Legislation, CDA Presents lecture, address prescription opioid abuse and CURES

While some recent studies put the percentage lower, the major studies cited today say dentists write 11 to 12 percent of immediate-release prescription opioids annually in the U.S. That’s fewer prescriptions than physicians write, but not by much. Perhaps more critically, oral surgeons write the majority of opioid prescriptions to patients who are in a particularly vulnerable age range: the 10- to 19-year-olds. Research says these patients’ brains are still developing and thus are more prone to addiction, and the patients are more likely to misuse opioids as adults.

The U.S. Department of Health and Human Services last fall declared the opioid crisis a public health emergency. But with no additional funding to combat the crisis, California and other states are still struggling to curtail the number of deaths and hospitalizations due to opioid overdose and to stem the flow of headline-making stories about lives and households upended by addiction. Opioid overdoses account for more than 1,900 deaths in California in 2016, according to California Department of Public Health data.

On the legislative front, in California alone, more than two dozen bills that address opioid prescription and misuse are working their way through the Legislature, including several by Assemblymember Jim Wood, DDS.

Some of these bills seek to limit access to Schedule II-IV controlled substances through, for example, shorter-term prescriptions — three days instead of the common 30 days. Extending the prescription beyond the three-day limit would require that the prescribing health care provider justify the continued drug treatment in the patient’s medical record.

Other bills would add security layers, such as serial numbers, to prescription forms for controlled substances and call for the Department of Justice to restrict the number of approved printers to three. Additionally, printers would be required to submit specific information to the DOJ for any prescription forms they deliver.

Assembly Bill 2760 (Wood, D-Healdsburg) would require opioid prescribers to co-prescribe for qualifying patients a medication that is used to rapidly reverse respiratory depression and other effects of opioids. The health care provider would “prescribe naloxone hydrochloride for patients when certain conditions are present and to provide specified education to those patients and their household” states the text of the bill.

“Many bills in the current legislative session are designed to help lift California out from the opioid epidemic,” said CDA Government Affairs Council Chair John Blake, DDS. “Some propose similar changes and actions but take different approaches to accomplishing them. CDA is engaging with bill authors and other stakeholders and is expected to take a position on one or more pieces of legislation in the coming weeks.”

Along regulatory lines, the Dental Board of California in January issued an email reminding dentists that “all health care practitioners authorized to prescribe or dispense Schedule II-IV controlled substances were required to register to use CURES 2.0 no later than July 1, 2016.” CURES 2.0 is the state’s Controlled Substance Utilization Review and Evaluation System, a database that aids prescribers and dispensers in identifying fraudulent activity and is intended to reduce prescription drug abuse and diversion.

Beginning Oct. 2, prescribers will be required to check a patient’s prescription history in the CURES 2.0 database prior to prescribing a Schedule II-IV substance in certain situations, with some exemptions. This requirement, as mandated by Senate Bill 482, was signed into law in by Gov. Jerry Brown in 2016.

CDA Presents course on legal and clinical considerations of prescribing

CDA continues to provide education and resources on opioid prescribing to members and dentists throughout California.

In May at CDA Presents The Art and Science of Dentistry in Anaheim, CDA Public Affairs will host “Clinical and Legal Considerations for Prescribing Controlled Substances.” Led by Michael J. Bundy, PharmD, DMD, MD, and Tony J. Park, PharmD, JD, the course will show dentists how to develop a plan for acute pain control for their patients, helping to safely and effectively manage pain while at the same time preventing the overprescribing of narcotic pain medication.

"Non-steroidal anti-inflammatory drugs, or NSAIDs, such as Ibuprofen, should be first-line therapy for acute pain control in dentistry,” says Bundy, who works in the maxillofacial surgery department at Kaiser Permanente Los Angeles. He says the effectiveness of NSAIDs is “often underestimated,” and as part of the course, he will teach dentists how to optimize their use in pain control. 

Bundy and Park have co-presented this lecture at past meetings, but have updated the course material to reflect recent statistics as well as the latest legal and regulatory developments, particularly with respect to CURES 2.0.

Course attendees will receive step-by-step instructions for accessing CURES 2.0 along with a review of legitimate medical purposes for prescribing and many examples of what to watch out for — red flags for drug-seeking behaviors.

“If the patient asks to be seen immediately, claims to live out of town or describes or exaggerates dental symptoms that are not corroborated by a physical exam … these are a few red-flag behaviors a patient might exhibit,” says Park. He adds that these red flags merely serve as “notice” to the prescribing dentist or health care provider of the possibility of abuse, addiction or diversion.

During the course, attendees will see a sample "patient/client activity" page from the CURES database. When accessing a patient’s or client’s record in the database, prescribers can look for additional red flags such as duplicate prescriptions, prescriptions in high strength or quantity and the use of multiple pharmacies.

“CURES 2.0 may not yet be ready for mandatory checks, but dentists with DEA numbers must still be registered to use it and can immediately start checking the database before prescribing a controlled substance in their practice,” Park says.

“Clinical and Legal Considerations for Prescribing Controlled Substances” takes place Saturday, May 19, from noon to 2:30 p.m., is open to the entire dental team and offers 2.5 core C.E. units.

Register for or learn more about the lecture. Find additional opioid and CURES resources at cda.org/opioid. CDA will keep members informed of legislative developments in the Update and at cda.org.

Related Items

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.

“All health care practitioners authorized to prescribe or dispense Schedule II-IV controlled substances were required to register to use CURES 2.0 no later than July 1, 2016,” the Dental Board of California reminds dentists in an email distributed late January. California’s Controlled Substance Utilization Review and Evaluation System aids prescribers and dispensers in identifying fraudulent activity and is intended to reduce prescription drug abuse and diversion.

With the U.S. Department of Health and Human Services on Oct. 26 declaring the opioid crisis a public health emergency, CDA reminds dentists, who prescribe approximately 11 percent of prescription opioids annually, of the resources available to them. CDA’s online opioid resource guide at cda.org/opioid is regularly updated with links to resources as they are published.