Gov. Brown Signs SB 482: Physicians Must Check CURES Before Dispensing Controlled Substances

Gov. Brown yesterday signed SB 482 which will require doctors to check the state prescription drug monitoring program (CURES) at least 24 hours before prescribing a Schedule II, III or IV controlled substance to a patient for the first time. The bill also requires doctors to check CURES at least once every four months when continuing to prescribe a controlled substance. The goal is to crack down on doctors who overprescribe addictive drugs and “doctor shopping” by patients who visit different providers to obtain multiple prescriptions for these drugs.

CWCI studies dating back to the early 2000s document how prescription painkillers have become a huge workers’ comp cost driver, with highly addictive drugs such as oxycodone and fentanyl often prescribed to injured workers, even for minor sprains and strains. These studies helped to build a broad consensus that combating overuse and abuse of these drugs will take an ongoing, multi-pronged effort. As part of that effort, in 2011, the DWC adopted chronic pain guidelines to better manage the use of prescription painkillers. Amendments to those guidelines, along with new Opioid Treatment Guidelines, were approved this summer and took effect July 28. In addition, the prescription drug formulary mandated by AB 1124 is being developed by the DWC and will take effect next July, which should further control the use of these drugs.

CURES offers another tool to combat prescription drug abuse by allowing doctors, pharmacists, and law enforcement to track the prescription history of patients receiving controlled substances so they can identify fraud and abuse patterns. That effort, however, has been hampered because prescribing physicians have not been required to check the system. Health & Safety Code §11190 and Business & Professions Code §1170 do require doctors licensed to dispense controlled substances to submit weekly dispensing reports to CURES, which is overseen by the Department of Justice, and Health & Safety Code §11165(d) requires dispensing pharmacies and clinics to report to CURES on a weekly basis. But past efforts to require physicians to check the database before prescribing or dispensing these substances have been strongly opposed by the California Medical Association and other physician lobby groups.

The multi-year campaign to require physicians to check CURES was spearheaded by Bob Pack, who began a crusade against prescription drug abuse after his two children were killed by a drugged driver in a hit-and-run accident in 2003. The CURES program came close to being defunded in 2013 when an emergency appropriation was needed to ensure its continuance. CWCI published a support study at the time that found that the use of CURES could lower claim costs 3 to 7 percent by reducing opioid use, netting a 15-to-1 return on investment. That year Bob Pack worked with State Senator Mark DeSaulnier to secure passage of SB 809, which provided long-term funding for CURES and made the system more robust by linking it to other states’ prescription drug monitoring systems and by streamlining the physician registration process. Before the bill passed, however, opponents succeeded in axing the requirement that doctors check CURES before prescribing opioids and other controlled substances. Undeterred, Pack submitted 830,000 signatures to place Prop 46 on the 2014 ballot, which would have required doctors to check CURES before prescribing controlled substances. But Prop 46, with financial backing from the Trial Attorneys Association, also called for increasing the cap on medical malpractice awards to $1.2 million and mandatory drug testing of doctors, raising the ire of the physician lobby, so it was soundly defeated following the most expensive initiative battle in California history.

Passage of SB 482 represents a big win for Bob Pack and others concerned with prescription drug abuse. Combined with the formulary, the Opioid Treatment Guidelines and the controls offered by MPNs, UR and PBMs, SB 482 could further reduce inappropriate use of controlled substances in California workers’ comp. The new CURES requirement will take effect six months after the Department of Justice certifies that it can handle the increased use of the system, which now has nearly 165,000 registered users.  For more on SB 482, see the final version of the bill, available here.

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