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When It Comes to Drugs, Legal Doesn't Mean Safe

Action against prescription abuses is urgently needed

August 25, 1996

Last year, the U.S. government spent $14 billion on a loudly proclaimed drug war that involved heightened surveillance of border stretches and urban dealers. Its effectiveness is far from clear, for a new federal survey shows teenage drug use soaring and adult consumption steady. Meanwhile, a far more treatable epidemic of drug abuse continues, virtually unrecognized. This scourge has caused up to half of all drug-related emergency room admissions in recent years. The substances involved could, in theory, be tracked down to the last milligram. They are legal prescription drugs.

In 1993 legal prescription drugs generated black market sales of $25 billion (the figure for cocaine and crack was $31 billion). But Washington has earmarked less than half of 1% of the money spent in the hard-drugs war to fight this second epidemic.

Most of us have been brought up to equate the word "legal" with "safe." As a Times series showed last week, however, the fraudulent, abusive and misinformed use of prescription drugs in America is anything but safe.

Prescription drug abuse is now getting some attention because of the ongoing state Department of Justice investigation into how several Los Angeles physicians allegedly helped Hollywood film producer Don Simpson acquire thousands of addictive pills, a handful of which caused his death in January.

Since the early 1990s, however, activists have struggled to prod state and federal agencies to tackle this growing problem, one exacerbated by people piling up prescriptions by visiting multiple doctors. It is high time to embrace the best of the proposed solutions:

* Revise enforcement and sentencing guidelines. State and federal laws make it next to impossible for drug agents to obtain felony convictions for prescription fraud. In one case cited in the Times series, federal officers arrested a drug runner carrying at least $600,000 worth of Dilaudid, a heroin-like drug. Rather than prosecuting him, the agents could only use him as an informant in a small-potatoes cocaine case. He eventually went free.

* Mandate triplicate prescription forms for the most addictive and abused drugs.Triplicate-form rules require doctors in 10 states, including California, to send a copy of their prescriptions for some addictive drugs to a state oversight agency. Triplicates have shown solid results in states like New York. Some doctors oppose the system on the grounds that it prompts them to treat patients overcautiously to avoid being second-guessed by the oversight panels. But a study of states now using triplicates shows that warnings are meted out far more often than punishment.

* Computerize triplicates in California. Four years ago, an independent commission concluded that the state's paper-based triplicate system was so antiquated and inefficient that the state could review only 10% to 15% of the 1.5 million triplicate forms it received yearly. "If they catch anything," said Sandra Bauer, a recently retired member of the Pharmaceutical Board of California, "it's by accident." By requiring doctors and pharmacists to enter triplicate prescriptions directly into a state computer database, patients' use and abuse of drugs could be tracked far more efficiently. There is a bill in the Assembly, AB 3042, that would computerize the triplicates. It deserves to be passed.

* Create new connections between medical databases. Prescription drug abusers are able to fool the system largely because few pharmaceutical databases in California are linked.

State-of-the-art computer technology such as the Medicaid Evaluation and Decision Support System and the HInet Healthcare Information System are helping to curb abuse. The former was introduced in Wisconsin and the latter in Boise, Idaho. Meanwhile, in California, the home of Silicon Valley, where the technology behind both these systems was developed, health workers continue to spend costly hours rifling through the microfiches and leather-bound medical files of yesteryear.

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