At a news conference this week in Los Angeles, California Attorney General Edmund G. Brown Jr. unveiled a Web-based prescription-drug database that tracks all controlled substances (Schedule II, III and IV) prescribed in the state and gives doctors and law enforcement a powerful tool to combat prescription-drug abuse. Brown was joined at the event by Scott Fishman, professor of anesthesiology and pain medicine and chief of the UC Davis Division of Pain Medicine, who led a UC Davis study that demonstrated the benefits of the new database.
“There is a clear need for averting prescription drug abuse and for doctors to know where their patients are getting medications,” said Fishman. “The unique environment at UC Davis includes collaboration with computer programmers and database experts in our Clinical and Translational Science Center, which enabled us to create an application that could sift through over 50 million prescription records and identify potential problems with abuse.”
Fishman is a national leader in the treatment of chronic pain and the development of models to help physicians identify patients who are at risk of becoming addicted to pain medications. He is among the UC Davis medical experts who are working with California Department of Justice officials to investigate the impact of prescription drug monitoring.
For the past three years, Fishman and Barth Wilsey, a UC Davis clinical professor of anesthesiology, have been working on the largest study of a prescription monitoring program ever undertaken. Funded with a grant from the Robert Wood Johnson Foundation, the study identified substantial multiple-provider episodes that clearly support the need for the state’s new database, which allows doctors and pharmacists to quickly access previous prescriptions for controlled substances when new prescriptions are written.
The password-protected online system will help prevent so-called “doctor shopping” among drug abusers by allowing providers to verify appropriate prescribing of medications. Doctor shopping occurs when a patient visits multiple physicians and multiple pharmacies and, unbeknownst to each prescriber, the individual obtains the same or repetitive amounts of controlled substances within a short period of time.
The state's database, known as the Controlled Substance Utilization Review and Evaluation System (CURES), contains more than 50 million entries for controlled substances that have been dispensed in California. Working with database programmers from the UC Davis Clinical and Translational Science Center (CTSC), Fishman and Wilsey were able to develop a de-identified secondary database that enabled researchers to measure the prevalence of “multiple-provider episodes,” in which a patient obtained prescription orders from several different physicians.
To develop the database, CTSC programmers created a complex algorithm that enabled researchers to link patient prescriptions in CURES. They found that the magnitude of patients with multiple-provider episodes – visits to different doctors and pharmacies for the same controlled substances – was significant and potentially represented serious medical and law enforcement problems. The new point-of-care access to CURES’ prescription drug reports and data from the UC Davis study bridges an important gap between the needs of medicine and law enforcement.
“My hope with this new CURES system is that physicians will have the information they need when making critical patient-care decisions so that we can greatly reduce multiple-prescriber episodes and therefore help avoid the potential for drug abuse problems before they start,” said Fishman.
Doctors, pharmacists and investigators have traditionally had access to Department of Justice patient records under the state’s drug monitoring program by fax and mail. But the turnaround times for these requests would typically take days or weeks. The new online system provides information immediately, which is particularly helpful for the emergency department and all other physicians who need to treat patients with pain.