CURES Database Developed to Combat Over-Prescribing of Opioids

Many physicians were trained at a time when doctors were told they were under treating pain, and that patients recovering from surgery were unlikely to develop a drug addiction. With tens of thousands of Americans dying from opioid overdoses every year, the pendulum is rightfully swinging in the other direction, said Chief of Staff Ed Damrose, MD.

“Providers have been trying to do right by the patient, but we’ve probably been contributing unwittingly to an epidemic of addiction,” he said. “CURES is the first of many changes to come for opiate prescribing. By creating visibility around Schedule 2, 3 and 4 prescription drugs, CURES is an attempt to get physicians to move away from using heavy-duty narcotics as a first line of pain management for routine operations, routine procedures and routine illnesses.”

“I believe that mandatory CURES checking is a step in the right direction,” said Anne Lembke, MD, associate professor of psychiatry. “Data show that checking the database before prescribing an opioid decreases injudicious opioid over-prescribing, decreases prescription opioid-related deaths and decreases so-called “doctor-shopping.” Unfortunately, less than 35 percent of prescribers check the database before prescribing, when checking is voluntary, she said. “This legislation will promote more careful prescribing, and indirectly send the message to providers that opioids and other scheduled drugs are deadly drugs and should not be prescribed lightly.”

When to consult CURES

• The first time a patient is prescribed, ordered, administered or furnished a controlled substance, unless one of the exemptions apply.
• Within the 24-hour period, or the previous business day, before prescribing, ordering, administering, or furnishing a controlled substance, unless one of the exemptions apply.
• Before subsequently prescribing a controlled substance, if previously exempt.
• At least once every four months if the controlled substance remains a part of the patient’s treatment plan.

“We understand that CURES puts an additional burden on our prescribing physicians, especially those in specialties that rely heavily on these medications such as pain management, oncology and primary care,” said Damrose. IT is working to develop ways to make the Epic-CURES connection more seamless, he said. For example, Epic is being built with the capability to alert physicians when it’s time to recheck the database for patients taking these medications longer than four months. There will also be an embedded link in Epic that takes physicians directly to the CURES database.

What exemptions are there to consulting CURES?

Providers are exempt from consulting the CURES database before prescribing, ordering, administering, or furnishing a controlled substance in any of the following circumstances:

• While the patient is admitted to or during an emergency transfer between a licensed clinic, outpatient setting, health facility or county medical facility
• In the emergency department of a general acute care hospital, and the controlled substance does not exceed a non-refillable seven-day supply.
• As part of a patient’s treatment for a surgical procedure, and the controlled substance does not exceed a non-refillable five-day supply, when a surgical procedure is performed at a licensed clinic, outpatient setting, health facility or county medical facility or place of practice.
• The patient is receiving hospice care.

The California Medical Association is working with the Department of Justice and the State of California to develop an exemption for cancer patients, said Damrose.

CURES is one of many measures being implemented to curb the opiate epidemic. A number of pharmacies like CVS and Walgreens are beginning to limit the number of pills a patient can receive at one time. Also, on January 1, 2019, a new law will go into effect requiring physicians to prescribe Narcan if they prescribe more than 90 morphine equivalents.

“Robust data show that patients receiving an opioid prescription over 90 morphine milligram equivalents daily, are much more likely to die from those opioids, even when taken as prescribed,” said Lembke, an addiction expert. “Co-prescribing Narcan is an important safety measure.”

For more detailed information about CURES, visit http://www.mbc.ca.gov/CURES.