I first became aware of the CURES program a few years ago, after a psychiatrist left a voicemail warning me that patient X, to whom I had been prescribing a controlled substance, was receiving the same drug not only from him, but, he had recently learned, from a pharmacist using a state database, also from a third physician.
Thinking that it would be extremely helpful to have the almost magical capacity to learn which patients are not telling the truth about their medications, I enrolled in the CURES program. CURES gives the physician the capacity to review the details of every controlled substance prescription the patient has received within the last 12 months: name of drug, strength, number of pills, date of prescription, name of the prescribing physician, and dispensing pharmacy.
The following signs suggest the need for consultation with the patient’s previous physician:
- The patient is taking high doses of controlled substances.
- The patient is using greater than the maximum dosage of a medication
- The patient has seen several different physicians, sequentially, for their prescriptions.
The worst-case scenario, and precisely what the CURES is designed to prevent, is the patient seeing multiple physicians at the same time, receiving prescriptions for identical medications, and filling them at different pharmacies. For example, a patient I was asked to see had received prescriptions from 16 physicians in the last 12 months, had them filled at 16 different pharmacies, and had a 60 day prescription for the maximum dose of a schedule II controlled substance filled, then one week later another 60 day prescription for the same drug filled, then 4 days later a 120 day prescription for the same drug filled by a different physician, and then a 60 day prescription filled 18 days later, receiving 9 months supply of the drug, at its maximum dosage, in less than 30 days.
I routinely screen all patients who receive controlled substance prescriptions, and 98-99% of the time I find nothing of concern.
Until recently, I screened all new patients a few minutes before interviewing them. But for the 1-2% where there is a problem, this is inefficient. When I tell patients that I have concerns about their prescription drug use, and that I want to consult their previous physicians before prescribing for them, they invariably leave my practice. Occasionally they take the time to post critical reviews on Yelp. Perhaps a better way of proceeding would be to screen the patient after scheduling their appointment, but well before their actual visit, so that if their profile raises concerns, there is time to ask them to please send me their previous physicians’ records to review before their appointment. This would give them the option of cancelling their appointment, saving them money, time, and aggravation.