BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 2018
A
AUTHOR: Thomson, et al.
B
AMENDED: June 29, 2000
HEARING DATE: July 5, 2000
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FISCAL: Appropriations
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CONSULTANT:
8
Umino / ak
SUBJECT
Controlled Substances: Schedule II Triplicate
Prescriptions
SUMMARY
This bill makes changes to the existing triplicate
prescription requirements for Schedule II controlled
substances and requires the Attorney General to determine
if the electronic Controlled Substance Utilization Review
and Evaluation System should be continued on and after July
1, 2003.
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 the Department of Justice (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 Controlled
Substance Utilization Review and Evaluation System (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:
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1.Allows a practitioner to orally, electronically, or in
writing request larger amounts of prescription blanks,
which are issued by DOJ in serially numbered groups of
not more than 100 forms each in triplicate.
2.Deletes the requirement that DOJ limit the issuance of
triplicate prescription blanks to 100 forms during a
30-day period.
3.Removes the provision that prevents DOJ from issuing more
than one "prescription group" to the same prescriber at
one time.
4.Specifies that (a) the signature on each "triplicate"
prescription for a Schedule II controlled substance must
be wholly written in ink or indelible pencil in the
handwriting of the prescriber, and (b) each prescription
must contain specified information either typewritten or
handwritten by the physician or his or her employee.
5.Allows a pharmacist to fill a Schedule II controlled
substance prescription, which contains an error or
errors, if (a) the pharmacist notifies the prescriber and
(b) the prescriber approves any correction.
6.Requires a prescriber to fax or mail a corrected
prescription to the pharmacist within seven days of the
prescription being dispensed.
7.Removes the provision that the sum of $1,050,000 is
appropriated from the Pharmacy Board Contingent Fund to
the Board of Pharmacy for the purpose of entering into an
interagency agreement with DOJ for the implementation,
operation, and evaluation of CURES.
8.Requires the CURES pilot project to become inoperative on
July 1, 2003 and repeals the section on January 1, 2004,
unless the Attorney General determines and provides
timely written notification to the Legislature that the
CURES program should be continued on and after July 1,
2003, "on the basis that the CURES program provides more
timely data."
9.Specifies that if the CURES program remains in effect on
or after July 1, 2003, then the requirement that a
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prescription for a Schedule II controlled substance must
be written on a triplicate prescription must terminate on
July 1, 2003 and must, instead, meet the same
prescription requirements for controlled substances
classified as Schedule III, IV, or V.
10.Provides for additional emergency situations specified
in federal regulations, which allow a Schedule II
controlled substance to be dispensed by a oral, written,
or electronic data transmission and subject to specified
requirements.
FISCAL IMPACT
Unknown
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.
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
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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 the previous version of 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, 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.
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 [a previous version of]
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
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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,
"[T]hose 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.
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.
PRIOR ACTIONS
Assembly Floor: 47-23 Do pass
Assembly Appropriations: 21-0Do pass
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Assembly Public Safety: 5-0Do pass as amended
Assembly Health: 14-0Do pass
POSITIONS IN SUPPORT
Previous versions of this bill
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|California State Board of |Hospice of Amador |
|Pharmacy (sponsor) |Hospice by the Bay |
|AARP |Hospice Care of California |
|Adventist Health Home Care |Hospice of the Central Coast |
|Services |Hospice of the Foothills, Grass |
|Alliance of Catholic Health |Valley |
|Care |Hospice of InterHealth |
|American Academy of Pain |Hospice of Marin |
|Medicine |Hospice of Napa Valley |
|American Academy of Pediatrics |Hospice and Palliative Care of |
|American Cancer Society |Contra Costa |
|American Chronic Pain |Hospice of Petaluma |
|Association |Hospice of Saddleback Valley, |
|American Federation of State, |Laguna Hills |
| County and |Hospice of San Joaquin |
| Municipal Employees |Hospice of the Sierra |
|American Medical Group |Hospice of Tulare County, Inc. |
|Association |Hospice of the Valley |
|American Medical Women's |Hospice of the Valleys |
|Association-CA Region |Kaiser Permanente Medical Care |
|American Pain Foundation |Program |
|Americans for Better Care of |Los Angeles County Medical |
|the Dying |Association |
|Americans for Death for Dignity |Madrone Hospice, Yreka |
|Assisted Home Hospice |Marian Medical Center, Santa |
|Association of Northern |Maria |
|California Oncologists |Medical Board of California |
|Betty Ford Center |Mercy Hospice, Redding |
|Board of Registered Nursing |Mercy Hospital and Health |
|California Academy of |Services, Merced |
|Ophthalmology |Mission Hospice, Inc. of San |
|California Academy of Family |Mateo County |
|Physicians |Mission Hospital Regional |
|California Arthritis Foundation |Medical Center |
|Council |National IPA Coalition |
|California Association of |NorthBay Hospice and |
|Health Facilities |Bereavement |
|California Association of |Older Women's League of |
|Health Plans |California |
|California Association of |Orange County Medical |
|Health Services at Home |Association |
|California Association of Nurse |Osteopathic Physicians and |
|Anesthetists |Surgeons of California |
STAFF ANALYSIS OF ASSEMBLY BILL 2018 (Thomson et al) Page
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|California Association of |Pharmaceutical Research & |
|Public Hospitals and |Manufacturers of America |
| Health Systems |Presbyterian Intercommunity |
|California Church IMPACT |Hospital Home Services |
|California Coalition of Nurse |Riverside County Medical |
|Practitioners California |Association |
| Dental Association |Sacramento-El Dorado Medical |
|California Disability Alliance |Society |
|California Grocers Association |Saint Agnes Medical Center, |
|California Hospice and |Fresno |
|Palliative Care Association |San Diego Hospice |
|California Hospital Medical |Siskiyou County Sheriff-Coroner |
|Center |Charles Byrd |
|California Medical Association |Solano County Medical Society |
|California Nurses Association |Southern California Cancer Pain |
|California Pharmacists |Initiative |
|Association |St. Elizabeth Hospice, Red |
|California Podiatric Medical |Bluff |
|Association |St. Joseph Health Foundation of |
|California Psychiatric |Northern California |
|Association |St. Joseph Health System |
|California Retailers |St. Joseph Health System - |
|Association |Greater Sonoma County |
|California Society of |St. Joseph Health |
|Anesthesiologists, Inc. |System-Humboldt County |
|California Society of |St. Joseph Health System, |
|Health-System Pharmacists |Southern California Region |
|Catholic Healthcare West |St. Joseph's Medical Center |
|Catholic Healthcare West Bay |Sutter Hospice/Roseville |
|Area Region |TMJ Society of California |
|Catholic Healthcare West |Torrance Memorial Home Health & |
|Central Coast Region |Hospice |
|Catholic Healthcare West North |Union of American Physicians |
|State Region |and Dentists |
|Catholic Healthcare West, San |United Food & Commercial |
|Joaquin-Sierra Region |Workers Region 8 |
|Citizens for the Right to Know | States Council |
|City and County of San |Visiting Nurse Association and |
|Francisco |Hospice |
|Coalition of Concerned Medical |VITAS Healthcare Corporation |
|Professionals |VNA and Hospice of Northern |
|Congress of California Seniors |California |
|County Health Executives |VNACare Hospice in the Home |
|Association of California |Western Service Workers |
|Death With Dignity National |Yolo County Medical Society |
|Center |Yolo County Sheriff's |
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|Dental Board of California |Department |
|Hospice Services of Lake County |ZG International Health Care |
|The Elizabeth Hospice |Division |
|Friends Committee on |6 Individuals |
|Legislation of California | |
|Greater Los Angeles Chapter of | |
|the Oncology Nursing Society | |
|Hoffmann Hospice | |
|Home Hospice | |
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POSITIONS IN OPPOSITION
Previous versions of this bill
Association for Los Angeles Deputy Sheriffs
Attorney General Bill Lockyer
California District Attorneys Association
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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