California Legislation Cracks Down on Opioid Doctor Shoppers

As a defensive strong safety on his high school football team, Aaron Rubin was no stranger to injury treatment. He’d apply ice, take ibuprofen and – unbeknownst to his parents – self-medicate with prescription drugs.

Over time, as treatment turned to addiction, Rubin graduated from painkillers like Vicodin and Percocet to the highly addictive opioid OxyContin. In pursuit of pills, he would doctor shop, getting prescriptions from multiple physicians, his mother said.

A bill by Democratic Sen. Ricardo Lara of Bell Gardens attempts to address the opioid crisis by cracking down on this practice. It would mandate providers consult an existing database of patient prescription histories before recommending addictive drugs. More than 20 states have similar laws.

Advocates for prescription drug legislation have unsuccessfully pushed for California to require such database checks in the past. But they’re hoping recent national attention to the issue will persuade legislators to support reforms. The crisis is so undeniable that people no longer can “stick their head in the sand,” said Carmen Balber, executive director of Consumer Watchdog.

Between 1999 and 2014, more than 165,000 people died nationwide from prescription opioid overdoses, according to the U.S. Centers for Disease Control and Prevention. High-profile deaths – like that of musician Prince, who accidentally overdosed on the painkiller fentanyl in April – have increased the spotlight on the issue.

“These drugs ultimately are a weapon if not used properly, stored safely and taken properly,” said Rubin’s mother, Sherrie Rubin, of Escondido, who founded the Hope2gether Foundation for prescription drug education and awareness.

Despite stints in rehab, her son overdosed in 2005 at age 23 after combining painkillers with a muscle relaxant. He is quadriplegic and unable to speak.

The state maintained records of narcotic prescription histories for years in an early, paper version. The database, known as CURES, moved online in 2009 and was upgraded this year.

CURES offers patient histories at a glance, but doctors vastly underutilize it, advocates say.

Lara’s bill would require doctors to check the database when initially prescribing drugs like OxyContin, Vicodin, Percocet and a host of other narcotic painkillers, as well as steroids, sleep aides and psychiatric medications. They would then have to check it every four months for as long as the drug regimen is continued.

Advocates say the law would help prescribers identify at-risk patients and reduce the overall number of opioids in the market. Plus, with patient histories in hand, they could prevent dangerous drug combinations, Balber said.

CURES data from 2010 to 2013, made public by the California Health Care Foundation, suggests more than one in 1,000 residents were doctor shoppers who had obtained pills from at least six prescribers or pharmacies.

The measure, SB482, passed the Senate and is waiting to be heard by an Assembly committee.

Its main opponent is the California Medical Association, a lobbying group for doctors, which finds flaw with the idea of legislating medicine, said Janus Norman, vice president of government relations and political operations.

The organization is concerned about patient privacy, Norman said, and the database’s ability to handle the full number of California prescribers and pharmacists, which he estimates is around 200,000.

Providers can include physicians, nurse practitioners, physician assistants and other licensed professionals who have a controlled substance registration certificate from the Drug Enforcement Administration. There were about 122,500 approved CURES users as of mid-June, said Rachele Huennekens, a spokeswoman for the attorney general’s office.

Without mandatory checking, the database is ineffective, said Bob Pack, an advocate whose children were killed in 2003 by a driver who ran off the road while abusing prescription narcotics.

“It just kills me to see all of those children who have died after we created the CURES database, knowing that if it were used, some of those children would be alive today,” he said.

Proponents recognize the bill won’t halt the spread of illegal drugs but say it’s part of the solution.

In New York, doctor shopping fell by 75 percent the year after the state enacted a law that mandated checks by pharmacists and providers, according to a March CDC report.

Any reduction would help curb the crisis, Sherrie Rubin said. When she asked her son in 2008 whether he wanted to share his story to help others, she said, he lifted his finger to communicate yes faster than she’d ever seen.

“We’re not doing this for our family. It’s too late for us,” she said. “We’re doing it for other families who don’t even know that this could potentially save them from living with the challenges we do every day.”