DUE DILIGENCE

SB 482 (Lara) is one of many bills whose fate rests with Governor Brown.

The bill is essentially a due diligence bill. Prescribing doctors would be required to check a database before prescribing or continuing opioids under certain circumstances.

There are several well-publicized concerns surrounding opioid prescriptions. One concern is that some patients might be getting prescriptions from multiple providers, thus raising the possibility of overdoses. Another concern is that some patients could obtain supplies from multiple sources and sell or divert the medications.

I’ve had several injured worker clients die due to overdoses, so when I hear stories in the media about prescription drug abuse, the problem is not just theoretical. The circumstances surrounding the demise of those workers was somewhat unclear, but keeping better track of who is getting what seems like a no brainer.

SB 482 would require a health care practitioner to consult the CURES database to review a patient’s controlled substance history no earlier than 24 hours (or the previous business day) before prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient for the first time.

The health care practitioner would be required to check the CURES database once every four months thereafter.

Pharmacists are exempted, as is hospice care , care provided under certain surgical situations, certain care prescribed in an ER of an acute care hospital, and certain situations where the physician determines that consulting CURES would result in an inability to obtain a prescription in a timely manner and “thereby adversely impact the patient’s medical condition”.

Failure to consult the CURES database could have professional license consequences. Provisions are made for exceptions in the event of inability to access the CURES system.

The CURES database system is established under Health and Safety Code 11165, which provides for electronic transmission of controlled substance prescription information to the Department of Justice. Prescribing practitioners are required to apply for participation in CURES under H&S Code 11165.1.

Implementation of the bill is subject to DOJ certification that the CURES database is ready for statewide use.

A second generation of CURES became operational in 2015.

Support for SB 482 has been broad. The bill passed out of the Assembly on an 84 to 0 vote. The California Senate voted 38 to 1 in favor of the bill.

According to the August 30 Senate analysis of the bill, the only verified opponents are the Association of Northern California Oncologists, the US Oncology Network and The Doctor’s Company, a major liability insurer for physicians and surgeons.

Given the overwhelming bipartisan support,I would expect Governor Brown to sign this bill. He has until the end of September to act.

Concern about opioids has been growing in the comp system, and this is one component of a strategy to deal with possible abuse. Other components of that are the recently adopted Chronic Pain Medical Treatment and Opioid Treatment Guidelines (effective July 28, 2016) and the prescription drug formulary which is under development by the DWC.

Here is a link to the California legislative website which contains the text of SB 482 and the legislative analysis:

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB482

Here are the Chronic Pain Medical Treatment and Opioid Treatment Guidelines:

http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Opioids-ChronicPain/MTUS-Opioids-ChronicPain.htm

Here is the DWC page on the formulary. The comment period ends September 16:

http://www.dir.ca.gov/dwc/ForumDocs/Implementing-AB-1124-Drug-Formularyand-update-of-MTUS-Guideline/Implementing-AB-1124-Drug-Formularyand-update-of-MTUS-Guidelines.htm

Stay tuned.

Julius Young