Byung Sik Yuh, the owner of Nichols Hill pharmacy in Oakland, filled more than 5,000 online prescriptions for addictive painkillers before the California State Board of Pharmacy moved last year to revoke his license. The patients who picked up the prescriptions at Mr. Yuh's pharmacy had never met their doctors, nor had physical examinations. They filled out a brief online survey and paid an anonymous doctor to write prescriptions over the Internet.
Today, a contrite Mr. Yuh, who agreed to pay $150,000 in fines to avoid having his license revoked, says he supports the state's prescription drug monitoring program, a real-time online database that displays a patient's prescription drug history. As attorney general, Gov. Jerry Brown promoted the online database in 2009 as a new solution to the prescription drug abuse epidemic.
Using the system, Mr. Yuh could have instantly looked up the prescription histories of his customers and refused to provide medication to a patient whose drug shopping habits seemed suspicious or out of control. More than 40 states are using similar systems to help curb prescription drug abuse.
But in California, the system has not put a dent in prescription drug abuse because enrollment in the drug-monitoring database program is optional, and neither Mr. Yuh nor thousands of other pharmacists and doctors in the Bay Area and the state, are enrolled. Of more than 30,000 doctors and pharmacists in the Bay Area, only 86 are signed up to use the system, according to records obtained by The Bay Citizen.
And although federal authorities are spending millions of dollars to expand systems across the country, money and staffing for California's program is almost entirely gone, after Governor Brown slashed $71 million from the Department of Justice budget.
After marijuana, prescription painkillers are now considered the most abused drugs among youth in the United States, according to a national annual survey. Overdoses, mostly on prescription drugs, are the No. 1 cause of accidental deaths in the United States, surpassing motor vehicle accidents, and nearly 11 people die every day from prescription drug overdoses in California, according to the United States Centers for Disease Control and Prevention. The C.D.C. reported in January that every year since 2003, more Americans have died from prescription painkiller overdoses than from heroin and cocaine combined.
If California does not fix its system, "it will pay a huge price in terms of people who end up dying whose lives could have been saved, of people overdosing and going into hospitals, or nursing homes, or ultimately on disability," said John Eadie, the executive director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Mass. "The health care costs are massive."
California's system was beset by problems almost from the outset. Unlike in Arizona and Utah, where enrollment is mandatory, California's system has drawn few participants. Statewide, in the first year, only 282 pharmacists and 1,559 prescribers, of more than 165,000, enrolled in the program. Today, the numbers are larger but still dismal: 1,216 pharmacists and 6,755 prescribers are registered.
The program shut down completely in November because of the budget cuts; it is back online now, but so far this year only two new prescribers in the Bay Area have enrolled in the program; no pharmacists have registered.
Doctors who use the system said it is slow and cumbersome and lacks the capability to analyze data systematically.
"It's hit or miss," said Dr. Richard Gracer, who runs a pain management clinic in San Ramon. "Once in a while it's slow. Sometimes it gives the wrong answers. If the amount of doctors who should be using it signed up, it would probably die right away."
Mike Small, a former administrator from the Investigation and Intelligence Bureau at the Department of Justice who inherited the task of running the California system from a former staff of 13, said that in just its third year, the system is already "old and falling apart."
"Doctors don't want to spend 10 minutes waiting when they have a patient in front of them," Mr. Small said.
"It was clunky on arrival," said Dr. Scott Fishman, professor and chief of the Division of Pain Medicine at the University of California, Davis, who said he uses the system regularly. "It's not the high-tech information technology system it could be."
Bob Pack, who formed the Troy and Alana Pack Foundation in Danville after his two children died in a car crash caused by a driver under the influence of prescription drugs, said the California system is reactive, rather than proactive.
"Right now, they go and backtrack and say, 'O.K., this guy prescribed too much to Michael Jackson, let's look at him,' " Mr. Pack said. "They're not making the best use of the system."
Sixteen states use their prescription monitoring programs to proactively send reports to pharmacists and prescribers about patients who appear to be doctor shopping, according to a 2011 survey of state programs. Eight states send such reports to law enforcement agencies, and seven states send reports to licensing agencies.
Some states employ staff or have automated systems that identify patients who appear to fill an excessive number of prescriptions, and the doctors who serve them. Then they reach out to licensing boards, law enforcement agencies, or the doctors themselves. In California, the same type of data collects in the system until a complaint or tip prompts state investigators to find it.
In 2010, Senator Mark DeSaulnier, Democrat of Concord, proposed that manufacturers of certain types of prescription drugs pay an estimated 1 percent of their profits, or a total of about $5 million a year, for improvements and operating costs of the monitoring program, including data analysis software. The bill failed to make it out of committee.
Mr. Brown said in 2009 that the system would cost about $3.5 million for three years. Mr. Small, who now runs the system, estimated that an overhaul would cost about $1.2 million, including $800,000 in annual personnel costs and about $400,000 for maintenance.
According to Mr. Eadie of Brandeis, more than 20 states have instituted a fee to pay for monitoring systems, paid by hospitals, health care facilities, drug distributors and manufacturers, and others involved in the use of controlled substances.
But Mr. Pack, who is trying to gather signatures for a ballot initiative in support of Mr. DeSaulnier's proposed fee, said it will be a challenge. "The ship is sinking and the captains don't want to do anything about it," he said.
Even Mr. Yuh, the Oakland pharmacist who filled thousands of online prescriptions, said he believes the system is a good idea. In 2006, he received a call from a "smooth talker" with a proposition: $5 for every online prescription the company sent to be filled. The prescriptions soon began pouring in from doctors and patients all over the country.
In 2010, after learning his license could be revoked, Mr. Yuh wrote an open letter to his fellow pharmacists across the state. "I am ashamed to have to write this letter and admit my stupidity, actually my extreme short-sightedness caused by greed and induced by promises of quick easy money," he wrote.
Mr. Yuh told The Bay Citizen that he still regrets his decision to fill online prescriptions, but that he will not sign up for the state's online prescription system until it is mandatory. "In the pharmacy world, every minute there is constant work," he said. "If an order comes, we have to move it out as fast as we can. There's no time to think about it."
