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CURES: One Piece of the Opioid Puzzle

The CURES (Controlled Substance Utilization Review and Evaluation System) has been certified as of April 2nd to be ready for statewide use.  This database allows physicians to be able to check for controlled substance prescriptions on any of their patients, which can be a great tool in combating opioid misuse and addiction.  There is already a 2016 California law in place requiring that physicians check this database; it was awaiting this certification to activate and will be effective as of October 2, 2018.

According to the law, a physician must check the database prior to prescribing a controlled substance to the patient for the first time, and at least once every four months thereafter.  There are some exceptions which allow short term prescriptions from the emergency department or as part of a surgical procedure, or for patients on hospice care; and exceptions when technological limitations that are beyond the control of the physician make it impossible.

There are efforts to try to link the California state database with databases from other states – currently about 39 states have some sort of controlled substance database although the details vary from state to state, and of course patients do not necessarily get all of their medications in just one state.  CMA would also like to see the database moved to be part of the department of public health as it is in many of these other states, so that the emphasis would be focused on health rather than law enforcement.   Getting the database to interact with our electronic medical record systems would also increase its effectiveness and decrease the administrative burden for physicians.  Finally, there is a bill in the legislature (AB 2086) which would allow a provider to get a list of CURES data for all of the patients for which they prescribe, rather than having to query the database one patient at a time.  Another bill (AB1752) suggests that schedule V drugs (which are medications like cough syrups with codeine) should be added to the database.

One of the concerns about the database is monitoring it for appropriate patient privacy, or who should determine when the database should be mined.  I have been told that the Medical Board of California is going through the records of all people who died from drug overdose in 2012 and 2013 and will be using the CURES database to investigate the physicians involved in prescribing for these people.  This investigation may find some cases of inappropriate prescribing, but at what disruption to many other doctor’s practices – doctors who were and are trying to appropriately provide care for their patients who are in pain.  And there are several cases where the California Medical Board has pushed to look at medical prescribing for a patient who has not given or withdrawn consent of their medications to be looked at, as well as a case where Oregon is refusing to give their database information to the federal government.

Hopefully the CURES database will continue to improve care for patients and the upcoming mandate will be manageable by physicians.  I am happy to be a part of the Board of Trustees and know that the California Medical Association is involved in many aspects of this evolving situation.   Please feel free to contact me at any time with your ideas or input on this issue or any others in organized medicine.

Dr. Weissman is a member of the SMCMA Board of Directors and represents the Specialty Section on the CMA Board of Trustees.