The overuse of prescription opioids and opiates has become a national crisis. According to the state Department of Health, there were 1,966 opioid-related overdose deaths in 2015 in California. The Federal Drug Enforcement Agency (DEA) controls prescription pain relievers. In 2016, we lost the privilege to prescribe opioid analgesics, such as Hydrocodone (Vicodin, Norco), with refills. Hydrocodone has been changed from a Schedule III to a Schedule II drug like Oxycodone (Percocet, OxyContin). Although Codeine remains a Schedule II drug, the opiate combination drug Acetaminophen with Codeine is classified as a Schedule III drug. The CURES 2.0 system is the State of California, Department of Justice (DOJ), prescription drug monitoring program.
To assist health care practitioners in their efforts to ensure appropriate prescribing, ordering, administering, furnishing, and dispensing of controlled substances, law enforcement and regulatory agencies in their efforts to control the diversion and resultant abuse of Schedule II, Schedule III, and Schedule IV controlled substances, and for statistical analysis, education, and research, the Department of Justice established the Controlled Substance Utilization Review and Evaluation System (CURES). This California state government program is administered by the Attorney General’s office.
The CURES 2.0 system makes it possible for controlled drug prescribers, those that possess an active DEA license and a California Healthcare Provider License, to review the data base prior to prescribing medications with the potential for abuse.
California law (Health and Safety Code Section 11165.1) requires all California licensed prescribers authorized to prescribe scheduled drugs to register for access to CURES 2.0 by July 1, 2016 or upon issuance of a Drug Enforcement Administration Controlled Substance Registration Certificate, whichever occurs later.
California Health and Safety Code Section 11165(d) requires dispensing pharmacies, clinics, or other dispensers of Schedule II through IV controlled substances to provide specified dispensing information to the Department of Justice on a weekly basis.
California Health and Safety Code Section 11165.4 (A)(i), which was put into law in 2016, says, “A health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance shall consult the CURES database to review a patient’s controlled substance history BEFORE prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient for the first time and AT LEASE ONCE EVERY FOUR MONTHS THEREAFTER if the substance remains part of the treatment of the patient.” It will not go into effect until 6 months after the DOJ certifies the system, but we are expecting that the requirement will be implemented within the next few years.
Once a provider is registered in the system, the program requires passwords to be changed every 90 days. The system is very easy to use and takes approximately two minutes to utilize the web page. Go to oag.ca.gov/cures to log in with your username and password.
When the DASHBOARD comes up, click on the Patient Activity Report tab. Only the patient’s first name, last name and date of birth are required. The PATIENT ACTIVITY pops up. Click on that person and a 12 month report is generated.
The information generated is: Date Filled and Sold, Drug Name, Form (tablet, capsule, etc), Drug Strength, Days Supply, Prescription Number, Refills Authorized, Payment Method, Prescriber’s Name, Prescriber’s DEA Number, Pharmacy Name, and Pharmacy Number.
Under the PATIENT ACTIVITY section, there is also another useful tab. It is called the Compacts and Messages tab. By clicking the Add button under Compact Action, a treatment exclusivity compact is generated making other prescribers aware of your action. This optional feature is provided to help avert potentially counter-productive treatment or prescribing. This is a one-way messaging process, only. This message is sent to the prescribing pharmacist and stays posted on the site until removed by the messenger. Prescribers are encouraged to regularly review their compact listings and remove outdated designations.
The CURES 2.0 system is committed to the reduction of prescription drug abuse and diversion without affecting legitimate healthcare practice or patient care. Hopefully, this state mandated program will help improve the current opioid and opiate abuse epidemic.
Ned L. Nix, DDS, MA