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CURES Controversy Rekindled

CALIFORNIA HEALTHLINE
http://www.californiahealthline.org/insight/2015/cures-controversy-rekindled

A yearlong study released last month suggests Kentucky's new law requiring physicians and pharmacists to register with and use the state's new electronic prescription drug monitoring system is working.

Two weeks ago, New Jersey became the 10th state to establish a "meaningful mandate" requiring physicians to check a database before prescribing certain drugs, according to the Brandeis Prescription Drug Monitoring Program Center of Excellence.

California is not one of the 10.

News from Kentucky and New Jersey along with campaigns in other states have rekindled interest in California efforts to force physicians to use the Controlled Substance Utilization Review and Evaluation System -- California's electronic monitoring system known as CURES.

A bill calling for such a mandate stalled in the California Legislature this year after encountering opposition from the California Medical Association.

SB 482, by state Sen. Ricardo Lara (D-Bell Gardens), would require doctors to check CURES before prescribing controlled substances for the first time to a patient in California, and annually if the course of narcotic treatment continues. The state Senate passed the bill, but it has stalled in the Assembly.

CMA, a trade group representing about 40,000 physicians in the state, opposes the bill, saying it "would create an unnecessary regulatory burden to prescribing and increase the threat of litigation, both of which would have a detrimental impact on patient care."

CMA officials added another reason to oppose the bill last month when a new version of the electronic system -- CURES 2.0 -- was rolled out. The new version's reliance on the use of up-to-date Web browsers posed a problem for some physicians and physician groups, according to the CMA.

"We support the CURES database, but it needs to be workable before we start mandating the use of it," said Molly Weedn, associate vice president of public affairs for CMA.

CMA Resistance Called 'Troubling'

Carmen Balber, executive director of Consumer Watchdog, said California policymakers should recognize and join the national trend toward mandatory use of prescription databases. 

"More and more states across country are moving in this direction and we're seeing more and more authorities saying it's part of the answer to stemming the epidemic of drug abuse," Balber said.

"This isn't just patient or consumer advocates saying this. CDC is strongly pushing in that direction and the American Medical Association has announced a task force to explore the issue," Balber said.

Balber said the CMA's opposition to Lara's bill is ill advised.

"I find it really troubling that the [California] medical association continues to throw out scare tactics to doctors instead of embracing change that could save lives," Balber said.

Before CURES 2.0 launched, CMA officials warned physicians about potential connectivity problems, saying that if the California Department of Justice did not change its implementation plan, "a minimum of thousands of physicians will lose access to CURES."

DOJ modified its plans and called for a "soft" launch, allowing physicians with older browsers to retain access to the older version of the system.

Kentucky Database Triggered Decline in Drug Abuse

Research from the University of Kentucky Institute for Pharmaceutical Outcomes and Policy shows a decline in the number of prescriptions for commonly abused medications, a reduction in "doctor shopping" and an increase in the number of Kentuckians seeking treatment for prescription medication addiction.  

The research specifically measured the effect of a law enacted in 2012. Among other things, the new law required all physicians and pharmacists to register with and use the state's recently upgraded electronic system for monitoring prescription drugs. The Kentucky All Schedule Prescription Electronic Reporting, or KASPER, system is similar in scope and intent to CURES.

According to the study, the number of patients in Kentucky who "shop around" for doctors to obtain prescriptions declined by 52%, opioid prescriptions to doctor-shopping individuals dropped by 54% and overdose-related deaths declined in 2013 -- the first drop in such deaths in six years.

Other states have reported similar results. Earlier this year in a report to the Tennessee General Assembly:

  • 41% of prescribers in Tennessee reported they are less likely to prescribe controlled substances after checking a prescription database;
  • 34% said they were more likely to refer a patient for substance abuse treatment; and
  • 86% of prescribers believe the database is useful for decreasing doctor shopping.

"The study from Kentucky is consistent with the results in every other state that has mandatory use of the electronic system," Balber said.

Balber discounted the argument that physicians will use the system without being forced to.

"There are some states that have mandates only in name -- saying physicians should check the database 'if they think they need to.' But research has shown that only the truly mandatory requirements have any effect," Balber said.

The CURES system, used to monitor Schedule II and Schedule III drugs -- such as OxyContin and other opioids -- "is seldom used in California because checking is voluntary, and that lack of use is costing lives," Balber said.

Although CMA officials said they support the use of CURES 2.0, they said they wouldn't necessarily support mandatory use -- or Lara's bill -- even if the system is working at 100%.

"I think the most important thing is that we don't know what other problems might arise," Weedn said. "We didn't know until a few days before the rollout that there would be an issue (with browser connectivity) for example," Weedn said.