As physicians in the Acute Care Continuum, we want to treat our patients' problems quickly, especially their pain. While I would prefer to give pain medications to many people who do not need to be treated rather than to deny one person in pain, it would be ideal to know who really needs these drugs. Fortunately for physicians in California, a database reporting application called the Controlled Substance Utilization Review and Evaluation System (CURES) provides timely information aiding in the process of making this determination.
Just as the vast majority of physicians prescribe drugs appropriately, the vast majority of patients also use them appropriately. Nevertheless, when prescribing to an unknown patient, physicians face uncertainty about that patient’s history of controlled substance use. Physicians in the Acute Care Continuum frequently find themselves in this difficult position. As CURES catches on and becomes more generally adopted, it is much more likely that we can choose appropriate treatment for our patients.
CURES contains over 100 million entries of controlled substance drugs that were dispensed in California. The information comes from pharmacies, from the state, and from individual physicians. Physician access to this data base protects patients from easy access to drugs of abuse, and also protects doctors, who can be held liable both for failing to treat pain adequately and for overprescribing. CURES allows physicians to look up which drugs the patient is getting and from what sources by providing objective verifiable information. Physicians are less likely to act on an incorrect belief that a patient is abusing and deny a patient needed pain medication. Conversely, CURES can identify patients who are lying in order to obtain drugs for misuse or sale.
CURES funding has been eliminated as of January 1, 2013 and physicians can no longer sign up to use it. The system itself is confusing, slow, and hard to use. For maximum utility, CURES should be as user-friendly as Amazon so that designated ED staff other than physicians could use it and save physician time. But improving the accessibility and usability of the database will take money.
California —and all other states as well — should fund further development and improvement of this program because it can provide significant financial benefits to the public. It helps doctors stem the flow of prescription drugs to the streets. By making it harder for addicts to feed their addictions, it helps prevent lost economic opportunity due to disability and early death, as well as decreasing spending on care for overdoses and addictions. Medi-Cal spending on illegitimate prescriptions would be reduced. And private insurance companies would also save money they are now spending for unfounded prescriptions and doctor visits by drug-seeking addicts.
CURES contains the data to help the state identify problem prescribers, problem pharmacies, and problem patients. However we need to keep in mind that this system is only a screening tool. Appropriate medical and or pharmacological experts, specialty specific, must make the final determination if an investigation for improper prescribing is indicated for those screened as possible problems. A program to screen and investigate “problem” prescribers, must be developed with caution so that prescribers and pharmacists do not become so fearful of prosecution that they fail to prescribe treatment truly needed by a patient. Legislators should use experts to help write improved laws regarding CURES to avoid the unintended consequences of legislating medical care.
An easily accessible CURES database can ease the ED physician’s dilemma of trying to prescribe appropriate pain medication to patients suffering from pain while also trying to avoid drug diversion and addiction. As healthcare reform demands integration of clinical care, CURES is an example of an application of the future which seamlessly links together important pieces to the puzzle of how to best help people in need. I encourage California to reinvest in the CURES program and further develop its functionality. It is an important public health tool for appropriate controlled substance prescribing.
All patient encounters are unique, and CURES provides practitioners timely information to make good decisions for each patient. This is far preferable to regulations in other areas of the country restricting the amount or type of pain medications for all patients. I encourage all California providers to use CURES and for providers across the country to use their own states' prescription monitoring programs.