By Jeffrey Grolig, MD, Guest Columnist
Like many other states, California has enacted a series of laws to more tightly regulate the prescribing of opioid medication. One such law that took effect January 1 is AB 1753, which requires doctors to use new prescription pads for controlled substances that have uniquely serialized identification numbers. The idea is to prevent counterfeiting and to get more prescriptions filed electronically.
The serial numbers begin with three letters, followed by six numbers, followed by one letter, and end with five more numbers. There are 46-thousand trillion potentially different combinations of numbers and letters – making California’s prescription pads more complicated than the serial numbers on U.S. currency.
Only publishers who are fingerprinted, pass a security check, and approved by the Department of Justice (DOJ) are authorized to print these new pads.
What could possibly go wrong? A lot.
Shortly before Christmas, the California Medical Association (CMA) expressed concern that doctors would not be able to get the new prescription pads before the new year:
“Physicians were finally notified this week that the updated forms were available for purchase... with less than two weeks to go before the compliance date. The CMA is very concerned that this does not provide enough time for physicians to re-order forms... and could be a serious barrier to patients who must access necessary medications in a timely manner.”
And a serious barrier it has become.
Up to a million old prescriptions for controlled substances became technically invalid in California at the stroke of midnight on New Year’s Eve, potentially leaving hundreds of thousands of patients with medication delays and denials, including some who need emergency room treatment.
On January 2, I was barraged with telephone call interruptions while I tried to see my patients. Dozens of messages were left by pharmacists stating that my prescriptions were invalid and that I needed to phone them immediately.
When I returned the calls, I was informed about the new law and told to order new scripts immediately as the old ones would not be honored. The pharmacists told me all I needed to do was write a note that I was aware of the new law and was ordering the new pads. Fortunately, in each case the pharmacist made an exception.
But the following week, the problem worsened. A colleague told me he fielded some 40 telephone calls dealing with the new law and invalid scripts. Not all his patients were lucky. One woman, just discharged from abdominal surgery, went an entire weekend without pain medication as her pharmacist could not get through on the telephone to her surgeon.
Then last Friday, a pharmacist telephoned me about a patient I had on methadone. “I cannot fill this script, because it is written on the old form,” she said.
“But I wrote on the top that I was aware of the new law,” I replied.
“Yes, I noted that. However, my board has told me that I need your purchase order number, or else I cannot fill the prescription,” she answered.
I informed her I had not been given any information on which printers might be able to produce the new prescription pads with their complicated 15-character serial numbers. She provided me with a telephone number to the DOJ. I called and learned about a website which had recently posted the compliant printers. It was 5:00 p.m. Friday before the weekend, and many of the approved printers were located back east and had already closed.
I asked the pharmacist if an exception could be made, and she stated it could not. She required a valid purchase order number and I needed to scramble. I had patients waiting over an hour in the examination rooms while I telephoned printing companies on the west coast. Mostly I got recorded messages. I received website and fax information. But what I could not get was a purchase order number. They were all too busy to take an order over the telephone.
I went back to seeing patients, my main priority. Then I stayed late, copied my DEA and medical license certificates and a voided prescription like they had requested, and I placed my order via fax. I still had no purchase order number. I called my methadone patient over the weekend and fortunately her methadone script had been honored. She would not go through withdrawal or end up at the ER.
A public healthcare crisis emerged in California the first day of the new year due to this new law. Pharmacists who fill a prescription on an old pad risk losing their licenses and there is no grace period to allow doctors time to order the new script pads.
The pharmacists have been told by the Board of Pharmacy “to exercise their best judgement in handling these situations” and to refuse to fill a prescription if they’re not comfortable with it. If they do fill one, they are required to telephone the prescriber and get their purchase order number for the new pads in every case. This represents hundreds of thousands of telephone calls between pharmacists and physicians. And millions of dollars in new prescription pad orders.
Because of the new law, patients are being subjected to numerous delays and denials of pain medication. And physicians and pharmacists are losing countless hours on the telephone. One physician texted me:
“This whole fiasco has been nothing short of a delusional nightmare, construed as improved patient safety, although California already requires at least two different types of security features that have worked flawlessly for many years.”
Meanwhile, insurance companies are saving millions of dollars in unfilled prescriptions. Is the government really worried about mathematical-genius counterfeiters working feverishly in their basements to make fake Norco scripts? Or is the true reason because insurance companies no longer wish to fund the annual $500 billion price tag of chronic pain treatments?
Is the serial number law a sincere attempt to reign in prescription theft or is it yet another transparent effort to further limit pain patients' access to opioids?
Jeffrey W. Grolig, MD, JD, is a board-certified specialist in Physical Medicine & Rehabilitation. He has taught at UC Davis Medical Center in both the departments of Family Practice and Physical Medicine & Rehabilitation. Dr. Grolig has formerly worked as a licensed attorney and has authored 6 books, including “The Physician Primer: Prescribe Like a Lawyer.”
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.