Here's a public health probability pop quiz:
1. Do more Americans die from drug overdoses involving heroin and cocaine or from overdoses involving prescription drugs?
2. Do more Americans die from automobile accidents or from prescription drug overdoses?
If you answered "prescription drugs" to both questions, you have a fairly good awareness of why the federal Centers for Disease Control calls prescription drug abuse a public health epidemic.
Drug overdose deaths in the United States doubled from 1999 to 2010, and 60 percent of the deaths were caused by pharmaceuticals. In 2011, 1.4 million Americans checked into emergency rooms as the result of nonmedical use of prescription drugs.
It's a big problem -- and one that California was once at the forefront of addressing, but now is at risk of slipping to the back of the pack.
The late Oxnard Assemblyman Nao Takasugi got things started back in 1996 when he authored legislation establishing a pilot project in the Department of Justice called the Controlled Substance Utilization Review and Evaluation System, or CURES, to electronically monitor the prescribing and dispensing of opiate-based pharmaceuticals such as Vicodin and OxyContin.
Eight years later, the program was made permanent.
The following year, a grieving father named Bob Pack parlayed his savvy as a tech executive with his outrage over the circumstances of the tragic deaths of his son and daughter to help the state develop a technologically advanced monitoring system.
Then came the Great Recession and the ensuing state budget actions that included a $171 million cut to the Department of Justice's Division of Law Enforcement, which housed the CURES program.
Attorney General Kamala Harris moved the program to another division and, as she says, put it "on life support." At one point it was being kept alive by five part-time staffers, assisted by four unpaid student assistants.
It became time for Danville resident Bob Pack to re-enter the picture.
On a Sunday afternoon in 2004, Pack had taken his family for a walk to the ice cream store. A car driven by a woman stoned on Vicodin jumped the curb, fatally striking 10-year-old Troy and 7-year-old Alana, and injuring his wife, Carmen, who lost the twins she was carrying.
The driver, it turns out, had been a doctor-shopper who had received enough prescriptions from enough physicians to amass thousands of narcotic pills.
"It started me down a path of providing needed data to doctors and pharmacists," Pack says.
Pack has been working with his local state senator, Democrat Mark DeSaulnier of Concord, in a thus far unsuccessful effort to create an ongoing funding source to upgrade and make permanent California's drug-monitoring program.
DeSaulnier has failed in two previous attempts, partly because a proposed per-pill tax on prescription painkillers was a nonstarter with the pharmaceutical industry. This year, DeSaulnier's SB809 eliminates the tax and proposes to fund CURES with a 1.19 percent increase in the annual license renewal fees paid by medical professionals. For doctors, it would amount to $9 per year.
"The genesis for my interest in this is Bob Pack," DeSaulnier told me this week. "My struggle is to get it funded."
SB809 has passed the Senate and made it through one Assembly committee. It will face another committee test on Aug. 13.
In the meantime, Pack has upped the issue's profile. Last week, he filed a proposed ballot initiative that would increase a $250,000 cap on noneconomic damages in medical malpractice lawsuits that has been unchanged since 1975. Also included in the initiative is language that would make it mandatory for physicians to check the CURES database before prescribing narcotic drugs.
Although mandatory utilization is recommended by the national Prescription Drug Monitoring Center of Excellence, SB809 doesn't go that far. It would mandate only that doctors and hospitals enroll in the program.
The California Medical Association, which will vigorously fight any attempt to increase malpractice awards, last week called the CURES database provision "window dressing" for the initiative.
That suggests doctors are aware that it is an issue voters would find appealing.
If they want to help their cause on the malpractice front, doctors might consider dealing right away with that "window dressing" by diverting some of their political energy into making certain that the bill to fund the CURES system is approved before lawmakers adjourn on Sept. 13.
Prescription drug abuse is a big problem, and California ought to be a leader in addressing it.
As Attorney General Harris said recently, "Each day, someone is abusing drugs or a doctor is abusing his license. They need to be caught."