9.1 CURES: Registration, the Duty to Consult, and the Exemptions Dentists Use Most

What CURES is

The Controlled Substance Utilization Review and Evaluation System (CURES) stores every dispensed Schedule II–V prescription in California. Pharmacies, clinics, and other dispensers report each one within one working day of release to the patient (Health and Safety Code § 11165(d)). Prescribers use a patient's patient activity report to spot doctor shopping, overlapping opioids and benzodiazepines, and dangerous total doses. The outline tests it directly: "Knowledge of laws for using CURES" (K1181).

Registration

Under § 11165.1(a)(1)(A), a practitioner authorized to prescribe, order, administer, furnish, or dispense Schedule II–V drugs must apply for CURES access when they receive a federal DEA registration. A dentist who holds a DEA registration must register, even if they rarely prescribe controlled substances. Access is for the prescriber's own patients. Looking up a neighbor, relative, or employee is a privacy violation.

The duty to consult (§ 11165.4)

Schedule V drugs are reported to CURES but are not covered by the mandatory-consult rule. Common dental examples by schedule:

• Schedule II: hydrocodone combination products and oxycodone.
• Schedule III: acetaminophen with codeine.
• Schedule IV: tramadol, and benzodiazepines such as triazolam or diazepam used for anxiety or oral sedation.

Exemptions (§ 11165.4(c))

The duty does not apply when:

1. The drug is administered to the patient in a licensed clinic, outpatient setting, health facility, county medical facility, health care practitioner's office, or correctional clinic, or during a transfer between them. An example is an oral sedative given in the office before a procedure.
2. The drug is prescribed for a surgical, radiotherapeutic, therapeutic, or diagnostic procedure, the quantity is a nonrefillable supply of seven days or less, and the procedure is performed at a listed facility, which includes a dental office ("place of practice" under B&P § 1658). This is the exemption dentists use most often, for example three days of hydrocodone-acetaminophen after surgical extractions.
3. The prescription is for an emergency-department patient with a nonrefillable supply of seven days or less, or for buprenorphine in an emergency department.
4. The patient is terminally ill.
5. CURES cannot be accessed in time, no other authorized user is available, and the supply is a nonrefillable seven-day supply or less. Document the reason.
6. CURES is not operational, or technological limits outside the prescriber's control prevent access. The prescriber must work to fix any failure within their control.
7. Checking would delay the patient's timely access and harm their condition, and the supply is seven days or less.

Consequences

A prescriber who fails to consult is referred to their licensing board for administrative sanctions. The statute creates no private cause of action, but it does not limit liability for negligent care (§ 11165.4(d)). Under B&P § 1680(m), violating laws on dangerous drugs and controlled substances is unprofessional conduct.

Clinical use of the report

A CURES report is only useful if you read it. Look for:

• Overlapping opioid prescriptions from several prescribers.
• Recent benzodiazepines, which also trigger a naloxone offer if you prescribe an opioid (B&P § 741; Section 9.2).
• Early refills and multiple pharmacies.
• High total daily doses (90 morphine milligram equivalents or more is the naloxone trigger).

If the report raises concern, talk to the patient, choose non-opioid analgesics (NSAIDs combined with acetaminophen are first-line for most dental pain), coordinate with the other prescriber, and document your reasoning. A prescriber may give the patient a copy of their own CURES report if a copy stays in the chart (§ 11165(c)(4)).

Worked scenario

Dr. Kim extracts four third molars under local anesthesia in her office and prescribes 12 tablets of hydrocodone-acetaminophen with no refills, a three-day supply. The patient has never received a controlled substance from her.

• Exempt: a surgical procedure in a dentist's office with a nonrefillable supply of seven days or less.
• Two weeks later, the patient asks for more. The exemption no longer covers a subsequent prescription. Dr. Kim must review CURES within 24 hours before prescribing and document the review.
• She must also have the § 11158.1 risk discussion before the first opioid prescription in the course of treatment and consider whether § 741 requires a naloxone offer.