January 20, 2017
Area(s) of Interest: CURES Drug Prescribing/Dispensing
Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must be registered to use the Controlled Substance Utilization Review and Evaluation System (CURES). Currently, physicians are encouraged—but not required—to check the database before prescribing controlled substances. Checking the CURES database will eventually be mandatory, under a law passed by the California Legislature in 2016. The exact date the mandate will take effect is unclear, but will depend on the Department of Justice (DOJ) making a certification about the system’s readiness.
Under the new law (SB 482), prescribers will be required, except in certain limited circumstances, to consult the CURES database prior to prescribing a Schedule II, III or IV controlled substance for the first time and at least every four months when that controlled substance remains a part of a patient's treatment.
The California Medical Association (CMA) continues to assert the importance of adequate technical support for physicians who will have to rely on the system as a part of their prescribing workflow. For this reason, we negotiated into the final legislation a requirement that the mandate cannot take effect until DOJ certifies that the CURES database is ready for statewide use and that the department has adequate staff to handle the related technical and administrative workload. The mandate will go into effect six months after DOJ certifies that the database and the agency are ready.
CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which is reflected in the final version of the bill. Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill clarifies that health care providers sharing the information within the parameters of the Health Insurance Portability and Accountability Act and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.
Currently, the Medical Board of California’s “Guidelines for Prescribing Controlled Substances for Pain” recommend checking CURES as part of a comprehensive patient assessment and risk stratification when considering long-term opioids for chronic, non-cancer pain and as part of compliance monitoring. Whenever performed, the results of CURES data searches should be included in the patient’s medical record, per the medical board guidelines.
For more details about the new law, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA's Health Law Library. Nonmembers can purchase documents for $2 per page.
Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or firstname.lastname@example.org. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or email@example.com so that we can ensure they are addressed before the mandate takes effect.
For more information on CURES, visit www.cmadocs.org/cures.