Getting more out of CURES
Like 48 other states, California has an online database that records all the prescriptions issued for potentially habit-forming or abuseable drugs, such as OxyContin and Ritalin. The hope is that the system will deter patients from “doctor shopping” to obtain excess quantities of a drug, and help authorities crack down on healthcare professionals who negligently — or cynically — prescribe pills on demand.
With opioids and other prescription drugs accounting for more than half of the overdose deaths in the United States, curbing excess prescribing needs to be part of the effort to slow the epidemic of ODs. That’s one reason numerous states share information across state lines (but not, sadly, California’s). One study found that doctors in Ohio who consulted the state’s prescription database tended to change the amount of opioids they prescribed, typically to reduce or eliminate them.
But as researchers have shown, most prescribers don’t consult drug databases when they’re not required to do so. That’s why Sen. Ricardo Lara (D-Bell Gardens) has proposed a bill requiring doctors and pharmacists to look up a patient’s prescription history on the state’s database, called CURES, before prescribing or dispensing a controlled substance to that patient for the first time, and again at least once every year that the patient continues to receive it.
The bill (SB 482) passed the Senate last year but has yet to move in the Assembly, and a trade group for California doctors is opposing it (as it has with similar proposals in the past). One of the group’s main concerns is that the database isn’t ready for the added volume of inquiries the bill would generate; but if the bill did cause CURES traffic to surge, that would only show how badly the database has been underused. The association also argues that not all doctors are in a position to consult CURES, and that the system doesn’t sufficiently protect the privacy of prescribers or patients.
A compromise seems within reach. It’s reasonable to hold off the mandate to consult CURES until the system can handle the extra volume, and to provide carefully tailored exemptions for some emergency-room physicians and others who can’t reasonably be expected to access the database — as long as the exemptions don’t create easy pathways for abuse. The privacy concerns, meanwhile, boil down to setting the right limits on how the CURES records can be used. With the alarming rise in prescriptiondrug overdose deaths, though, lawmakers need to finish the job they started in 2009. The database won’t truly serve the purpose for which it was created unless those who prescribe and dispense dangerous drugs check it routinely.