Survey shows most MDs still not using RX drug-tracking system

SPECIAL REPORT /// Opioid epidemic


 

 

Using the Controlled Substance Utilization, Review and Evaluation System is routine for Carlo Reyes, an emergency room physician at Los Robles Hospital and Medical Center in Thousand Oaks.

“Because the opiate overdose epidemic is becoming more and more recognized, I’m seeing more emergency physicians taking the initiative to open up the CURES database and make sure the patients they’re treating are not overutilizing (prescription drugs) or inappropriately requesting pain prescriptions,” the doctor said.

Reyes may be the exception rather than the rule as database usage is not mandatory.

Whether it’s too time-consuming or they’re simply not interested, some doctors aren’t using CURES, said Detective Sgt. Victor Fazio of the Ventura County Sheriff’s Office, leaving doctors vulnerable to drug addicts and dealers who know how to game the system.

In February, Calabasas resident Jennifer Williams, 49, was arrested on suspicion of doctor shopping after a Ventura County physician looked her up on CURES and tipped off law enforcement.

Williams had visited 80 doctors in a year’s time—25 of them in Ventura County—obtaining about 4,700 pain pills in less than a year, police said.

While CURES alone can’t end the opioid epidemic, Fazio said, he hates to think even one life was lost because a physician declined to check the system.

“The main reason we push . . . for doctors to use CURES is because we know that doctors who look at the database actually write less opiate prescriptions and prescriptions for controlled substances, and that directly translates to less people becoming dependent and eventually addicted to the medication, which also leads to less people then transitioning to heroin,” he said.

CURES 2.0

The state’s prescription-tracking system actually dates back to 1939. What started as a paperbased system launched into a new all-digital program in 2013 and is now referred to as CURES 2.0. It allows doctors and pharmacies to log all of their prescriptions and, in a matter of minutes, see a record of prescriptions for any person they’re treating.

Detective Matthew Winter of the VCSO pharmaceutical crimes unit said doctor-shopping cases don’t always stem from a personal addiction problem. Sometimes street dealers go from physician to physician hoping to increase their supply and turn a larger profit.

“They look at this as a way to make money,” Winter said. “Other people are (doctor shopping) because of their addictions . . . . They realize they’re doing something wrong, but they don’t really have any choice because the addictions have that strong of a pull.”

In some cases, Fazio said, doctor-shopping detection by a physician can compel an addict to seek help even if law enforcement doesn’t get involved.

“We know that many physicians have discovered that existing patients have engaged in doctor-shopping type behavior, and the CURES system has actually given them the opportunity to address addiction or issues with their patients and then get their patients help,” Fazio said.

Doctors using CURES

According to the results of a November 2017 survey of more than 1,900 California physicians and pharmacists, 28 percent said they use CURES for at least half of their patients who are prescribed opiates; 47 percent said they could use additional training to better understand how to use CURES.

“One of the barriers to the CURES database is its clunkiness, and the fact that emergency physicians have a very rapid workflow, so anything that slows us down is really not desirable in terms of our ability to be efficient and make sure that we’re seeing our patients as quickly as possible,” Reyes said.

Other respondents said the CURES program should be better advertised to doctors and pharmacists to get the word out more widely.

The California Department of Justice has publications and training videos on their websites to help doctors and pharmacists to use the program more efficiently, but doctors said that’s not enough.

Reyes, who is also a malpractice attorney, said he has not seen doctors use CURES to the best of their ability, especially when it comes to new patients.

“It happens very frequently that patients will come and they know that we have never seen them before, so we’re—I don’t want to use the word susceptible— but there’s an increased risk that we may not look up the CURES database,” he said.

While about 70 percent of doctors in Ventura County are registered for CURES, up from 15 percent in 2013, just having physicians registered isn’t enough, said Dan Hicks, manager of the Ventura County Behavioral Health alcohol and drug programs.

“Registration is different than utilization,” Hicks said.

Arresting MDs

While there is no punishment for a doctor who fails to use CURES, they can face jail time should the police find evidence that they’ve overprescribed controlled substances, especially if one of their patients overdoses on the drugs.

Last September, William Matzner, a Simi Valley internal medicine doctor, was sentenced to 270 days in jail and five years’ formal probation after he admitted to using his office as a drug supply site for users and dealers.

Fazio previously headed up the Ventura County interagency pharmaceutical crimes unit and now supervises the county’s major narcotics violator team. He said there are no open investigations into Ventura County physicians at this time.

“We feel that most doctors in V.C. are operating within the guidelines of where they’re supposed to be,” Fazio said. “Then that begs the question of where are the pills coming from. Not only are they coming initially from a doctor writing it, but we have a lot of medication that comes from overseas and from Mexico that could be counterfeit.”

Fazio said his new team, which focuses more on meth and heroin than prescription pills, puts most of their effort into finding the source of the drug that’s led to an overdose death. In some cases, the sheriff’s office has been able to use CURES to achieve this.

“We all try to track any deaths back to the source of supply and hold the dealer accountable for the death of another human being,” the detective said. “So we’ll track that back, and sometimes, unfortunately, it’s been where physicians have been the person who overprescribed, and that has led to a person’s death, so we’ve used CURES to help us track that back as well.”

Winter said that over the last year, his first with the pharmaceutical crimes unit, he’s seen three investigations into doctors. None has led to an arrest.

Since the unit’s inception in 2013, he said, there has been a significant drop in the number of doctors being reported for suspicious prescribing activity.

“When (the unit) first started operating, there was quite a few known target doctors that they were looking at, and arrests were made,” Winter said.

“As soon as the word got out that these doctors were actually getting in trouble for what they were doing, a lot of the other doctors that might have been on the radar, per se, for our unit, got their act together and cleaned up their act.”

Hicks said the number of doctors overprescribing opiates continues to decrease due to education regarding the medications’ ineffectiveness as a solution for short-term or long-term pain management.

“I think the change is relatively slow but growing because it’s really about changing the culture of prescribing,” he said.