BILL ANALYSIS
AB 2018
Page 1
ASSEMBLY THIRD READING
AB 2018 (Thomson)
As Amended May 3, 2000
Majority vote
HEALTH 14-0 PUBLIC SAFETY 5-0
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|Ayes:|Gallegos, Bates, |Ayes:|Washington, Cedillo, |
| |Aanestad, Davis, Cox, | |Firebaugh, Keeley, Romero |
| |Firebaugh, Kuehl, | | |
| |Granlund, Thomson, | | |
| |Vincent, Wayne, Wesson, | | |
| |Wildman, Zettel | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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APPROPRIATIONS 21-0
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|Ayes:|Migden, Campbell, | | |
| |Ackerman, Alquist, | | |
| |Aroner, Ashburn, Brewer, | | |
| |Cedillo, Corbett, Davis, | | |
| |Kuehl, Maldonado, Papan, | | |
| |Romero, Runner, Shelley, | | |
| |Thomson, Wesson, Wiggins, | | |
| |Wright, Zettel | | |
| | | | |
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SUMMARY : Repeals, on January 1, 2003, the requirement that
Schedule II controlled substances be written on an official
prescription form (triplicate form) issued by the Department of
Justice (DOJ), and repeals the sunset date of the Controlled
Substance Utilization Review and Evaluation System (CURES) pilot
project, thereby making this program permanent. Specifically,
this bill :
1)Repeals, on January 1, 2003, provisions of law relating to the
triplicate prescription requirement for Schedule II controlled
substances (as specified in existing law below).
2)Includes, beginning on January 1, 2003, Schedule II controlled
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substances within existing provisions of law governing the
prescribing of controlled substances listed in Schedules III,
IV and V, except for provisions permitting the oral and
electronic transmission of prescriptions for controlled
substances.
3)Repeals the July 1, 2003 sunset date of the CURES project, and
repeals references to "pilot project," thereby making this
program permanent, and repeals a requirement that DOJ, in
consultation with the Board of Pharmacy (Board), submit an
annual report on the CURES pilot project.
EXISTING LAW :
1)Prohibits any person from furnishing any dangerous drug or
device except upon the prescription of a physician, dentist,
podiatrist, optometrist or veterinarian.
2)Establishes the California Uniform Controlled Substances Act,
which lists controlled substances in five schedules, with
Schedule I containing substances with the highest restrictions
(generally illegal), and Schedule V the least restrictive.
Schedule II substances are generally the most dangerous
substances that can still be legally prescribed (e.g.,
morphine, Demerol, and Percodan).
3)Requires each prescription for a controlled substance
classified in Schedule II to be wholly written in ink or
indelible pencil in the handwriting of the prescriber upon an
official prescription form, in triplicate, issued by DOJ.
Requires the original and duplicate of the prescription to be
delivered to the pharmacist filling the prescription.
Requires the duplicate to be retained by the pharmacist, and
the original to be transmitted to DOJ at the end of the month
in which the prescription was filled.
4)Requires triplicate prescription blanks to be issued by DOJ in
serially numbered groups of not more than 100 forms each, and
to be furnished to any practitioner authorized to write a
prescription for Schedule II controlled substances. Requires
the prescription blanks to bear the preprinted name, address,
and category of professional licensure of the practitioner to
whom they are issued, and the federal registry number for
controlled substances. Permits DOJ to charge a fee for the
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prescription blanks sufficient to reimburse the DOJ for the
actual costs associated with the preparation, processing, and
filing of the forms. Provides that any unauthorized person
possessing a triplicate prescription blank is guilty of a
misdemeanor.
5)Exempts orders for controlled substances from the prescription
procedure, including the triplicate form for Schedule II
substances, when used by a patient in a hospital, as long as
specified information is recorded in the patient's medical
record.
6)Exempts Schedule II prescriptions from the triplicate
procedure when prescribed for use by a patient who has a
terminal illness, defined in part as an illness that will, in
the judgment of the physician, bring about the death of the
patient within a period of one year. These prescriptions must
meet certain requirements, including a requirement that they
be wholly written in the handwriting of the prescriber.
7)Establishes the CURES Pilot Project within DOJ for the
electronic monitoring of the prescribing and dispensing of
Schedule II controlled substance in order to assist law
enforcement and regulatory agencies in their efforts to
control the diversion and resultant abuse of Schedule II
controlled substances. The CURES Pilot Project was
established on July 1, 1997, and is required to be
administered concurrently with the existing triplicate
prescription process to examine the comparative efficiencies
between the two systems.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis:
1)Ongoing costs to operate CURES of about $300,000 per year
[General Fund (GF)]. (Current CURES funding, from a $1
million appropriation from the Pharmacy Board Contingent Fund,
expires in 2000-2001.)
2)In addition to the $300,000 in contract and operating costs,
DOJ contends it will need auditors to check prescriptions
against the CURES database. Four auditors cost about $300,000
(GF) annually.
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COMMENTS : According to the author, triplicate prescriptions are
an administrative hassle for prescribers and can result in
inadequate relief for patients in pain. The author states that
for patients, pain management is frequently reported to be poor,
and the author argues that triplicates interfere with the
patient-physician relationship. The author cites a study
published in 1993 in the "Annals of Internal Medicine" that
showed physicians practicing in states requiring multiple copy
prescriptions were more likely to cite physician reluctance to
prescribe opioids and concern about excessive drug regulation as
barriers to cancer pain management when compared to physicians
in other states. The author states that researchers have found
that multiple copy prescription programs result in prescribers
substituting drugs that do not require a triplicate for those
that do. The author further asserts that many physicians do not
have the full range of tools necessary to treat patients with
severe pain because they do not have triplicate forms.
According to the author, only 40,333 of the 74,518
California-licensed physicians with Schedule II privileges had
triplicates issued to them. Finally, the author points to the
Institute of Medicine's 1997 book "Approaching Death: Improving
Care at the End of Life", which recommends the "reform of
prescription laws?that impede effective use of opioids to
releive pain and suffering." The author also cites a
recommendation from the 1994 California Pain Summit that
California "replace the requirement for a special, state-issued
prescription form (triplicate system) with electronic monitoring
of controlled substances prescriptions that can foster better,
more effective pain management and better diversion detection."
AB 3042 (Takasugi), Chapter 738, Statutes of 1996, established
the CURES Pilot Project, which was to begin July 1, 1997. As
required by Chapter 738, a report prepared by DOJ, in
consultation with the Board, was submitted to the Legislature in
January of 1999 regarding the implementation of CURES.
According to this report, CURES has been implemented in a timely
and cost-effective manner. At the time of the report, automated
collection of Schedule II prescription data from the state's
5,000 pharmacies had been in place for almost one year, and the
data analysis and on-line communications linkage to the state
agencies had also been established in its initial phase.
According to the report, in 1995, the triplicate program reached
its peak production level by manually entering data from 256,303
triplicate prescription forms into the computer system. Since
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1995, productivity has steadily declined, and in 1998 only
39,945 triplicate prescription forms, representing 1.7% of the
total, were manually entered into the system. The report states
that CURES has solved the data entry backlog problem experience
by the triplicate program. Through CURES, DOJ and
medical-related licensing boards have ready access to up-to-date
information on Schedule II drug prescriptions. In the first
seven months that CURES was operational, a total of 892,985
Schedule II prescriptions were transmitted by pharmacies into
the CURES system. The report made several recommendations,
including making CURES permanent, and reclassifying, as
appropriate, current triplicate prescription program staff to
classifications more suitable to the investigative and
analytical duties they will perform for CURES.
This bill is sponsored by the Board. According to the Board,
under the triplicate program, once the original is mailed by the
pharmacy to DOJ, these prescriptions must be entered manually
into a computer system and/or filed in boxes for manual
searches. This labor-intensive system resulted in fewer than 2%
of all triplicate prescriptions being entered into DOJ's
computer system in recent years. The Board states that CURES,
instead, works by having pharmacies make electronic copies of
all Schedule II prescriptions dispensed each month. The
electronic data from all California pharmacies is then compiled
into a statewide database that is provided to DOJ. The Board
states that it is sponsoring this legislation because the CURES
program has clearly established that electronic monitoring is a
superior alternative to collecting the more than 2 million paper
prescriptions that are written each year. The Board argues that
the CURES system makes identifying patterns of abuse and
diversion of prescription drugs into illicit markets much easier
because all data is readily available for analysis. The Board
states that with CURES, the triplicate prescription process has
out-lived its utility.
Numerous organizations are in support of this bill. The
American Cancer Society (ACS) states in support that research
indicates less than half of cancer patients get adequate relief
of their pain even though the means to relieve almost all cancer
pain currently exists. ACS states that it has found there is a
dichotomy between the effort to restrict the availability of
controlled substances and the need to adequately and
compassionately treat patients experiencing pain, and ACS has
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long supported CURES as a way to address both concerns.
Americans for Death with Dignity (ADD) states that physician's
fears about law enforcement are not idle fears given the lack of
understanding about the use of opioid drugs as acceptable
medical practice by both medical boards and physicians in this
country. ADD points to studies in the early 1990s which
revealed appalling statistics of medical board members and
physicians who thought that prescribing narcotics to relieve
pain was an illegal act and/or not acceptable treatment, which
it is neither. ADD argues that it is time to eliminate the
stigma of triplicate prescriptions for the medical use of
narcotics for terminally ill and dying patients.
This bill is opposed by the California Peace Officers'
Association (CPOA) and the California Police Chiefs Association
(CPCA). CPOA and CPCA state that California's triplicate system
enables law enforcement to monitor the distribution of Schedule
II controlled substances statewide through the issuance of
serialized triplicate prescription forms and the receipt and
review of cashed triplicates, and allows them to respond to
specific law enforcement or regulatory inquiry and to forward
investigative leads to prevent diversion of prescription drugs
into the illegal market, all without interfering with lawful
prescribing practices. CPOA and CPCA state that serialized
prescription forms are a useful tool in eliminating forgery and
counterfeiting, and point out in contrast that states that do
not have such a program are prone to high incidences of forgery
of prescriptions. For instance, CPOA and CPCA state that New
York reported a 12% forgery rate prior to the implementation of
its state-serialized program, while implementation of the
program slashed the forgery rate down to .0006%. CPOA and CPCA
state that surveys done by DOJ report that Oklahoma, Nevada,
North Carolina and Mississippi, which do not have a serialized
prescription program, have reported high incidences of forgeries
and counterfeited prescription pads. CPOA and CPCA state that
perhaps there will be a time when CURES will have sufficient
safeguards to operate as a "stand-alone" monitoring strategy,
but until CURES has technology to ensure security, or to be able
to capture signatures, fingerprints or retinal scans,
abandonment of the serialized triplicate system is premature.
Analysis Prepared by : Vincent D. Marchand / HEALTH / (916)
319-2097 FN:
AB 2018
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0004884