BILL ANALYSIS Ó
SB 482
Page 1
Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Rudy Salas, Chair
SB 482(Lara) - As Amended June 6, 2016
SENATE VOTE: 28-11
SUBJECT: Controlled substances: CURES database
SUMMARY: Requires a health care practitioner, as specified,
authorized to prescribe, order, administer, furnish, or dispense
a controlled substance to consult the Controlled Substance
Utilization Review and Evaluation System (CURES) database no
earlier than 24 hours before prescribing a Schedule II, Schedule
III, of Schedule IV controlled substance for the first time and
at least annually thereafter. Provides that a health care
practitioner who knowingly fails to consult the CURES database
is subject to administrative sanctions by the appropriate state
professional licensing board. Exempts a health care
practitioner, as specified, or any person acting on behalf of
the health care practitioner, from civil or administrative
liability arising from false, incomplete, or inaccurate
information submitted to or reported by the CURES database or
for failure to consult the database, as specified.
EXISTING LAW:
The Business and Professions Code (BPC)
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1)Establishes the Medical Practice Act which provides for the
licensing and regulation of physicians and surgeons by the
Medial Board of California (MBC) within the Department of
Consumer Affairs (DCA).
2)Establishes the Dental Practice Act which provides for the
licensing and regulation of dentists by the Dental Board of
California within DCA.
3)Establishes the Veterinary Medicine Practice Act which
provides for the licensing and regulation of veterinarians and
registered veterinary technicians by the Veterinary Medical
Board within DCA.
4)Establishes the Nursing Practice Act which provides for the
certification and regulation of registered nurses, nurse
practitioners and advanced practice nurses by the Board of
Registered Nursing within DCA.
5)Provides that a certified nurse-midwife may furnish or order
drugs or devices, including controlled substances, if
furnished or ordered incidentally to the provision of family
planning services, routine health care or perinatal care, or
care rendered consistent with the certified nurse-midwife's
practice; occurs under physician and surgeon supervision; and
is in accordance with standardized procedures or protocols as
specified. (BPC § 2746.51)
6)Provides that a nurse practitioner may furnish or order drugs
or devices, including controlled substances, if it is
consistent with a nurse practitioner's educational preparation
or for which clinical competency has been established and
maintained; occurs under physician and surgeon supervision;
and is in accordance with standardized procedures or protocols
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as specified. (BPC § 2836.1)
7)Establishes the Physician Assistant Practice Act which
provides for the licensing of physician assistants by the
Physician Assistant Committee, under the MBC, within the DCA.
8)Provides that a physician assistant while under the
supervision of a physician and surgeon may administer or
provide medication to a patient, or transmit orally or in
writing a drug order under specified conditions and protocols
adopted by the supervising physician and surgeon. (BPC §
3502.1)
9)Establishes the Osteopathic Act which provides for the
licensing and regulation of osteopathic physicians and
surgeons by the Osteopathic MBC within the DCA.
10)Establishes the Naturopathic Doctors Act which provides for
the licensing of naturopathic doctors by the Naturopathic
Medicine Committee within the Osteopathic Medical Board of
California within the DCA.
11)Establishes the Optometry Practice Act which provides for the
licensure of optometrists by the California State Board of
Optometry within the DCA.
12)Establishes the Podiatric Act which provides for the
licensure of doctors of podiatric medicine by the California
Board of Podiatric Medicine within the DCA.
13)Establishes the Pharmacy Law which provides for the licensure
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and regulation of pharmacies, pharmacists and wholesalers of
dangerous drugs or devices by the Board of Pharmacy within the
DCA.
14)Defines "dispense" as the furnishing of drugs or devices upon
a prescription from a physician, dentist, optometrist,
podiatrist, veterinarian, or naturopathic doctor or upon an
order to furnish drugs or transmit a prescription from a
certified nurse-midwife, nurse practitioner, physician
assistant, naturopathic doctor, or pharmacist acting within
the scope of his or her practice. Dispense also means and
refers to the furnishing of drugs or devices directly to a
patient by a physician, dentist, optometrist, podiatrist, or
veterinarian, or by a certified nurse-midwife, nurse
practitioner, naturopathic doctor, or physician assistant
acting within the scope of his or her practice. (BPC § 4024)
15)Specifies certain requirements regarding the dispensing and
furnishing of dangerous drugs and devices, and prohibits a
person from furnishing any dangerous drug or device except
upon the prescription of a physician, dentist, podiatrist,
optometrist, veterinarian or naturopathic doctor. (BPC §
4059)
16)Defines "practitioner" as a physician, dentist, veterinarian,
podiatrist, or pharmacist, registered nurse or physician
assistant acting within the scope of an experimental health
workforce projects authorized by the Office of Statewide
Health Planning and Development (HSC § 128125 et seq.), a
certified nurse-midwife according to BPC provisions outlined
above, a nurse practitioner according to BPC provisions
outlined above, a physician assistant according to BPC
provisions outlined above, or an optometrist licensed under
the Optometry Practice Act. Includes in the definition of
"practitioner" a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
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dispense, conduct research with respect to, or to administer,
a controlled substance in the course of professional practice
or research in this state. Also includes in the definition of
"practitioner" a scientific investigator, or other person
licensed, registered, or otherwise permitted, to distribute,
dispense, conduct research with respect to, or administer, a
controlled substance in the course of professional practice or
research in this state. (BPC § 11026)
The Health and Safety Code (HSC)
17)Establishes the California Uniform Controlled Substances Act
which regulates controlled substances. (HSC § 11000 et seq.)
18)Defines "dispense" to deliver a controlled substance to an
ultimate user or research subject by or pursuant to the lawful
order of a practitioner, including the prescribing,
furnishing, packaging, labeling, or compounding necessary to
prepare the substance for that delivery and "dispenser" as a
practitioner who dispenses. (HSC §§ 11010, 11011)
19)Defines "drug" as:
a) Substances recognized as drugs in the official United
States Pharmacopoeia, official Homeopathic Pharmacopoeia of
the United States, or official National Formulary, or any
supplement to any of them.
b) Substances intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in man or
animals.
c) Substances (other than food) intended to affect the
structure or any function of the body of man or animals.
(HSC § 11014)
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20)Defines "opiate" as any substance having an addiction-forming
or addiction-sustaining liability similar to morphine or being
capable of conversion into a drug having addiction-forming or
addiction-sustaining liability. (HSC § 11020)
21)Classifies controlled substances in five schedules according
to their danger and potential for abuse. (HSC § 11054-11058)
22)Prohibits any person other than a physician, dentist,
podiatrist, veterinarian, naturopathic doctor (according to
BPC provisions outlined above), pharmacist (according to BPC
provisions above), certified nurse-midwife (according to BPC
provisions outlined above), nurse practitioner (according to
BPC provisions above); a pharmacist or registered nurse or
physician assistant acting within the scope of an experimental
health workforce project authorized by the Office of Statewide
Health Planning and Development (HSC § 128125 et seq.); an
optometrist licensed under the Optometry Practice Act., or an
out-of-state prescriber acting in an emergency situation from
writing or issuing a prescription for a controlled substance.
(HSC § 11150)
23)Specifies that a prescription for a controlled substance
shall only be issued for a legitimate medical purpose and
establishes responsibility for proper prescribing on the
prescribing practitioner. States that a violation shall
result in imprisonment for up to one year or a fine of up to
$20,000, or both. (HSC § 11153)
24)Requires special prescription forms for controlled substances
to be obtained from security printers approved by DOJ,
establishes certain criteria for features on the forms and
requires controlled substance prescriptions to be made on the
specified form. (HSC §§ 11161.5, 11162.1, 11164)
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25)Establishes the Controlled Substances Utilization Review and
Evaluation System (CURES) for electronic monitoring of
Schedule II, III and IV controlled substance prescriptions.
The CURES provides for the electronic transmission of Schedule
II, III and IV controlled substance prescription information
to the Department of Justice (DOJ) at the time prescriptions
are dispensed. (HSC § 11165)
26)States that the purpose of CURES is to assist law enforcement
and regulatory agencies in controlling diversion and abuse of
Schedule II, III and IV controlled substances and for
statistical analysis, education and research. (HSC § 11165
(a))
27)Establishes privacy protections for patient data and
specifies that CURES data can only be accessed by appropriate
state, local and federal persons or public agencies for
disciplinary, civil or criminal actions. Specifies that CURES
data shall also only be provided, as determined by DOJ, to
other agencies or entities for educating practitioners and
others, in lieu of disciplinary, civil or criminal actions.
Authorizes non-identifying CURES data to be provided to public
and private entities for education, research, peer review and
statistical analysis. (HSC § 11165 (c))
28)Provides that pharmacies or clinics, in filling a
prescription for a federally Scheduled II, III or IV drug,
shall provide weekly information to DOJ including the
patient's name, date of birth, the name, form, strength and
quantity of the drug, and the pharmacy name, pharmacy number
and the prescribing physician information. (HSC § 11165 (d))
29)Provides that a licensed health care practitioner eligible to
prescribe Schedule II, III or IV controlled substances, or a
pharmacist, shall apply to participate in the CURES
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Prescription Drug Monitoring Program (PDMP) by January 1,
2016. Authorizes DOJ to deny an application or suspend a
subscriber for certain violations and falsifying information.
Provides that the history of controlled substances dispensed
to a patient based on CURES data that is received by a
practitioner or pharmacist shall be considered medical
information, subject to provisions of the Confidentiality of
Medical Information Act. (HSC § 11165.1)
30)Requires health practitioners who prescribe or administer a
controlled substance classified in Schedule II to make a
record containing the name and address of the patient, date,
and the character, name, strength, and quantity of the
controlled substance prescribed, as well as the pathology and
purpose for which the controlled substance was administered or
prescribed. (HSC § 11190 (a) and (b))
31)Requires prescribers who are authorized to dispense Schedule
II, III or IV controlled substance in their office or place of
practice to record and maintain information for three years
for each such prescription that includes the patient's name,
address, gender, and date of birth, prescriber's license and
license number, federal controlled substance registration
number, state medical license number, NDC number of the
controlled substance dispensed, quantity dispensed, diagnosis
code, if available, and original date of dispensing. Requires
that this information be provided to DOJ on a monthly basis.
(HSC § 11190 (c))
THIS BILL:
32)Exempts a health care practitioner, pharmacist, and any
person acting on behalf of a health care practitioner or
pharmacist, when acting with reasonable care and in good
faith, from civil or administrative liability arising from any
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false, incomplete, or inaccurate information submitted to, or
reported by, the CURES database or for any resulting failure
of the CURES database to accurately or timely report that
information.
33)Requires a health care practitioner authorized to prescribe,
order, administer, furnish, or dispense a controlled substance
to consult the CURES database to review a patient's controlled
substance history before prescribing a Schedule II, Schedule
III, or Schedule IV controlled substance to the patient for
the first time and at least annually thereafter if the
substance remains part of the treatment of the patient.
34)Defines "first time" to mean the initial occurrence in which
a health care practitioner, in his or her role as a health
care practitioner, intends to prescribe, order, administer,
furnish, or dispense a Schedule II, Schedule III, or Schedule
IV controlled substance to a patient and has not previously
prescribed a controlled substance to the patient.
35)Requires a health care practitioner to obtain a patient's
controlled substance history from the CURES database no
earlier than 24 hours before he or she prescribes, orders,
administers, furnishes, or dispenses a Schedule II, Schedule
III, or Schedule IV controlled substance to the patient.
36)Exempts veterinarians from the duty to consult the CURES
database.
37)Exempts health care practitioners from the duty to consult
the CURES database in any of the following circumstances:
a) If a health care practitioner prescribes, orders, or
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furnishes a controlled substance to be administered or
dispensed to a patient while the patient is admitted to any
of the following facilities or during an emergency transfer
between any of the following facilities:
i) A clinic licensed under the Department of Public
Health (DPH).
ii)An outpatient setting.
iii)A health facility, including acute care hospitals and
skilled nursing facilities.
iv)A county medical facility.
v) A dental place of practice.
b) If a health care practitioner prescribes, orders,
administers, furnishes, or dispenses a controlled substance
to a patient currently receiving hospice care.
c) Any time all of the specified circumstances are
satisfied. Requires the health care practitioner who does
not consult the CURES database under the circumstances to
document the reason he or she did not consult the database
in the patient's medical record. The required
circumstances are as follows:
i) It is not reasonably possible for a health care
practitioner to access the information in the CURES
database in a timely manner.
ii)Another health care practitioner or designee authorized
to access the CURES database is not reasonably available.
iii)The quantity of controlled substance prescribed,
ordered, administered, furnished, or dispensed does not
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exceed a nonrefillable five-day supply of the controlled
substance to be used in accordance with the directions
for use and no refill of the controlled substance is
allowed.
d) If the CURES database is not operational, as determined
by the Department of Justice (DOJ), or when it cannot be
accessed by a health care practitioner because of a
temporary technological or electrical failure. Requires a
health care practitioner to, without undue delay, seek to
correct any cause of the temporary technological or
electrical failure that is reasonably within his or her
control.
e) If the CURES database cannot be accessed because of
technological limitations that are not reasonably within
the control of a health care practitioner.
f) If the CURES database cannot be accessed because of
exceptional circumstances, as demonstrated by a health care
practitioner.
38)Requires that a health care practitioner who knowingly fails
to consult the CURES database, be referred to the appropriate
state professional licensing board solely for administrative
sanctions, as deemed appropriate by that board.
39)Provides that the requirement to consult the CURES database
does not create a private cause of action against a health
care practitioner.
40)Provides that the requirement does not limit a health care
practitioner's liability for the negligent failure to diagnose
or treat a patient.
41)Provides that the requirement is not operative until six
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months after the DOJ certifies that the CURES database is
ready for statewide use. Requires the DOJ to notify the
Secretary of State and the office of the Legislative Counsel
of the date of the certification.
42)States that all applicable state and federal privacy laws
govern the duties required by this bill.
43)States that the provisions of this bill, once they become
law, are severable. States that if any provision or its
application is held invalid, that invalidity shall not affect
other provisions or applications that can be given effect
without the invalid provision or application.
FISCAL EFFECT: According to the Senate Appropriations Committee
analysis, "No significant costs are anticipated by the
Department of Justice. The Department has almost completed a
substantial upgrade to CURES and anticipates that by July 2015
the system will have the capability to meet the demand expected
due to this bill. Minor costs to the relevant boards that
license prescribers, such as the Medical Board of California,
the Osteopathic Medical Board, and the Dental Board [are
anticipated]. Licensing boards will incur some additional cost
to notify their licensees of the new requirement to check CURES.
Those costs are expected to be minor for the impacted boards."
COMMENTS:
Purpose. This bill is co-sponsored by the Consumer Attorneys of
California and the California Narcotics Officers' Association .
According to the author, "According to the Centers for Disease
Control and Prevention, drug overdoses are the top cause of
accidental death in the United States. Nearly 23,000 people
died from an overdose of pharmaceuticals in 2013 nationally-
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more than 70 percent of them from opiate prescription
painkillers. The CURES database is an invaluable investigative,
preventative, and educational tool for law enforcement and the
healthcare community. The current voluntary approach has not
been able to attract sufficient participation to make it truly
effective. SB 482 requires all prescribers to consult the CURES
system before issuing Schedule II, III, and IV drugs. This will
enable prescribers to make informed decisions about their
patient's care and limit the number of people who doctor shop
and over use prescription drugs."
Background. Drug Schedules. According to the United States
Drug Enforcement Agency, drugs, substances, and certain
chemicals used to make drugs are classified into five distinct
categories or schedules depending upon the drug's acceptable
medical use and the drug's abuse or dependency potential.
Schedule I drugs have the highest potential for abuse while
Schedule V is the lowest.
------------------------------------------------------------------
|Schedule |Potential for |Accepted for |Examples |
| |Abuse |Medical Use | |
| | |in the United | |
| | |States | |
|--------------+---------------+--------------+--------------------|
|Schedule I |High potential |Not currently |Heroin, lysergic |
| |for abuse |accepted for |acid diethylamide |
| | |medical use |(LSD), marijuana |
| |Lack of |in the United |(cannabis), peyote, |
| |accepted |States |methaqualone, |
| |safety for use | |methylenedioxymetham|
| |of the drug | |phetamine |
| |under medical | |("ecstasy") |
| |supervision. | | |
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|--------------+---------------+--------------+--------------------|
|Schedule II |High potential |Currently |Hydromorphone |
| |for abuse |accepted for |(Dilaudid), |
| | |medical use |methadone |
| |Abuse may lead |in the United |(Dolophine), |
| |to severe |States |meperidine |
| |psychological | |(Demerol), |
| |or physical | |oxycodone |
| |dependence | |(OxyContin, |
| | | |Percocet), and |
| | | |fentanyl |
| | | |(Sublimaze, |
| | | |Duragesic), |
| | | |amphetamine |
| | | |(Dexedrine, |
| | | |Adderall), |
| | | |methamphetamine |
| | | |(Desoxyn), and |
| | | |methylphenidate |
| | | |(Ritalin) |
|--------------+---------------+--------------+--------------------|
|Schedule III |Potential for |Currently |Combination |
| |abuse is less |accepted for |products containing |
| |than schedule |medical use |less than 15 |
| |I and II drugs |in the United |milligrams of |
| | |States |hydrocodone per |
| |Abuse may lead | |dosage unit |
| |to severe | |(Vicodin), products |
| |psychological | |containing not more |
| |of physical | |than 90 milligrams |
| |dependence | |of codeine per |
| | | |dosage unit |
| | | |(Tylenol with |
| | | |Codeine), and |
| | | |buprenorphine |
| | | |(Suboxone) |
|--------------+---------------+--------------+--------------------|
|Schedule IV |Lower |Currently |Alprazolam (Xanax), |
| |potential for |accepted for |carisoprodol |
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| |abuse is less |medical use |(Soma), clonazepam |
| |than schedule |in the United |(Klonopin), |
| |III drugs |States |clorazepate |
| | | |(Tranxene), |
| |Abuse may lead | |diazepam (Valium), |
| |to limited | |lorazepam (Ativan), |
| |physical or | |midazolam (Versed), |
| |psychological | |temazepam |
| |dependence | |(Restoril), and |
| |relative to | |triazolam (Halcion) |
| |schedule II | | |
| |substances | | |
|--------------+---------------+--------------+--------------------|
|Schedule V |Low potential |Currently |Cough preparations |
| |for abuse |accepted for |containing not more |
| |relative to |medical use |than 200 milligrams |
| |schedule IV |in the United |of codeine per 100 |
| |substances |States |milliliters or per |
| | | |100 grams |
| |Abuse may lead | |(Robitussin AC, |
| |to limited | |Phenergan with |
| |physical or | |Codeine), and |
| |psychological | |ezogabine. |
| |dependence | | |
| |relative to | | |
| |schedule IV | | |
| |substances | | |
------------------------------------------------------------------
Prescription Drug Overdose Deaths. According to the Centers for
Disease Control and Prevention (CDC), drug overdoses are the top
cause of accidental deaths in the United States. Overdose
deaths involving prescription opioids have quadrupled since
1999, as well as sales of these prescription drugs.
Additionally, approximately 20 percent of prescribers prescribe
80 percent of all prescription painkillers.
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In the years spanning 1999 to 2014, over 165,000 people died in
the United States from overdoses related to prescription
opioids. During this time period, overdose rates were highest
among people age 25 to 54 years. Overdose rates were higher
among non-Hispanic whites and American Indian or Alaskan
Natives, compared to non-Hispanic blacks and Hispanics. In
addition, men were more likely to die from overdose, but the
mortality gap between men and women is closing.
CURES. In 1996, California enacted the first prescription
monitoring drug program in the United States. According to the
California Department of Justice, CURES is a database of
Schedule II, III, and IV controlled substance prescriptions
dispensed in California serving the public health, regulatory
oversight agencies, and law enforcement. Access to CURES is
limited to licensed prescribers and licensed pharmacists
strictly for patients in their direct care; and regulatory board
staff and law enforcement personnel for official oversight or
investigatory purposes.
CURES receives about one million prescription records per week.
The database contains approximately 400 million entries of
controlled substance prescriptions dispensed in California. The
system retains seven years of prescription data that is
de-identified.
As of February 5, 2016, there were 74, 258 registrants of the
CURES system. All California licensed prescribers authorized to
prescribe scheduled drugs are required to register for access to
CURES version 2.0 by July 1, 2016, or upon issuance of a Drug
Enforcement Administration Controlled Substance Registration
Certificate, whichever occurs later. Licensed pharmacists must
register for access to CURES 2.0 by July 1, 2016, or upon
issuance of a Board of Pharmacy Pharmacist License, whichever
occurs later (Health and Safety Code §11165.1). Use of CURES by
prescribers and dispensers for prescription abuse prevention or
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intervention is voluntary.
Other States. Forty nine states currently have prescription
drug monitoring programs. Approximately 24 states have mandates
for prescribers to check a state based prescription drug
monitoring system (National Alliance for Model State Drug Laws,
Reporting Requirements and Exemptions to Reporting, 2014).
Significantly improved public health outcomes have been seen in
states that have required prescribers to check their drug
monitoring systems. According to information obtained from the
CDC, in 2012, Tennessee required prescribers to check the
state's prescription drug monitoring program before prescribing
painkillers. Within one year, there was a 36 percent decline in
patients who were seeing multiple prescribers to obtain the same
drugs. In Virginia, the number of doctor shoppers fell by 73
percent after use of the database became mandatory. In
Oklahoma, which requires mandatory checks for methadone,
overdose rates dropped approximately 21 percent in a single
year.
There are current efforts to link PDMP systems nationwide. The
National Association of Boards of Pharmacies (NABP) InterConnect
system permits authorized PDMP users in participating states to
access interstate data by logging directly into the state PDMP
in which they are a registered user. Currently, 33 states,
excluding California, have PDMPs that are linked to the NABP
InterConnect system.
Current Related Legislation. AB 611 (Dahle) of the current
Legislative Session authorizes an individual designated to
investigate a holder of a professional license to apply to the
DOJ to obtain approval to access information contained in the
CURES PDMP regarding the controlled substance history of an
applicant or a licensee, for the purpose of investigating the
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alleged substance abuse of a licensee. Clarifies that only a
subscriber who is a health care practitioner or a pharmacist may
have an application denied or be suspended for accessing
subscriber information for any reason other than caring for his
or her patients. Specifies that an application may be denied,
or a subscriber may be suspended, if a subscriber who has been
designated to investigate the holder of a professional license
accesses information for any reason other than investigating the
holder of a professional license. STATUS: The bill is
currently pending in the Senate Committee on Business,
Professions and Economic Development.
Prior Related Legislation. SB 500 (Lieu) of 2014, would have
required the MBC to update prescriber standards for controlled
substances once every five years and add the American Cancer
Society, specialists in pharmacology and specialists in
addiction medicine to the entities the MBC may consult with in
developing the standards. STATUS: The bill was amended to deal
with a different subject.
SB 1258 (DeSaulnier) of 2014, would have made several changes to
the ways that controlled substances are prescribed and tracked
in CURES and would have required medical providers to use
electronic prescribing systems, would have required additional
reporting of controlled substance prescribing, and would have
placed additional restrictions on the prescribing of controlled
substances. STATUS: The bill was held in the Senate Committee
on Appropriations.
SB 809 (DeSaulnier), Chapter 400, Statutes of 2013, established
a funding mechanism to update and maintain CURES, required all
prescribing health care practitioners to apply to access CURES
information, and established processes and procedures for
regulating prescribing licensees through CURES and securing
private information.
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SB 616 (DeSaulnier) of 2012, would have increased fees, up to
$10 per licensee authorized to prescribe or dispense controlled
substances, to fund CURES. STATUS: The measure failed passage
in the Assembly Committee on Business, Professions and Consumer
Protection.
SB 360 (DeSaulnier), Chapter 418, Statutes of 2011, updated
CURES to reflect the new PDMP and authorizes DOJ to initiate
administrative enforcement actions to prevent the misuse of
confidential information collected through CURES.
SB 1071 (DeSaulnier) of 2010, would have imposed a tax on
manufacturers or importers of Schedule II, III and IV controlled
substances to pay for ongoing costs of the CURES program. Fees
would have been collected by the BOE, at the rate of $0.0025 per
pill included in Schedule II, III, and IV. STATUS: The bill
was held in the Senate Committee on Health.
AB 2516 (Mendoza) of 2008, would have required a doctor to
ensure that any prescription he or she make be electronically
transmitted to a patient's pharmacy of choice. STATUS: The
measure was never heard in a policy committee of the
Legislature.
AB 1298 (Jones), Chapter 699, Statutes of 2007, sought to
protect the privacy of personally identifiable unencrypted
medical and health insurance information by requiring any state
agency or business that operates in California to inform any
potentially affected state resident of the loss of that
individual's health information. The bill also prohibited any
organization that holds electronic personal health record data
from disclosing that information without patient consent.
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ABX1 (Nunez) of 2007, would have required that by January 1,
2012 all prescribers, prescribers' agents, and pharmacies, have
ability to transmit and receive e-prescriptions, and would have
given licensing boards the authority to enforce this
requirement. STATUS: The measure failed passage in the Senate
Committee on Health.
AB 2986 (Mullin), Chapter 286, Statutes of 2006, required
designated prescription forms for controlled substances and
prescriptions for controlled substances to contain additional
information identifying the final consumer and any refill
information.
SB 734 (Torlakson), Chapter 487, Statutes of 2005, authorized
tamper resistant online access to the CURES system for
authorized physicians, pharmacists and law enforcement, pending
the acquisition of private funding.
SB 151 (Burton), Chapter 406, Statutes of 2004, made CURES
permanent, among other provisions.
AB 3042 (Takasugi), Chapter 738, Statutes of 1996, established
CURES as a three-year pilot program.
ARGUMENTS IN SUPPORT:
The American Insurance Association supports the bill and writes,
"CURES in a PDMP, and such programs have been shown to improve
and control the prescription of narcotic pain killers, assist
clinical practices, protect patients and improve outcomes. The
CURES database collects and makes available to prescribers
information about prescriptions of controlled substances."
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CalChamber also supports the bill and writes, "SB 482 ? requires
all prescribers to check California's CURES database to verify
that patient does not have an existing prescription for an
opioid pain killer or other Schedule II or III medication before
renewing or issuing a new prescription?This simple safeguard
will make it easier for physicians to identify high-risk
patients, discourage "doctor shopping"? and shine a much needed
light on the handful of prescribers that are responsible for the
vast majority of these inappropriate Schedule II and III
prescriptions."
The Teamsters support the bill and write in their letter, "It's
time we took decisive action to prevent prescription drug
addiction? SB 482 will help prevent this practice and help
identify those individuals at risk so they can get appropriate
treatment for their addiction."
The Center for Public Interest Law (CPIL) writes in support,
"California should join the growing list of states that require
prescribers and dispensers to consult with their PDMP before
prescribing addictive narcotics. CPIL urges your support for SB
482."
Consumer Watchdog shares their support, "Experience in
California and other states shows that the databases will seldom
be used when they are not mandatory. According to the
California Department of Justice, just 50,000 (less than 25%) of
all eligible prescribers are currently signed up for the CURES
database, let alone consulting it. This is a tragic failure of
the system for which patients?pay the price."
NAMI California supports the bill and writes, "This bill is a
common sense measure?Many individuals living with mental illness
see multiple providers for legitimate reasons, including
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difficulty obtaining timely mental health provider appointments,
housing instability, and the frequency of inpatient
hospitalizations. This can result in a multitude of
prescriptions, which would be better monitored through a
mandated use of CURES."
ShatterProof writes in support, "California has always led the
way for the rest of the country on policy issues, and SB 482 is
a bill that does just this. The bill has almost universal
community support, and is an important step toward ending the
devastation to our youth, our families and our communities."
ARGUMENTS IN OPPOSITION:
The California Medical Association opposes the bill for several
reasons including:
44)The language regarding frequency of checking the CURES
database is confusing.
45)The bill allows the Department of Justice to make the
determination that the database if ready to handle the duty to
consult requirement. We recommend that the state Chief
Information Officer be designated to make that determination.
46)The bill must increase the frequency of reporting of
prescribing information to every 24 hours.
47)The language establishing that Section 11165.4 does not limit
a practitioner's liability for negligent failure to diagnose
or treat a patient.
48)We continue to seek amendments to clarify the CURES
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disclosure and privacy structure.
49)California is one of three states that have a prescription
drug monitoring program housed in a law enforcement entity.
IMPLEMENTATION ISSUES:
1)The bill requires that a prescriber check the CURES system at
least annually after initially prescribing a Schedule II, III,
or IV substance to a patient. This may be burdensome for
prescribers who have patients who are taking multiple drugs
which are prescribed at various points in time.
2)Presently, the Centers for Diseases Control and Prevention
recommend that emergency room personnel prescribe no more than
three days of drugs to patients. This bill would allow an
emergency room prescriber to prescribe ten days of drugs- more
than three times the amount of time that the Centers for
Disease Control and Prevention recommend.
AMENDMENTS:
1)In response to implementation issue number 1 raised above, the
author should amend the bill to require that prescribers check
the database, at least once every four months, if they have
prescribed any Schedule II, III, or IV drugs to a patient.
2)In response to implementation issue number 2 raised above, the
author should amend the bill to require that emergency room
personnel prescribe no more than seven days of Schedule II,
III, or IV substances.
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REGISTERED SUPPORT:
Consumer Attorneys of California and California Narcotics
Officers' Association (co-sponsors)
American Insurance Association
California Chamber of Commerce
California Teamsters Public Affairs Council
Center for Public Interest Law
Consumer Watchdog
National Alliance on Mental Illness
ShatterProof
REGISTERED OPPOSITION:
California Medical Association
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Analysis Prepared by:Le Ondra Clark Harvey Ph.D. / B. & P. /
(916) 319-3301