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PRACTICE TIPS

Using CURES to Monitor Prescription Drug Use By John McCarthy, MD President, ACap Asset Management, Inc. This article originally appeared in the May/ June 2011 issue of Sierra Sacramento Valley Medicine. California is one of many states with a Prescription Drug Monitoring Program called CURES (Controlled Substances Utilization Review and Evaluation System). It tracks prescriptions of all scheduled substances, including names and addresses of patients, prescribing physician, and pharmacies. This program offers us the opportunity to know the past year of prescription use history of any patient we treat. As an addiction specialist using methadone and buprenorphine to manage opiate addiction, I have found it helpful in identifying patterns of use that assist in the diagnosis of opiate addiction — at least in those where prescriptions are the source of the drugs. And it helps detect those few who continue overuse of prescription meds in spite of treatment. In our case, this usually involves benzodiazepine prescriptions. So, the CURES program has become a regular part of our initial evaluation and on-going assessment. This program should also be incorporated into all practices with high risks for dealing with opiate and benzodiazepine addictions, such as primary and urgent care clinics, pain clinics, and ER departments. That said, this information can be misused to just kick patients out of our offices and ERs. Our job as physicians is to screen, do a brief intervention, and refer for treatment. Addicts are patients in need of help, but first they must be diagnosed and non-judgmentally engaged in a discussion of

treatment options. Showing a patient pattern of overuse of prescription drugs can be the first step in helping them to recover. The system is now close to real time, i.e., we can see very recent prescriptions. It is statewide, and there are plans at the federal level for an integrated nationwide system. Once a physician registers in the system, a patient name and address will lead to a Patient Activity Report (PAR). Access to the system requires registering on the state Bureau of Narcotic Enforcement (BNE) website, and providing notarized physician or AHP credentials to BNE for review and approval. One of our UCD psychiatry residents, rotating through Bi-Valley for addiction medicine training, got a CURES report in the course of an assessment of anxiety in one of our patients. She discovered that the patient got 16 benzodiazepine prescriptions from 10 different doctors in a one-month period and was taking at least 10-15mg/day of Xanax and/ or Klonopin. We got releases for the two doctors we knew to advise them of the situation, but most were ER docs and we haven’t figured out how to deal with ERs. We tried to start a controlled detox from benzos, but the patient left treatment and is no doubt still visiting ERs. Most of our CURES interventions have better outcomes. There is an epidemic of prescription drug abuse locally and nationally, and while doctors

14 | THE BULLETIN | SEPTEMBER / OCTOBER 2011

are not the primary source of all the pills out there (the cartels are dealing pills as an avenue to heroin), doctors in certain practice settings are constantly bombarded with requests for pain meds and benzodiazepines. CURES can help us in our efforts to provide appropriate medications for those who need them and appropriate diagnosis for those needing addiction treatment.

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2011 September/October  

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