Are You Ready to Check CURES? June 22, 2018 Tag 2022 Starting October 2, all physicians must consult database before prescribing controlled substances Effective October 2, 2018, physicians must consult California's prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. 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 must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload. On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018. What Physicians Need to Know Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient's treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient. The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient's inability to obtain a prescription in a timely manner and adversely impact the patient's conditions, so long as the quantity of the controlled substance does not exceed a five-day supply. Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: Admitted to a facility for use while on the premises; In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or Receiving hospice care. In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician. CMA Fights for CURES Protections CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). 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 also clarifies that health care providers sharing the information within the parameters of HIPAA 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. Save the Date: CURES webinar with DOJ on 8/22 CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events. For More Information For more information, 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 online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page. Additional Resources: CURES website: oag.ca.gov/cures CURES FAQ: oag.ca.gov/cures/faqs Medical Board CURES webpage: mbc.ca.gov/cures CMA CURES webpage: cmanet.org/cures CMA Safe Prescribing webpage: cmanet.org/safe-prescribing CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov. Sidebar 1: CMA publishes safe prescribing resources for physicians The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The page includes two CMA white papers on opioid prescribing, links to CMA's health law library resources on the topic, the Medical Board of California's "Guidelines on Prescribing Controlled Substances for Pain," a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state's prescription drug monitoring database. Members can find the page at cmanet.org/safe-prescribing. Sidebar 2: New report shows California's progress addressing opioid crisis The American Medical Association (AMA) recently issued a new report documenting how California's physician leadership is advancing the fight against the opioid crisis. The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California's Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid us disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017. "This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders," said California Medical Association (CMA) President Theodore M. Mazer, M.D. "CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment." For more details on the report visit end-opioid-epidemic.org.