CDA-supported bills modify opioid prescribing, CURES requirements

At least 130 bills to combat the nation’s opioid epidemic have been introduced in U.S. Congress since January, as the ADA reported in March when it unveiled its national policy on opioid prescribing.

California is simultaneously mounting its own legislative efforts to curb opioid abuse. CDA has identified 19 bills in the current session that can be classified into five main categories of opioid legislation: prescribing/dispensing, continuing education, CURES 2.0 — California’s prescription drug monitoring program, insurance and resolutions. Among these, CDA is taking an official support position on five bills and a support if amended position on a sixth. A summary of the bills and how they may impact the way dentists practice and prescribe follows.

CURES 2.0 and interstate prescription data sharing

AB 1751 by Assemblymember Evan Low (D-San Jose) authorizes the California Department of Justice to participate in an interstate data share hub for the purpose of sharing information in prescription drug monitoring programs across state lines.

The bill would link CURES 2.0, California’s prescription drug monitoring program, with drug monitoring databases in other states while ensuring that patient privacy remains adequately protected. The bill requires that any interstate access meets data security standards and complies with California law.

All prescribing dentists were required to register to use CURES 2.0 by July 2016. Beginning Oct. 2, 2018, prescribers must check a patient’s prescription history in the database before prescribing a Schedule II-IV substance, with some notable exceptions outlined in previous CDA member communications (read “Mandatory checks in CURES take effect Oct. 2”).

But CURES 2.0 only contains records of controlled substance prescriptions dispensed within California; prescriptions dispensed in Nevada and Oregon, for example, are not accessible to prescribers in California, nor are California prescriptions visible to out-of-state prescribers.

“Enhancing CURES to allow California’s prescribers, dispensers, regulators and law enforcement to share information across state lines will help curb the overprescribing of controlled substances and prevent ‘doctor shopping,’” CDA wrote in a letter of support. CDA also testified at the April 10 Assembly Business and Professions Committee hearing, where the bill passed unanimously.  

CURES 2.0 data reporting and access

Also authored by Low, AB 1752 proposes two significant changes: It adds Schedule V controlled substances to the CURES 2.0 database, noting an increase in theft and abuse of these drugs, and requires a dispensing pharmacy, clinic or other dispenser to report dispensed prescriptions no later than one working day after the controlled substance is dispensed.

Changing the reporting timeline from the current seven days after a prescription is dispensed to the next business day allows for “more real-time access to data used to prevent drug abuse” and provides dentists and other prescribers “with an even more powerful tool for saving lives from drugs like opioids,” Low’s office states in the bill’s fact sheet.

Another CURES-related bill, AB 2086 (Gallagher, R-Yuba City), would allow a prescriber of controlled substances to request from the Department of Justice a list of patients for whom he or she is named as a prescriber.

While dentists and other controlled substance prescribers can monitor the prescription history of their individual patients in the CURES database to help reduce prescription “shopping” and abuse, prescribers do not have the ability to see a list of all patients who have identified them, correctly or falsely, as having written a prescription for them.

CDA Supports AB 2086 for its intent to help prevent fraudulent prescriptions by “allowing providers to access their own prescribing history in order to verify accuracy,” CDA states in a letter of support. The bill unanimously passed the Assembly Business and Professions Committee.

Informed consent requirement

Assembly Bill 2741 (Burke, D-Inglewood) requires prescribers to provide specific information when prescribing opioid medication to minors and would not allow the provider to prescribe more than a five-day supply of an opioid medication to minors except in specified instances. The bill requires that providers obtain a standardized written consent form from an authorized adult.

Under the current iteration of the bill, the Medical Board of California would create the informed consent. CDA is advocating for the Dental Board of California to draft, with CDA’s assistance, a dentistry-specific informed consent form to be provided to dental patients. CDA expects this amendment to be folded into the bill in its next iteration and will take an official support position on the bill at that time.

Opioid antagonists and law enforcement

Under current state law, any individual can purchase an opioid antagonist, such as naloxone hydrochloride, at a pharmacy without a prescription for the purpose of reversing an opioid overdose. Law enforcement agencies can also purchase naloxone under current law, but not without a prescription.

Assembly Bill 2256 (Santiago, D-Los Angeles) would authorize a pharmacy or wholesaler to furnish naloxone hydrochloride or other opioid antagonists to law enforcement agencies without a prescription. The Los Angeles Sheriff’s Department, noting an initial weekslong delay in acquiring naloxone for its officers to administer in the field, also supports the bill.

Patrol officers frequently are first responders in opioid overdose situations. “CDA wholeheartedly supports this bill” for allowing law enforcement to “stabilize the condition of the overdose victim until paramedics arrive,” CDA states in a letter of support to the Assembly Public Safety Committee chair. 

Resolution recognizes impact of opioids

In connection with Opioid Overdose Death Awareness Week, SCR 115 (McGuire, D-Healdsburg) creates a resolution to recognize the impact that opioid-related deaths have had on California communities and encourages the state to increase funding for support and other programs in rural areas facing the epidemic. SCR 115 supports groups and organizations working in California to combat the opioid epidemic. The resolution designates the first week of March as Opioid Overdose Death Awareness Week.

As national attention on the opioid epidemic grows, CDA believes it is important that California continue to lead the way in more responsive policy. In addition to actively supporting bills, CDA is keeping a close watch on another eight opioid-related bills and may take support or oppose positions as the bills develop and move through the Legislature.

CDA will keep members informed of the status of opioid-related legislation in the CDA Update and on cda.org. For articles and resources on CURES and opioid prescribing, visit cda.org/opioid.

Related Items

The Department of Justice announced that California’s Controlled Substance Utilization Review and Evaluation System, also known as CURES 2.0, is ready for statewide use and that mandatory CURES consultation becomes effective Oct. 2, 2018. Beginning on this date, prescribers must check a patient’s prescription history in CURES 2.0 before prescribing a Schedule II-IV substance, with some exceptions.

The ADA on March 26 adopted a new policy to combat the opioid epidemic, calling it the potential first of its kind by a major health professional organization to support mandates on opioid prescription limits and continuing education. “I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” said ADA President Joseph P. Crowley, DDS, in a press release. The Interim Board Policy on Opioid Prescribing addresses continuing education, dosage and duration, and prescription and drug monitoring.