CURES

CURES: Mandatory Use

The mandatory use or consultation requirement means that unless an exemption exists in law, a physician must query the CURES database and run a Patient Activity Report (PAR) on each patient the first time a patient is prescribed, ordered, or administered a Schedule II-V controlled substance. The PAR must be run within twenty-four hours, or the previous business day, before prescribing, ordering, or administering the controlled substance. In addition, a physician must also query the database at least once every four months if the controlled substance remains a part of the patient’s treatment plan.

‘First time’ is defined as the initial occurrence in which a health care practitioner intends to prescribe, order, administer, or furnish a Schedule II-V controlled substance to a patient and has not previously prescribed a controlled substance to the patient.

Consulting CURES means the physician prescribing, ordering, administering, or furnishing the Schedule II-V controlled substance has received a Patient Activity Report (PAR) and has reviewed the information on the document. A delegate conducting a PAR on behalf of the physician will also satisfy this requirement.

If a physician consults CURES, it is not required to note it in the patient’s file; however, the Board recommends the physician do so. It is up to the physician to determine how to document that he or she consulted CURES, e.g., document it in the chart or print the report and place it in the patient’s file.

Most exemptions do not require a physician to document that he or she did not consult CURES because an exemption applied; however, the Board still recommends that a physician document the patient’s record with the reason for not consulting CURES.

Documentation of an exemption is required if it is not reasonably possible for a physician to access the information in the CURES database in a timely manner, another physician, who can access the CURES database, is not reasonably available, and the quantity of the controlled substance does not exceed a non-refillable five-day supply of the controlled substance.

Yes, the CURES Program has the ability to audit the activity of users within the system and the Board has access to this activity.

The Board can receive information about non-compliance through a number of ways. The Board may receive a complaint from a patient, another licensee, or any other source that the physician is not consulting CURES as required. In addition, during the review of any investigation into a physician’s care and treatment, the investigator, as part of the investigation process, will ensure CURES was consulted prior to prescribing, ordering, administering, or furnishing controlled substances as required by law.

Failing to consult CURES is a violation of the law and it could result in the issuance of a citation and fine, or it could be a cause of action in an accusation that leads to disciplinary action. Disciplinary action could be a public reprimand, suspension, probation, or revocation. Each violation of the law is reviewed on a case-by-case basis.

Please see DOJ’s October 14, 2022, memo that discusses delegate eligibility and access to CURES.

It is the Board’s recommendation that you review the specific sections of law for each of the facility types and determine if your facility is exempt while the patient is admitted to your facility or if the patient is seen at your facility for a surgical procedure. You may choose to seek legal counsel to assist in your review of the appropriate sections of law.

To assist with your review, here are the specific links for each facility type where an exemption may apply:

• Licensed clinic
• Outpatient setting
• Health facility
• County medical facility
• Place of practice

Yes, each physician is required to consult the CURES database prior to prescribing, ordering, or administering.

Yes, you must consult CURES unless one of the exemptions apply. Even if the other physician recently consulted CURES, if this is the first time you prescribed to the patient or is over six months from the last time you consulted CURES for this patient for this controlled substance, you must consult CURES.

Yes, the physician must consult CURES. The law states that a physician, who previously had an exemption, must consult the CURES database prior to subsequently prescribing a Schedule II-IV controlled substance to the patient and at least once every four months thereafter if the substance remains part of the treatment of the patient.

If you have not previously consulted CURES, you would be required to consult CURES at discharge no matter the number of days supplied. The exemption only pertains to controlled substances administered while the patient is admitted to or during emergency transfer between facilities specified in law.

According to the law, if the prescription is part of the patient’s treatment for the surgical procedure, the physician does not need to consult CURES as long as the supply does not exceed a nonrefillable five-day supply.

The physician needs to follow the standard of care when reviewing the patient’s controlled substance history. It is important that the patient receive appropriate care, which could include substance abuse treatment, discussion regarding pain management, titration of controlled substances, etc., depending upon the circumstances.

In addition, if a physician believes another physician is excessively prescribing controlled substances to a patient, the Board recommends that you report that physician to the Board for appropriate action.

The law requires complete compliance unless there is an exemption. The Board will review each violation on a case-by-case basis and take action as appropriate.

No, this is not a new ‘controlled substance’ as it is still the same drug, just a different dosage and therefore another check is not required for four months if that controlled substance remains a part of the patient’s treatment.

The law says the physician must consult the CURES database, which means the physician must log into the database, or access a health information technology system if it is integrated with the CURES database, to view a PAR. If the pharmacist is a delegate conducting a search for a Patient Activity Report while acting on behalf of the physician, that physician has met the mandatory consultation requirement for that instance.

While you may not prescribe that often, the law requires that if you have a DEA registration that authorizes you to prescribe Schedules II - IV controlled substances, you must be registered in CURES. Here is a link to a website regarding CURES registration.

In addition, as of October 2, 2018, the first time you prescribe a Schedule II - IV controlled substance to a patient, you must consult the CURES database prior to prescribing, with limited exemptions. You must also consult CURES every 4 months thereafter if that controlled substance remains a part of the patient's treatment. Visit our CURES Mandatory Use page for more information regarding that requirement.

If a physician holds a renewed and current license in California and is authorized to prescribe Schedules II-IV controlled substances in California, they must be registered in the CURES Program. In addition, if the physician is prescribing to a California patient (potentially via telemedicine), the physician would have to consult CURES unless one of the specified exemptions applied.