TRIPLICATE PRESCRIPTION

An estimated hundreds of millions prescribed medication doses are diverted to the street each year. Triplicate-prescription programs were developed as an effort to decrease the diversion of prescription medications to illicit markets at a reduced cost of government investigation. States with such laws require physicians to write prescriptions on special triplicate forms for all Schedule II drugs, including narcotic analgesics, Barbiturates, and stimulants. In 1989 New York State passed legislation requiring triplicate prescribing for the Benzodiazepines (Schedule IV substances).

In triplicate prescribing, the physician keeps one copy of the prescription for five years and sends two copies with the patient to the pharmacist. The pharmacist keeps one copy and forwards the third to a specified state agency. Here the prescription is used to track the physician's prescribing practices and the patient's use of the controlled substances. With some exceptions, refills are not permitted for medications prescribed under this system.

Opponents of the triplicate-prescription system claim that although it is effective in decreasing diversion, it does so at the expense of some patients who are unjustly denied analgesics, anxiolytics, or sedative-hypnotics. The New York experience with triplicate prescribing of benzodiazepines is often considered an example of this. Although benzodiazepine prescriptions were reduced by up to 60 percent, the number of prescriptions for the older and potentially more hazardous sedatives (such as Meprobamate, methyprylon, Ethchlorvynol, butalbital, and Chloral Hydrate) increased markedly—in contrast to continued decreases in prescribing them in the rest of the United States. New York also required that any physician who prescribed an applicable drug for a long term period was required to report the patient as a drug "addict" or "habitual user," a notion the doctors found unsettling, especially when the drug was prescribed for maladies like cancer. The American Medical Association called the practice of triplicate prescriptions no less than "intimidation by regulatory and law enforcement agencies" (Report 4). It was viewed as so intimidating by New York doctors that 82 percent of the doctors surveyed in 1998 did not use the drug deemed most appropriate because of the observation of regulators.

In 1990 an attempt to federally legislate triplicate prescriptions for Schedule II medications for all states was unsuccessful in the House of Representatives, but efforts in some states, like Texas, to develop an electronic method of gathering the information may, and is likely to phase out the triplicate prescription for a tighter method of control there. In the State of New York, some effort is being made to remove the triplicate prescription system for a single official system that is intended to be less intimidating, although there is no evidence to how successful it will be.

(See also: Controls: Scheduled Drugs/Drug Schedules, U.S. ; Iatrogenic Addiction ; Legal Regulation of Drugs and Alcohol ; Multidoctoring )

BIBLIOGRAPHY

American Medical Association Council on Scientific Affairs. (1995). Aspects of pain management in Adults. Journal of the American Medical Association.

American Medical Association Council on Scientific Affairs. (1982). Drug abuse related to prescribing practices. Journal of the American Medical Association, 247 (6), 864-866.

Brahams, D. (1990). Benzodiazepine overprescribing: Successful initiative in New York State. Lancet, 336, 1372-1373.

New York State Public Health Council, Report to the commissioner of health, Breaking down the barriers to pain management: recommendations to improve the assessment and treatment of pain in New York State, January 1998.

Texas Department of Public Safety. Triplicate Prescription Program. Available: http://www.txdps.state.tx.us. [12 September 2000].

Weintraub, M., et al. (1991). Consequences of the 1989 New York State triplicate benzodiazepine prescription regulations. Journal of the American Medical Association, 266 (17), 2392-2397.

Wilford, B. (1991). Prescription drug abuse: Some considerations in evaluating policy responses. Journal of Psychoactive Drugs, 23 (4), 343-348.

Myroslava Romach

Karen Parker

Revised by Andrew J. Homburg