Controlled substances are medications with a potential for abuse or misuse. They are often, also, medications that have powerful effects on brain function. Common controlled substances that doctors prescribe include:

Narcotic pain medications (Demerol, Norco, Tyco, etcetera)
Stimulant medications (Adderall, Ritalin, Concerta, etcetera)
Benzodiazepines and similar sedating and anti-anxiety medications (Xanax, Valium, Ativan, Ambien, etcetera)
Testosterone and some other hormone treatments

In 2017 California implemented a law that requires all physicians in the state to check a database of controlled substance prescriptions (the CURES database) before writing any prescription or refill for a controlled substance for one of their patients. Failure to do so can lead to the loss of your license to practice medicine.

This requirement is in addition to the other databases that we need to check including formulary databases, drug interaction databases, your clinical record, and the electronic prescribing software itself.

If there are questions that come up as a result of checking this database (for example questions about other controlled substances that may have been prescribed) then these questions have to be discussed with the patient before the prescription can be written.

This adds about 10 to 20 minutes to the process of approving a controlled substance refill. Also, in a significant percentage of cases, a conversation needs to take place because of information we find in one of these databases.

For example, one of my patients wanted a refill of Ambien. A check of the CURES database revealed that he had recently been prescribed a pain medication for back pain. He wasn’t aware of the potential serious interaction between these two medications.

Another patient had received a prescription for Ambien from her primary care doctor and then requested a refill of the Ativan I was prescribing for anxiety. Again, we had to talk about the interaction between these medications.

A third patient requested a refill of temazepam which was a little early. A check in the CURES database showed that she had actually picked up another prescription for temazepam two weeks ago and was taking double the prescribed dose.

For this reason, refills or new prescriptions for controlled substances require a scheduled appointment.

Appointments don’t have to be in person, they can phone or telehealth appointments. They are also usually short appointments (10 – 20 minutes depending on the issues that need to be discussed), but they have to be scheduled, which means there may be delays in approving refills.

This is why we ask you to fill out a short pre-visit questionnaire before each appointment that is designed to make sure that all issues get dealt with in that session, particularly any refill that will need to be approved before the next appointment.

To avoid costs for extra appointments and delays in approving refills please take extra care to note any refill for a controlled substance that you may need me to approve in that pre-visit questionnaire.