The opioid epidemic is real, and it is a big issue. There is a percentage of the population who becomes addicted after a single surgical procedure. There is a new program called CURES, put out by the California Department of Justice. It creates a database to look at opioid prescriptions, with the goal being to reduce prescription drug abuse without affecting legitimate medical patient care needs.
CURES must be consulted when
- A patient is first prescribed a controlled substance unless an exemption applies.
- A patient renews, every four months, if it is part of their treatment plan.
What is exempt?
- An emergency transfer between a licensed clinic, outpatient healthy facility, or a county medical facility
- In the ER of an acute care hospital and the amount does not exceed a non refillable 7 day supply
- A patients treatment for a surgical procedure and it does not exceed a non refillable 5 day supply, when the surgery is done at a licensed clinic, outpatient setting, place of practice, health facility, or county medical facility.
- Hospice care.
So what does this mean for my patients?
- I have to use tamper resistant prescription forms (I already do.) I cannot “call in” a pain medication.
- For surgical patients I can only prescribe a non refillable 5 day supply. (all narcotics are non-refillable already)
This program is new. I don’t know exactly how I will be registered and recording the information. I don’t know what they consider a 5 day supply. Some of my surgeries require more pain medication than others, and pain tolerance can vary between patients. As I get more information and training, I will update you. I think the overall program will be good- these medications are addicting. One should get off the medications as quickly as possible, and seek alternative non addicting pain medications when possible. In plastic surgery we need narcotics. Many of my surgeries have bleeding as a potential complication, so we rely on narcotics for pain relief. When possible, I add numbing agents and muscle relaxants to reduce the narcotic amount needed.
Kaiser has already implemented a plan to restrict pain medications, and they cap the number of pills. They used to give pills after surgery with a one month supply (! I have always aimed for a one week supply) When analyzing their new lower pill program, they found
- 30 percent reduction in prescribing opioids in high doses
- 98 percent reduction in number of prescriptions with greater than 200 pills
- 90 percent decrease in opioid prescriptions with benzodiazepines and carisoprodol
- 72 percent reduction in prescribing of Long Acting/Extended Release opioids.