A system that tracks prescription drugs and has assisted in several celebrity death investigations is in jeopardy of ending, prompting California's top law enforcement official to seek new funding.
The state created the nation's first prescription drug monitoring program in 1939 and shifted to a computerized database in 1997. The online system tracks prescriptions written by doctors and filled by pharmacies.
It also has been used in recent years in the death investigations of Michael Jackson, Anna Nicole Smith and actor Corey Haim, among others.
But the database nearly fell victim to budget cuts 18 months ago, forcing Attorney General Kamala Harris to divert enough money from federal grants and other programs to keep it functioning until July. She now is working with lawmakers, medical providers and law enforcement agencies to collect enough money to retain and improve the system.
Harris estimates it would cost about $3.8 million to upgrade the Controlled Substance Utilization Review and Evaluation System and another $1.6 million to run it each year. Her plans to expand it are prompting the most debate.
She is seeking another $4.3 million annually to create two law enforcement teams, split between Northern and Southern California, that would ensure doctors, pharmacists and other medical providers are reporting their prescriptions for controlled substances, as required by law. The teams would then use the computerized system to look for patterns or anomalies that could suggest abuse.
"I've talked to a number of physicians who were shocked when they started to see the numbers and realized that that one patient that they see has gone to four other different doctors to get the same prescription," Harris said in an interview.
Harris said the database also is needed for investigations like the one that resulted in the federal indictment of 16 Los Angeles-area doctors and pharmacists in October on charges of improperly prescribing more than 900,000 Oxycontin pills. The powerful painkillers were then sold on the street for as much as $27 per pill.
Authorities say the scam defrauded state and federal health care programs of millions of dollars. Moreover, expanded use of the tracking program could reduce California's workers' compensation claim costs by more than $50 million a year, Harris said, citing a recent California Workers' Compensation Institute estimate.
California started a paper-based system 74 years ago to track prescriptions of highly addictive controlled substances. Since 2009, doctors and pharmacists have been able to look up their patients' prescription history online to make sure they're not prescribing a dangerous combination of drugs and to determine if patients are doctor-shopping to feed their addictions.
Prescription drug abuse, particularly among young people, is not only dangerous on its own but often serves as a precursor to other addictions, Harris said. The state Department of Justice calls misuse of prescriptions the nation's fastest-growing drug problem, with deaths now exceeding fatalities from vehicle accidents.
So-called "pill mills" also can feed other criminal activities, she said, as in 2011 when agents from the justice department's Bureau of Narcotic Enforcement disrupted a cross-border drug smuggling operation. Investigators said gang members would buy wholesale quantities of controlled prescription drugs in Southern California, smuggle them into Tijuana, then sneak hundreds of thousands of dollars back into the United States to pay for more criminal activities.
An expanded tracking system could allow investigators to spot unusual spikes in sales from particular pharmacies or to specific individuals.
"They have figured out that unlike trafficking of guns or illegal drugs ... trafficking of prescription drugs is high-profit, low-risk," Harris said.
Harris is proposing to increase fees for providers and drug manufacturers to pay the program's ongoing costs. Providers would pay a 1.2 percent premium on their annual licensing fees, ranging from $2 for pharmacists and registered nurse practitioners to $9 for physicians and $10 for podiatrists.
Provider groups generally support funding and upgrading the state tracking system, although the California Medical Association prefers the money come from general taxes.
Medical association spokeswoman Molly Weedn and California Pharmacists Association chief executive Jon Roth also are concerned by proposals seeking to divert the program from its original purpose, which was trying to prevent patients from doctor-shopping to obtain prescription drugs.
Policing of providers should be done by the state's licensing boards, not the state Department of Justice, Roth said.
"We would have two separate enforcement agencies working in parallel" under Harris' proposal, he said.
Harris has general support from Senate President Pro Tem Darrell Steinberg, D-Sacramento, even before the funding bill is formally introduced by Sen. Mark DeSaulnier, D-Concord, in coming weeks.
Assemblyman Bob Blumenfield, D-Sherman Oaks, chairman of the Assembly Budget Committee, favors upgrading the tracking program, but with caution. It might be difficult to find the money, he said, and lawmakers want to make sure the upgraded computer system will not turn into "a technological boondoggle."
He cited a 2011 study by the nonpartisan Legislative Analyst's Office that found just 3 percent of California's 185,000 prescription providers were using the tracking system to make sure their patients were not filling multiple prescriptions.
"It could save lives and it could save money," Blumenfield said. However, "we don't want to initiate a system that's going to become some sort of a witch hunt against doctors or pharmacists or providers. Some sort of system that spits out the raw data is dangerous, but having some analysis can be helpful."
That's the goal in assigning a dozen special agents to track down leads generated by the computerized system,Harris said.
"This is not a 'gotcha' program," she said. But with an upgraded system backed by special agents, "not only would it flag things, but we could do something about it."