, seven-year-old Alana, and ten-year-old Troy, to get ice cream. Alana was riding her bike in her Halloween costume and Troy was on his scooter. On their way, Jimena Barreto’s Mercedes was travelling at 50mph when it plowed into the family. Doctors had been prescribing her a cocktail of opioids.
Alana was killed instantly. Troy was left fighting for his life. Carmen was also injured but grabbed Barreto’s keys, so she couldn’t drive off. Barreto was a 46-year-old nanny. She fled the scene on foot and was found a few days later – not before Troy also passed.
Barreto told the police she’d taken opioid painkiller pills and muscle relaxants and blacked out at the wheel. Prosecutors suspected she was drinking, too, although she denied it. Carmen and her husband, Bob, would later discover Barreto had multiple prescriptions for hundreds of opioid pills from six doctors who all worked in the same Kaiser Permanente hospital.
“She would just go to a doctor saying: my back hurts, my arm hurts, or my neck. All these fake things,” said Bob Pack. “She asked for the medication and they just gave it to her. I was incensed. How can these doctors be so irresponsible?”
Bob worked in technology as a former executive at America Online at the time and he knew it couldn’t be that hard to set up a database to keep track of opioid dispensing and prevent “doctor shopping.” He set out to change the reporting system. What he didn’t realize was how powerful financial, medical, and political interests that would delay implementation of such a system for fifteen years.
With a little bit of digging, Bob found there was already a system in place going back to 1939 which required California pharmacists to report the narcotics they dispense to the state’s justice department. In 1997, it was turned into a database – the Controlled Substance Utilization Review and Evaluation System (Cures). The system has tedious and time-consuming and had been left outdated for some time. Now, finally, Bob can see the results of his efforts. Beginning this month, California physicians must consult Cure to check their patients’ prescribing records before giving them opioids and other controlled medicines.
“I thought this would all be done quickly, like in two years, when I set out. I was just a guy that said: ‘This makes so much common sense, and this could have prevented the deaths of my children and others.’ I just kind of figured everybody would be for it. But then I learned the reality of life,” Pack said.
Carmen Balber, director of Consumer Watchdog, which backed Pack’s initiative, said, “Bob fought for many years to pass legislation requiring the use of this simple tool to identify dangerous prescribing to no avail because of the continued and strident opposition of the California Medical Association, the hospitals and the insurance industry and the political allies they fund in Sacramento.”
Meanwhile, Barreto was convicted of second-degree murder, because she had previous convictions for driving under the influence and was sentenced to thirty years to life in prison.“There were six doctors prescribing to her for a long time. They never talked to each other or shared a medical file. She would go in one week, get 60 Vicodin, and a week or two later go in and get another 60 from a different doctor,” Pack said. “I thought, aren’t they required to share medical files, so they know what they’re doing? Isn’t there some kind of computer system where they can look that up or track it? I couldn’t believe that there wasn’t any of that.”
The California Medical Association’s (CMA) president, Dr. Theodore Mazer, defended its position, stating of the organization’s fight against the opioid epidemic and the mandatory use of Cures, “The California Medical Association has been actively engaged in addressing opioid abuse and overdose while ensuring patient access to appropriate care. While more work is needed, even before the duty to consult Cures, our efforts have helped California lead the nation in reducing opioid prescriptions by over 24%. After working with the state to ensure adequate support for physicians who will have to rely on Cures, CMA is optimistic that the system is ready for statewide use, and we will continue to monitor implementation.”