Controlled substances: CURES database Testimony to California State Senate, Sacramento 4-30-15


 (a) A prescriber shall access and consult the CURES database for the electronic history of controlled substances dispensed to a patient under his or her care before prescribing a Schedule II or Schedule III controlled substance for the first time to that patient and at least annually when that prescribed controlled substance remains part of his or her treatment. If the patient has an existing prescription for a Schedule II or Schedule III controlled substance, the prescriber shall not prescribe an additional controlled substance until the prescriber determines that there is a legitimate need for that controlled substance.

My name is Clark Smith.  I’m a medical doctor, board-certified in both Addiction Psychiatry and in Pain Medicine, and medical director of RecoveryWorks, a drug, alcohol and pain rehabilitation program.

As the medical director of treatment programs for the past 25 years, I’ve witnessed an explosion of prescription drug abuse, with a 500% increase in overdose deaths from 1999 through 2010.

Before the CURES database came online I’d have to tediously chase down all the doctors prescribing pills to my doctor shopping and pill addicted patients. . And then the patient could just get a new set of doctors to feed their addiction. With the advent of the CURES database, I had a powerful life saving tool that could show me exactly what pills my patients were taking and which doctors were prescribing them.

In New York State,  in the first year after a database check was required by legislation, doctor shopping was cut 75% and total opiate prescriptions were cut by 10%. The other states that require doctors to check the database have had similar decreases in doctor  shopping, pill overdose deaths, emergency treatment and Medicaid prescription drug costs.

The  CURES database has been proven to save lives and to save money wasted on prescription drug fraud, yet less than 10% of California doctors are even enrolled to use it, and much fewer doctors use it with any regularity.

Why is this? Until now there have been several glitches that made it too difficult to even enroll, much less use, the old CURES program.

Why would a doctor stand up here for a bill that would add even one more requirement onto my workload?  Let me tell you about how CURES saved my patient’s life:

Mary was 10 years clean and sober but had to take pain meds during painful back surgery. I had arranged her medications to carefully ease the pain without triggering craving, but the
back-up surgeon on call doubled her medications when her pain increased after discharge.   She then missed appointments and did not return calls, lost in a drugged out haze.
I never discovered the problem until I checked the database. First responders found her at home with a surgical infection in her spine, requiring emergency re-hospitalization.

Most California doctors do not use the database today, because it has been too cumbersome. CURES 2.0 will fix those problems and Senator Lara’s bill will require doctors to check the database at least once, when they start a new patient on a controlled substance, but as of now, more than 90% of California doctors have never even seen the database.  I feel certain that when doctors find out that CURES 2.0 is a manageable and life-saving tool, they will continue to use it regularly, as part of good medical care to help every patient in California, but even the best doctors will miss 100% of the pill addicted patients they don’t check.

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