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ACP Updates

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AB 2760, Wood. Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs.
Requires a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another drug to the patient and specified others, except as specified. The law subjects a prescriber to referral to the board charged with regulating his or her license for the imposition of administrative sanctions, as that board deems appropriate, for violating those provisions.This law does not exclude hospice patients. Therefore, it is essential that hospice patients/caregivers are educated on how to prevent opioid overdose and offered a prescription for naloxone, if narcotics are being ordered. If the patient declines the prescription, this should be documented to protect the prescriber. If a prescription is accepted, the patient is responsible for having it filled at a pharmacy of choice and at their own expense. The hospice agency isn’t required to provide and cover the cost of the naloxone, unless it is their choice to do so.AB 1753, Low. Controlled substances: CURES database.
Requires prescription forms for controlled substance prescriptions to have a uniquely serialized number, in a manner prescribed by the department, and would require a printer to submit specified information to the department for all prescription forms delivered.There was no grandfathering period to allow for this implementation. It was effective immediately. Unfortunately, the DOJ, who controls approval of the security form printers, did not make the new prescription forms available to prescribers prior to January 1. The Board of Pharmacy issued a subscriber alert to pharmacists last week recognizing the dilemma and stated the Board will not make enforcement a priority (until July 1, 2019), so long as the prescription form being used in the interim is otherwise valid with the current security features. They are asking pharmacists to use their best professional judgment when accepting prescriptions for controlled substances in determining what is in the best interest of your patient and the public health. The Medical Board of California has also sent a similarly-worded alert to their licensees. This law applies to “original hard copy” prescription forms and will not affect controlled substance orders that are phoned in by the nurse or prescriber for an emergency or pre-authorized refill dispensing for hospice patients.

BPC 4076.7 Caution Label Required For Drug Containing an Opioid
Whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container, by means of a flag or other notification mechanism attached to the container, a notice that states “Caution: Opioid. Risk of overdose and addiction.”

Advance Care Pharmacy has implemented this addition to the labeling requirements by attaching a label with the mandatory statement to all drugs containing an opioid, when dispensed for outpatient use.


Pharmacies across the country continue to experience shortages of frequently prescribed drugs. Currently, the hospice-related drugs that are in short supply or unavailable are the following:

  • atropine 1% solution
  • haloperidol tablet 0.5mg, 1mg, 2mg, 5mg
  • hydromorphone 1mg/ml oral solution
  • hydromorphone injectable for PCA
  • lorazepam tablet 0.5mg, 1mg
  • temazepam tablet 30mg

Fewer generic manufacturers, supply and demand, and pharmacy allocation are the explanations for the shortage. Note that shortages change frequently and what is available today may not be available next week. Please discuss the available options and alternatives with the pharmacist when placing orders. It is very important to understand what is being provided for your patients, so that administration errors do not occur.

Opioid Safety and How to Use Naloxone
Prescription Drug Disposal

California law prohibits the return of drugs to the pharmacy once they have been dispensed. Any unused medications must be disposed of properly to avoid harm to others. Visit the DEA’s website:


or call 1-800-882-9539 for more information and to find an authorized collector in your community. ACP is not licensed as a reverse distributor and cannot accept the return of medications from deceased or discharged patients. Drug “Take Back” programs are a good opportunity to dispose of unused medications.

Alternative collection sites include the following:

If no programs are available in your area, the medications can be disposed of in the following manner. Remove them from their original container and mix them with water to dissolve the medication. Pour the mixture into used coffee grounds, dirt, or kitty litter, making it undesirable and unrecognizable to others. Seal the contents in a zip lock bag, or empty can, and place in the trash. Remember to adhere to individual hospice and facility protocols when disposing of unused medications. Ask your organization’s management for information and assistance.