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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
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.
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