Additionally, orders of 300 or more triplicates were trimmed to stretch the supply. Physicians whose orders could not be filled should already have been notified by the state Department of Justice (DOJ).

The shortage was caused by an unanticipated increase in physician orders in the days before the July 1 ordering deadline for triplicates, which are being phased out of use during the next six months. This announcement was made during a meeting hosted by CMA and attended by officials of DOJ, the California Board of Pharmacy, the California Narcotic Officers’ Association, the Compassion in Dying Federation, and others.

The meeting is one in a series of sessions to discuss the state’s new tamper-resistant prescription forms, which are being phased in for prescribing controlled substances. Both the new forms and the current triplicate forms may be used throughout 2004. Beginning January 1, all prescriptions for controlled substances (Schedules II-V) must be written on the new, secure prescription forms.

DOJ recommends that affected physicians invoke the emergency prescription statute (Health and Safety Code §11167), which permits the use of regular, nonsecure prescription forms for Schedule II prescriptions in “an emergency where failure to issue a prescription may result in the loss of life or intense suffering.” To do this, physicians simply write “11167” on the regular prescription form and submit it to a pharmacy.

Although section 11167 requires physicians to follow-up by submitting a triplicate or tamper-resistant form to the pharmacist within 7 days of the initial prescription, DOJ and the pharmacy board recognize that because of the lack of proper prescription forms that may be impossible for some physicians. As a result, enforcement of the 7-day rule will be a low priority during the transition period, according to officials with DOJ and the pharmacy board.

“DOJ will not pursue enforcement efforts against these physicians who have documented their situation, including their attempts to order the appropriate forms. DOJ will not investigate physicians for this technical noncompliance until it is clear to our staff that physicians can fully comply with the law,” said Alberto Gonzales, special assistant attorney general with DOJ.

Patricia Harris, executive officer for the California Board of Pharmacy, agreed, saying “the Board of Pharmacy is interested in whether the prescription is valid and whether the patient is being adequately treated.”

DOJ does not have the statutory authority or funding to print and/or distribute additional triplicates after the July 1 deadline, said Gonzales. As a result, CMA may pursue fast-track legislation that would allow DOJ to print more triplicates and make it more straightforward if physicians must utilize the “emergency fill” exemption, which is currently allowed under Health and Safety Code Section 11167.

Remember, physicians are still allowed under Health and Safety Code Section 11159.2 to issue prescriptions for Schedule II drugs on regular prescription pads for terminally ill patients. Triplicate or tamper-resistant prescription forms are not required for terminally ill patients who are certified by a physician as 1) suffering from a incurable, irreversible, illness; 2) expected to die within one year; and 3) receiving the Schedule II prescription for symptom management and not cure. The words “11159.2 exemption,” however, must appear on the prescription form.

CMA continues to work with state officials and others to ensure the transition from triplicates to the new tamper-resistant forms is as easy and inexpensive as possible.

Click here for more information on the new record keeping requirements for physicians who dispense schedule II drugs.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.