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
and as proposed to be amended in Committee
2
HEARING DATE: August 18, 2000
0
FISCAL: Appropriations
1
8
CONSULTANT:
Umino / ak
SUBJECT
Controlled Substances: Schedule II Triplicate
Prescriptions
SUMMARY
This bill changes existing triplicate prescription
requirements for Schedule II controlled substances to
reduce administrative complexities.
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
psychological or physical dependence, if abused.
c. Schedule III drugs (e.g., Vicodin, anabolic steroids,
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STAFF ANALYSIS OF ASSEMBLY BILL 2018 (Thomson et al.) Page
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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, with not more
than 100 forms issued to the same prescriber at one time,
(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:
1.Allows a practitioner to orally, electronically, or in
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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 and provides,
by fax or mail, a corrected prescription to the
pharmacist within seven days of the prescription being
dispensed.
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
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Schedule II controlled substances, had "triplicate"
prescription forms issued to them.
According to the author, this bill would reduce some of the
"administrative hassles" involved in writing triplicate
prescriptions for Schedule II drugs by:
1.Lifting the cap on the number of triplicate prescriptions
issued to a physician because, for a physician who
specializes in pain management or treatment of cancer
patients, the cap is low;
2.Allowing a physician with a busy practice and/or
illegible handwriting to either type the "triplicate"
prescription or have an employee type or write the
prescription, as long as the physician signs the
prescription; and
3.Permitting a pharmacist to fill a Schedule II
prescription containing errors, if (a) the pharmacist
notifies the prescriber of the error, (b) the prescriber
approves any corrections, and (c) the prescriber faxes or
mails a corrected prescription within seven days of the
prescription being dispensed.
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)
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Prior Legislation
AB 3042 (Takasugi, Chapter 738, Statutes of 1996) created
the Controlled Substance Utilization Review and Evaluation
System (CURES) to monitor electronically the prescribing
and dispensing of Schedule II controlled substances.
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 and required DOJ to submit
annual status reports on the program to the Legislature.
PRIOR ACTIONS
Senate Health & Human Services: 1- 1 Fail
Senate Health & Human Services: 4- 1 Fail,
Reconsideration Granted
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
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 Professional |Northern California |
|Firefighters |St. Joseph Health System |
|California Psychiatric |St. Joseph Health System - |
|Association |Greater Sonoma County |
|California Retailers |St. Joseph Health |
|Association |System-Humboldt County |
|California Society of |St. Joseph Health System, |
|Anesthesiologists, Inc. |Southern California Region |
|California Society of |St. Joseph's Medical Center |
|Health-System Pharmacists |Sutter Hospice/Roseville |
|Catholic Healthcare West |TMJ Society of California |
|Catholic Healthcare West Bay |Torrance Memorial Home Health & |
|Area Region |Hospice |
|Catholic Healthcare West |Union of American Physicians |
|Central Coast Region |and Dentists |
|Catholic Healthcare West North |United Food & Commercial |
|State Region |Workers Region 8 |
|Catholic Healthcare West, San | States Council |
|Joaquin-Sierra Region |Visiting Nurse Association and |
|Citizens for the Right to Know |Hospice |
|City and County of San |VITAS Healthcare Corporation |
|Francisco |VNA and Hospice of Northern |
|Coalition of Concerned Medical |California |
|Professionals |VNACare Hospice in the Home |
|Congress of California Seniors |Western Service Workers |
|County Health Executives |Yolo County Medical Society |
|Association of California |Yolo County Sheriff's |
STAFF ANALYSIS OF ASSEMBLY BILL 2018 (Thomson et al.) Page
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|Death With Dignity National |Department |
|Center |ZG International Health Care |
|Dental Board of California |Division |
|Hospice Services of Lake County |7 Individuals |
|The Elizabeth Hospice | |
|Friends Committee on | |
|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 Narcotic Officers' Association
California Peace Officers' Association
California Police Chiefs 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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