As a teen, Kristin Greene was devoted to horses. She rode, groomed and trained them at her family’s Lakeside ranch.
Kristin won praise and a room full of trophies during a decade of equestrian competition.
“If she got into something, she was into it a hundred percent," said Kristin’s sister, Lisa Bond.
But Kristin left the horses behind with the birth of her first child.
“Her behavior completely changed," Bond said. She said Kristin complained of post-partum depression and severe migraine headaches, and took strong prescription medicine for those aliments.
Bond and Kristin’s father, Mike Greene, said Kristin repeatedly lied and minimized her problems when confronted about her growing dependence on prescription pain-killers, sleeping pills and sedatives.
Her family persuaded Kristin to enter a drug rehab program in 2011. Despite that intervention, they said Kristin tried to kill herself several times by overdosing on prescription narcotics.
Then, on Nov. 28, 2013, the day after Thanksgiving, Kristin succeeded in ending her life with a toxic cocktail of prescription pain-killers and sedatives.
“So ‘Black Friday’ to us is really a Black Friday," said Bond.
Bottles of Pills
That same day, investigators from the county Medical Examiner’s office found more than 30 prescription bottles in the bedroom of Kristin’s Lakeside home.
Some of those bottles were empty; others were missing just a few pills. Many of the medications were powerful and potentially addictive, including sedatives, anti-anxiety medicines and narcotics.
After investigators left, Kristin’s family searched her bedroom again. They found 32 more pill bottles, many of them also for potentially dangerous controlled substances.
“We found stuff in the craziest places” Bond said. “In pockets of jackets, in old shoe boxes, inside her shoes, hidden in Tampon boxes."
In all, more than 60 prescriptions written by nine different medical professionals, in the previous five years.
What the family learned in the aftermath of that tragedy prompted them to ask questions about how medical professionals handled Kristin’s treatment, and the huge numbers and kinds of prescription medications they gave her.
It was also the first time they saw, in black-and-white, just how much medication Kristin had been taking. According to her family, Kristin consumed many other prescription drugs in the years leading up to her suicide, resulting in a history of deadly abuse that they feel could have been treated more effectively by her doctors and managed more effectively by the pharmacies that filled all those prescriptions.
CURES: A Possible Solution
Dr. Clark Smith, a psychiatrist and addiction medicine specialist, agrees with Kristin’s family. He and other professionals told NBC 7 Investigates about a computer database that might have saved Kristin’s life and the lives of the more than 1000 other Californians who die every year of accidental prescription drug overdose or who struggle with unrelenting prescription drug addiction. (In San Diego County last year, 259 people died of prescription drug overdoses, according to the Medical Examiner’s office.)
The database is called the “Controlled Substance Utilization Review and Evaluation System”, or “CURES.” It was developed more than six year years ago by the California Department of Justice.
Doctors, pharmacists and other medical professionals can access CURES on their computer to review a patient’s prescription history.
That information is designed to alert them to potential problems, including over-prescribing and doctor-shopping, when a patient obtains controlled substances from multiple providers without those providers knowing about the other prescriptions.
“I think if CURES were used on a regular basis, we would see tremendous progress in cutting back prescription drug dependence,” Smith said.
Database Faces Hurdles
But, NBC 7 Investigates found that CURES is not used on a regular basis by medical professionals. Our investigation also revealed that CURES has been dogged by problems since its inception.
In testimony to the Medical Board of California last July, the state employee who administers the database, Mike Small, admitted it’s very cumbersome and time consuming for doctors and other medical professionals to register for CURES.
Small acknowledged that CURES sometimes cannot handle the demands of multiple users accessing patient prescription histories. “I get kicked out myself, and it doesn’t show me your password expired. It kind of leaves it to your imagination,” he said.
Viewing patient data is equally challenging and unpredictable, Small he told the medical board. “Usually in the existing system, it can be moments to never” for a provider to access a patient’s history.
In addition, data obtained by NBC 7 Investigates reveals as of this month, less than 20 percent of eligible health care workers are registered for CURES.
Other problems with CURES date back to its debut, when state legislators unknowingly made it illegal for medical professionals to share patient information, which is the very reason CURES was created.
That legislation was later rewritten to remove that prohibition, but in 2011, Governor Jerry Brown cut all funding for CURES as a result of the state’s financial problems.
Also, pharmacists have up to seven days to enter a prescription in the database, which can give drug abusers time to “doctor-shop” and stockpile addictive medications.
Despite Small’s commitment and dedication to fixing the database, he made the embarrassing admission to doctors that shortcomings beyond his control have badly undermined the system’s potential. “My joke to my colleagues is if I tried as hard as I can to build a terrible system, I don't think I could meet this," he said.
Problems with the CURES database provided ammunition for the California Medical Association to defeat a ballot measure last November that would have required doctors to check a patient’s prescription history before prescribing a controlled substance.
Database Upgrades Coming
The legislature recently restored funding for CURES, paid for by a fee imposed on California physicians, and Small is confident that “CURES 2.0,” which is scheduled to debut on June 30, will be much easier to use.
Small said the new system will be able to handle many more users, which is important because the new legislation also requires all California pharmacists and prescribers to register for CURES.
Dr. Clark Smith said he hopes those improvements are made as scheduled. “The incidence of overdose deaths, emergency room visits and addiction problems related to prescription drugs is going up every year. We need every tool available to us to try and control this.”
If CURES works as planned, Smith and other professionals told NBC 7 Investigates they would support legislation requiring medical professionals to check the CURES system before prescribing controlled substances for a new patient, and to make periodic follow-up checks on those patients.
Such a requirement would have increased the odds of preventing Kristin’s suicide, her family said.
Less than two months before her death, Kristin tried to kill herself with an overdose.
She ended up in the emergency room at a local hospital.
According to Smith, if Kristin's doctors and the pharmacies that filled her prescriptions had known about that earlier suicide attempt, they would not have given her the ten additional prescriptions she obtained in the seven weeks before her death.
The first of the prescriptions was written just four days after Kristin was discharged from the emergency room. She obtained the last one just two days before she killed herself.
At least four of those medications were found in Kristin’s system when she died, including the powerful narcotic Oxymorphone, which the Medical Examiner says contributed to Kristin’s death.
One of the two doctors who wrote those ten prescriptions told us no one from the emergency room notified him about Kristin's attempted suicide.
This doctor says had he known, he never would have given Kristin those medications and would have instead insisted that she immediately get intense mental health and addiction treatment.
The other doctor declined to discuss any aspect of Kristin's treatment.
Pharmacist Role in CURES
A review of Kristin’s medication history by NBC 7 Investigates also reveals all but one of those ten prescriptions -- and the vast majority of her medications obtained by Kristin in the four years before her death -- were filled by CVS pharmacies in San Diego County. Smith and Kristin’s family said they feel CVS should have been more aggressive in alerting Kristin’s doctors to potential problems with over-prescribing and dangerous drug interactions.
Dr. Smith notes that Kristin was given prescriptions for short-acting barbiturates, a tranquilizer and a strong narcotic, all in the seven weeks before she overdosed. Smith said those medications are a dangerous, potentially deadly combination.
According to Smith, the pharmacists should have alerted Kristin’s doctors to the problem. “Just like they would stop a penicillin prescription for someone allergic, they could stop a barbiturate prescription for someone who already has it,” said Dr. Smith.
Citing patient confidentiality, a CVS spokesperson declined to discuss Kristin’s case and would not disclose whether its pharmacists contacted any of Kristin’s doctors.
In a statement, the company told NBC 7 Investigates “our pharmacists use their professional judgment when determining whether a prescription for a controlled substance was issued for a legitimate reason.” A CVS spokesman also said the company is combating prescription drug abuse by reviewing prescriber data to identify providers “with extreme patterns of prescribing controlled substances and suspend(ing) the dispensing of these high-risk drugs…”
But the company indicated it does not require its pharmacists to use the CURES database, and instead allows them to “exercise their professional judgment to determine when to check those databases prior to filling a prescription.”
Families Push Forward
Kristin’s family members say they’ll keep asking tough questions about CURES and other preventative measures that might have saved Kristin’s life.
They’ll be helped in that effort by another Californian who suffered a similar tragedy.
Bob Pack, whose two young children were killed in 1993 by a drug-impaired driver, now spends much of his time lobbying for a stronger CURES system and mandatory use of that system by medical professionals.
“You just look at the numbers, and it’s terrible,” Pack told NBC 7 Investigates. “More people are dying from abusing prescription narcotics in California than from car accidents each year.”
Pack said the four other states that require mandatory use of a CURES-type database have reduced “doctor-shopping” by addicts by more than 50 percent and have seen a significant reduction in the number of narcotics prescribed by doctors. Those states are New York, Kentucky, Tennessee and West Virginia.
“I just believe that it’s a kind of life-long journey for me,” Pack said of his efforts to strengthen the CURES system. “Maybe a healing process for me, personally, knowing that I could help save someone else’s life, when the things I’m working on could have saved my own children’s lives.”
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