California gives dying patients pain relief

New law takes effect Jan. 1

Calif. Gov. Pete Wilson has signed a new law, A.B. 2693, exempting terminally ill patients from the state’s triplicate prescribing system for Schedule II controlled substances such as opioids for pain relief.

The law, which takes effect Jan. 1, was sponsored by the California State Hospice Association (CSHA) in Sacramento and hailed as an important step in ongoing efforts to improve the undertreatment of pain. However, pain advocates now are challenged to get the word out about the new law to the state’s medical community, CSHA reports.

Intent and effect differ

Triplicates are state-issued, serially numbered prescription forms to licensed physicians. One copy of each prescription is sent to the state Department of Justice in Sacramento. Although the intent of triplicates is to discourage inappropriate prescribing and diversion of controlled substances, they also have the effect of discouraging the legitimate use of narcotics for treating pain from serious illnesses such as cancer. Surveys have shown repeatedly that many physicians avoid prescribing triplicate-controlled drugs, often substituting less effective, nontriplicate drugs because of their concerns about regulatory scrutiny.

Terminal illness in the California law is defined in terms of suffering from an incurable, irreversible illness that, in the reasonable judgment of the prescribing physician, will bring about the patient’s death within one year, if the illness takes its normal course.

In a related development, New Jersey’s prescribing law was changed recently to permit doctors to call in orders for an emergency supply of pain medications for terminally ill patients, to prevent them from waiting for pain relief.