BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 2018
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AUTHOR: Thomson, et al
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AMENDED: June 15, 2000
HEARING DATE: June 21, 2000
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FISCAL: Appropriations
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CONSULTANT:
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Umino / ak
SUBJECT
Controlled Substances: Schedule II Triplicate
Prescriptions
SUMMARY
This bill repeals the requirement that Schedule II
controlled substances be written on an official
"triplicate" prescription issued by the Department of
Justice (DOJ) beginning January 1, 2003, and makes the
Controlled Substance Utilization Review and Evaluation
System (CURES) pilot project a permanent program.
ABSTRACT
Existing federal and state laws rank controlled substances
according to their potential for abuse, accepted medical
use, and safety under medical supervision:
a. Schedule I substances (e.g., heroin) have a high
potential for abuse, no currently accepted medical use,
and lack accepted safety for use.
b. Schedule II drugs (e.g., morphine, codeine, Demerol,
Dilaudid and Percodan) have a high potential for abuse,
accepted medical use in treatment, and severe
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psychological or physical dependence, if abused.
c. Schedule III drugs (e.g., Vicodin, anabolic steroids,
codeine with aspirin or Tylenol) have less potential for
abuse than Schedule I and II, accepted medical use in
treatment, and moderate or low physical dependence or
high psychological dependence, if abused.
d. Schedule IV drugs (e.g., Darvon, Valium, and Xanax) have
a low potential for abuse, accepted medical use in
treatment, and limited physical or psychological
dependence, if abused.
e. Schedule V drugs have low potential for abuse relative
to Schedule IV, accepted medical use in treatment, and
limited physical or psychological dependence, if abused.
Existing state law requires each prescription for a
controlled substance classified as Schedule II to be wholly
written in ink or indelible pencil in the handwriting of
the prescriber upon an official "triplicate" prescription
form issued by DOJ. The original and duplicate of the
prescription must be delivered to the pharmacist who fills
the prescription and must then transmit the original
prescription to DOJ, as specified.
Existing law also requires that the "triplicate"
prescription forms, which are issued by DOJ, must (a) be
in serially numbered groups of not more than 100 forms, (b)
be furnished to an authorized practitioner, (c) be
nontransferable, and (d) bear the preprinted name, address,
category of professional licensure of the practitioner to
whom they are issued, and the federal registry number for
controlled substances.
Furthermore, existing law establishes the CURES pilot
project within DOJ to electronically monitor the
prescribing and dispensing of Schedule II controlled
substances. DOJ, in consultation with the Board of
Pharmacy, must submit annual reports to the Legislature
until January 1, 2002, on, among other things, the ability
of CURES to provide complete, accurate, and timely data on
Schedule II controlled substances prescribed and dispensed
in California.
This bill:
1.Repeals, on January 1, 2003, the requirement that
Schedule II controlled substances must be written on an
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official "triplicate" prescription form issued by DOJ.
2.Specifies that beginning January 1, 2003, Schedule II
controlled substances must be subject to the same
requirements as controlled substances in Schedule III,
IV, or V, but, unlike the other controlled substances,
oral or electronic transmission of a Schedule II
controlled substance is not allowed.
3.Deletes the July 1, 2003 sunset for the CURES pilot
project, which results in a permanent program, and
deletes the requirement for DOJ to submit a report to the
Legislature on the ability of CURES to provide complete,
accurate, and timely data on Schedule II controlled
substances prescribed and dispensed in California.
FISCAL IMPACT
The Assembly Committee on Appropriations reports ongoing
costs to operate the CURES program of about $300,000 per
year from the General Fund for contract and operation
costs. Furthermore, the addition of four auditors to check
prescriptions against the CURES database will cost about
$300,000 annually from the General Fund.
BACKGROUND AND DISCUSSION
The author reports that "triplicate prescriptions are an
administrative hassle for prescribers and can result in
inadequate relief for patients in pain. . . . Studies
indicate that cancer-related pain could be well-controlled
in 80% to 90% of affected patients, but recent findings
indicate that more than 40% of cancer patients receive
inadequate pain relief." According to the author, many
physicians do not have access to the full range of drugs
necessary to treat patients with severe pain, because they
do not have "triplicate" prescription forms. As of
February 1999, only 40,333 of the 74,518
California-licensed physicians, who could prescribe
Schedule II controlled substances, had "triplicate"
prescription forms issued to them. Furthermore, the author
believes that it is unnecessary to continue to require the
use of government-issued prescription forms when the same
data is being reported electronically through CURES.
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The Summit on Effective Pain Management, sponsored by the
State of California in 1994, supports some of the author's
views:
"The triplicate prescription system - which must be
used when Schedule II controlled substances are
prescribed - is outdated, impractical for many modern
health care settings (especially long-term care), and
generally ineffective for monitoring and controlling
diversion of medications for non-therapeutic purposes.
Because of the administrative complexities of and
implied intimidation by the triplicate system, almost
half of California's physicians have chosen not to
seek prescribing privileges of Schedule II
medications. This system of oversight is often viewed
as persecution by physicians and pharmacists, and the
result is that patients in pain suffer." (Source:
California Department of Consumer Affairs, Summit on
Effective Pain Management: Removing Impediments to
Appropriate Prescribing, 1994)
The 1999 Controlled Substance Utilization Review and
Evaluation System (CURES) Report to the Legislature
recommends, among other things, seeking legislation to
establish CURES as a permanent operational program.
(Source: California Department of Justice, Bureau of
Narcotic Enforcement, and Department of Consumer Affairs,
Board of Pharmacy)
Opponents to this bill report that the existing triplicate
prescription program tracks the prescribing of Scheduled II
controlled substances that have medical use, but are highly
addictive and prone to be diverted into the illicit market.
According to the California Police Chiefs Association and
the California Peace Officer's Association, who oppose this
bill, the triplicate prescription program enables law
enforcement to monitor the prescribing of dangerous drugs
and to minimize the chances of those drugs being diverted
into the illegal market These associations also report
that electronic transmission in CURES is not secure and can
be compromised by entering false or incorrect data.
Furthermore, the opponents report that CURES serves as a
framework for analysis of the triplicate prescription
program; and, in fact, the triplicate prescription program
serves as a check against CURES being compromised.
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The U.S. Department of Justice, Drug Enforcement
Administration, Office of Diversion Control, in a letter to
the Office of the Attorney General reports that "it appears
that the policies embodied in Assembly Bill 2018 are
contrary to the best practices of preventing the diversion
of Schedule II controlled substances in your state.
California's triplicate prescription monitoring program has
effectively cut off a major source of pharmaceutical
controlled substance diversion within the state and we
applaud your efforts." The Office of Diversion Control
(ODC) states that because California has had a triplicate
prescription monitoring program in place since 1940, the
state has avoided some of the major drug problems
encountered in other states in the 1970s and 1980s.
According to ODC,
"those states that have utilized multiple copy
prescription forms indicate that forgeries have
decreased substantially. . . . The 18 states that
currently operate prescription monitoring programs
report a reduction in the illicit market availability
of legitimately produced controlled substances. The
same states have also reported that prescription
monitoring programs enable them to conduct more
investigations with fewer resources since targets of
investigation can easily be identified."
Finally, ODC supports prescription monitoring programs
as an effective law enforcement tool and recommends
that state agencies considering the operation of a
controlled substance prescription monitoring program
combine electronic monitoring and an official
serialized prescription form. ODC explains that "this
combination will be the most effective monitoring
method for deterring, preventing and reducing the
diversion of licit controlled substances into illicit
use."
Prior Legislation
AB 3042 (Takasugi, Chapter 738, Statutes of 1996) created
the CURES program on a pilot basis.
AB 2693 (Migden, Chapter 789, Statutes of 1998) exempts
Schedule II controlled substances for patients with a
terminal illness from triplicate prescription form
requirements.
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SB 1308 (Committee on Business and Professions, Chapter
655, Statutes of 1999) extended the sunset date of the
CURES program to July 1, 2003, required DOJ to submit
annual status reports on the program to the Legislature.
Comment:
The author may wish to include a provision in this bill for
DOJ and the Board of Pharmacy to monitor the CURES program
until January 1, 2003 and report to the Legislature on:
(a) the completeness, accuracy, and timeliness of data for
Schedule II controlled substances, (b) the effectiveness
of the information collected in investigating and
prosecuting individuals suspected of diversion activities,
and (c) improvements necessary to ensure effective
monitoring of Schedule II controlled substances to deter,
prevent, and reduce diversion.
PRIOR ACTIONS
Assembly Floor: 47-23 Do pass
Assembly Appropriations: 21-0Do pass
Assembly Public Safety: 5-0Do pass as amended
Assembly Health: 14-0Do pass
POSITIONS IN SUPPORT
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|California State Board of |Greater Los Angeles Chapter of |
|Pharmacy (sponsor) |the Oncology Nursing Society |
|AARP |Hoffmann Hospice |
|Adventist Health Home Care |Hope Hospice, Inc. |
|Services |Hospice of Amador |
|Alliance of Catholic Health |Hospice by the Bay |
|Care |Hospice Care of California |
|American Academy of Pain |Hospice of the Central Coast |
|Medicine |Hospice of Marin |
|American Academy of Pediatrics |Hospice of Napa Valley |
|American Cancer Society |Hospice and Palliative Care of |
|American Chronic Pain |Contra Costa |
|Association |Hospice of Petaluma |
|American Federation of State, |Hospice of San Joaquin |
| County and |Hospice of the Sierra |
| Municipal Employees |Hospice of Tulare County, Inc. |
|American Medical Group |Hospice of the Valley |
|Association |Hospice of the Valleys |
|American Medical Women's |Kaiser Permanente Medical Care |
|Association-CA Region |Program |
|American Pain Foundation |Madrone Hospice, Yreka |
|Americans for Death for Dignity |Marian Medical Center, Santa |
|Assisted Home Hospice |Maria |
|Association of Northern |Medical Board of California |
|California Oncologists |Mercy Hospice, Redding |
|Betty Ford Center |Mercy Hospital and Health |
|Board of Registered Nursing |Services, Merced |
|California Academy of |Mission Hospice, Inc. of San |
|Ophthalmology |Mateo County |
|California Academy of Family |Mission Hospital Regional |
|Physicians |Medical Center |
|California Arthritis Foundation |National IPA Coalition |
|Council |NorthBay Hospice and |
|California Association of |Bereavement |
|Health Facilities |Older Women's League of |
|California Association of |California |
|Health Plans |Osteopathic Physicians and |
|California Association of |Surgeons of California |
|Health Services at Home |Pharmaceutical Research & |
|California Association of Nurse |Manufacturers of America |
|Anesthetists |Riverside County Medical |
|California Association of |Association |
|Public Hospitals and |Sacramento-El Dorado Medical |
STAFF ANALYSIS OF ASSEMBLY BILL 2018 (Thomson et al) Page
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| Health Systems |Society |
|California Church IMPACT |Saint Agnes Medical Center, |
|California Coalition of Nurse |Fresno |
|Practitioners California |San Diego Hospice |
| Dental Association |Siskiyou County Sheriff-Coroner |
|California Disability Alliance |Charles Byrd |
|California Grocers Association |Solano County Medical Society |
|California Hospice and |Southern California Cancer Pain |
|Palliative Care Association |Initiative |
|California Hospital Medical |St. Elizabeth Hospice, Red |
|Center |Bluff |
|California Medical Association |St. Joseph Health Foundation of |
|California Nurses Association |Northern California |
|California Pharmacists |St. Joseph Health System |
|Association |St. Joseph Health System - |
|California Podiatric Medical |Greater Sonoma County |
|Association |St. Joseph Health |
|California Psychiatric |System-Humboldt County |
|Association |St. Joseph Health System, |
|California Retailers |Southern California Region |
|Association |St. Joseph's Medical Center |
|California Society of |Sutter Hospice/Roseville |
|Anesthesiologists, Inc. |TMJ Society of California |
|California Society of |Torrance Memorial Home Health & |
|Health-System Pharmacists |Hospice |
|Catholic Healthcare West |Union of American Physicians |
|Catholic Healthcare West Bay |and Dentists |
|Area Region |United Food & Commercial |
|Catholic Healthcare West |Workers Region 8 |
|Central Coast Region | States Council |
|Catholic Healthcare West North |Visiting Nurse Association and |
|State Region |Hospice |
|Catholic Healthcare West, San |VITAS Healthcare Corporation |
|Joaquin-Sierra Region |VNA and Hospice of Northern |
|Citizens for the Right to Know |California |
|Coalition of Concerned Medical |VNACare Hospice in the Home |
|Professionals |Western Service Workers |
|Congress of California Seniors |Yolo County Medical Society |
|County Health Executives |ZG International Health Care |
|Association of California |Division |
|Death With Dignity National |6 Individuals |
|Center | |
|Dental Board of California | |
|Hospice Services of Lake County | |
|The Elizabeth Hospice | |
|Friends Committee on | |
STAFF ANALYSIS OF ASSEMBLY BILL 2018 (Thomson et al) Page
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|Legislation of California | |
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POSITIONS IN OPPOSITION
Association for Los Angeles Deputy Sheriffs
Attorney General Bill Lockyer
California Narcotic Officers' Association
California Peace Officers' Association
California Police Chiefs Association
California State Sheriffs' Association
League of California Cities
Los Angeles County Sheriff Leroy Baca
Los Angeles Deputy Sheriffs, Inc. Association
Los Angeles Police Protective League
Peace Officers Research Association of California
Riverside Sheriff's Association
San Bernardino County Sheriff's Department
San Diego County Sheriff's Department
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