Dealing with forged prescriptions
Everyone has their own preferred method of dealing with forged prescriptions. Ryan at EclecticEsoteric recently asked what I would do. It so happens that Andrew at PharmCountry has a related post, so it seems an opportune time…
When you've got a forged or altered prescription, there are two basic things you SHOULD do.
1) Contact the prescriber. Verify that it has been forged or altered.
2) Initiate a PharmAlert, the details of which can be obtained by contacting your state's board of pharmacy. I believe this is how such an alert is usually initiated anyway — I'd say "always" but I haven't worked in every state, so that's impossible for me to know.
PharmAlerts start a cascading reaction. A notice is typically faxed to the pharmacy at the top of the list in your area, and they, in turn, fax to other pharmacies who fax to other pharmacies. You are also supposed to pick up the telephone, and notify the pharmacist at the receiving pharmacy as well, but we rarely do. I should take a picture of the PharmAlert notification map for my area. It's kind of nifty because one of my stores is #1 on the list. If I had to guess, I would say that the seed pharmacies at the top of the lists are probably chosen that way because they are lower volume, and it's thought that they have more time to seed the word along? I have nothing to back this up, I'm only guessing. We are responsible for notifying three pharmacies, whereas everyone lower on the list than us is only responsible for one.
Doctors' offices can also initiate pharmalerts, and often do if a prescription pad is stolen.
There are a couple of things you COULD do beyond these two steps, depending on how crazy you want to be. These include contacting the police, the DEA, and anyone else you might want to contact. It all depends on how zealous you want to be. Me? I don't bother because I don't particularly want to be a law enforcement officer. If I did, I'd work for the DEA. Some pharmacists also take the opportunity to lecture the person about altering a prescription. That's not really my style either. The person already knows they did it, and they know it's wrong. I don't need to beat it into their head, or threaten to call the police on them.
All this changes, though, if you're a habitual offender and/or I suspect there might be organized crime involved. In that case, I verify the script, call the police very quietly, and keep you waiting until the officer arrives, at which point you are arrested. And yes, it always does seem to fall on me to keep the person waiting and so on. I have no idea why. Apparently my poker face is pretty good.
Assuming no drastic measures are taken, I would also say that you shouldn't give the prescription back to the person, but I have seen it done. (An act which never ceases to boggle my mind!) By doing this, you are giving the person another chance to take the script elsewhere. This is unacceptable!
Regardless, I believe it's important to keep whatever action you decide to take low-key and professional. You are not this person's parent. You aren't the police. You are the medication gatekeeper. Politely deny them, do what you must do, and keep the ball rolling.
[tags]Pharmacy, pharmalerts, pharmacy practice[/tags]
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Forged prescriptions…
OnThePharm tells us what to do in these cases….
Trackback by Trusted.MD Network — June 20, 2007 @ 8:59 am
Thanks for the reply. I did hand the script back to the person, which I knew was a bad idea, but I wasn't really sure what to do.
if I knew it was a forgery, is it really ok to just keep it? I guess so, oh well. I like to learn things the hard way anyway.
Comment by Ryan — June 20, 2007 @ 5:00 pm
Hey, thanks for the link. I only wish we had been able to catch that adipex patient. I keep wanting to get someone caught and taken out in handcuffs, but unfortunately, I'm only the tech and the RPh gets to make the decision. (my pharmacists are either too scared or too indifferent to actually follow up on it.)
If we confirm that something is fake (or can't confirm that it is real) we usually stick our label on the back along with our phone number. That alone usually keeps it from getting filled somewhere else because our labels are too sticky to pull off without ripping the script
Comment by Andrew — June 20, 2007 @ 6:18 pm
As I understand it, the written prescription is the property of the patient. Unless you are positive it is a forgery, I would give it back.
Comment by Kirsten — June 24, 2007 @ 6:51 am
If I suspect it's a forgery, I'm going to hold onto it until I can verify one way or the other. It's the doctor's property, as far as I'm concerned, and I don't want them to (possibly) get into trouble for drug distribution. Then there's always covering my own ass. I'd rather get slapped on the wrist for bad "customer service" than fill a fake script.
The "patient" can go screw. If they can't wait 12 hours (it's popular to come in 10 minutes before closing), then I guess they'll have to go to the ER.
What you don't know, and you'll have to just accept, is that I'm pretty darn liberal when it comes to filling prescriptions. For what it's worth, I've never called an office to find out that the prescription is real. It's always been fake. So it stands to reason that I've filled some fake ones — in fact, I know I have — and I'd rather fill a fake one than deny a patient who is legitimate and in need.
Comment by RJS — June 24, 2007 @ 8:50 am
I just had another fake script, this one called in. And we got her arrested too. (See my blog for more details). I just hope she pleads guilty so I don't have to go to court.
Comment by Andrew — July 4, 2007 @ 12:12 am
Hey you "wannabe" cops–If you like to play narc so much, you should have been DEA agents instead of pharmacists. You need to get over your sadism Andrew. These people whom you take so much pleasure in busting, as it were, are in need of medical attention one way or another. You really should be ashamed of yourselves. They will meet with a bad ed in their addiction without you playing God, or pathetically trying to at any rate. I've never seen such a bunch of high-school hall-monitor antics from supposed professionals in all of my life, let alone my career a neurologist. Pretty lame, sergeant dork…
Comment by doctor bryan — March 29, 2008 @ 7:09 pm
[...] KevinMD, this advice on dealing with them from OnThePharm: Everyone has their own preferred method of dealing with forged prescriptions. Ryan at [...]
Pingback by GruntDoc » Blog Archive » Forged Scripts — April 3, 2008 @ 2:29 am
First of all "doctor bryan" most of the time, when I call a doc to find out a rx is fake-they WANT us to press charges. You are right tho, the person trying to receive the fake rx does need medical attention; they sure as heck are not going to receive it if they don't ever get in trouble. They will just move on to another pharmacy. Your just another example of a "dumb doctor"- we see a lot of those. Then again you probably are not even a doc.
Comment by Jac — August 29, 2008 @ 10:21 pm
I don't think it is fair for us to call each other "dumb doctor" or "narc". I agree with both sides.I don't know what the solution is but I wish we could find some happy medium.I agree that Rx fraud is wrong and should be stopped but MOST of the people trying to fill those Rxs are desperate, emotionally hurting human beings who need help.Sometimes it takes getting caught to stop it.If anyone can help stop the cycle of addiction, it can change that person's life.But no matter what, it should be done with respect whether we believe they "deserve" it or not.I have been an RN for 15 years.I was taught to be the patient advocate and that each person I care for should be treated as well as I would want to be treated.I think we all have to do what we can to stop Rx fraud-not so we can "see somebody get arrested" but for their own good.Because as licensed professionals that is what we are supposed to do-help people get well. Andrew, you need to change your attitude or your career choice.May I suggest you become an executioner because you would probably enjoy that too.Cruel behavior has no place in healthcare.It makes us all look bad.Just remember we all become patients one day and karma is a bitch. Write that in your blog.
Comment by RedHead — October 3, 2008 @ 6:24 pm
Well just so where all clear, everyone in here must be talking about the touchy subject of pain pills and how they are prescribe, and purchased!! Now I'm going to start off by saying the Court system of America has failed again by persecuting Doctors and holding them liable for the stupidty of the user's actions!!! Someone takes a pill and crashes a car, suddenly its the doctors fault! (what the Fuck happened to taking Responsibility for ourselves as an individual!! Now let me inform all of the bias users on the this site by saying there are beyond thousands of American's that can benefit from these pain pills, who may have poor insurance, or none at all!! with that said people are going to find ways of purchasing what they need!! by not allowing them to buy legally, than they will purchase illegally, (so if this is what you want then we will all hafta pay higher taxes because the DEA will be inforcing this law federally, meaning there will be minimum 5 years and that come out of our pockets) Now the smarter individuals will purchase the pills online from other countries, who already sell them at a lower rate, so now America is losing more income because of uneducated people and there personnel war on pills!!! The last thing i want to point, is do alittle research about other countries and how they control their drug problem's in their region!!! i swear everyone in here would be surprised to know that about 75% of all nations in the world have a variation of pain pills sold on shelves at an astonishing lower rate, as well as marijuana!! (And the funniest part of it is their
crime rates are so much more lower than America's is its just mind boggling) We are depriving our poor people the Freedom to do what ever the Fuck they want to do as long as they dont interfere with others. Are police are turing into the Goddam Gestopo, We are ruining our freedom by deprivation, because when people are deprived they will do anything to get what they need!!! (just look what happened to Germany, in the 1940's the most deprived country at the time allowed a deranged prisoner to rule their country) Now its only safe to say that without the worry of the Doctors being charged,(except for extreme circumstances) then their should be no problem prescribing such pills, in low dosages or what not!!
If anyone read my ramble, thanx for tuning in!!
Comment by Micheal M.D. — April 17, 2009 @ 6:18 pm
I can only thank those professionals that agree medical personnel are not gestopo. As for Andrew he should have applied for a position as a guard at a federal prison. As for the DEA, they are the biggest assholes this country has ever created. They practice medicine though they are not doctors and then tell the rest of the country what they can and can't take. We've spent billions of dollars on so called drug wars and what results have we seen? Nothing, crime is at an all time high, kids get stoned on whatever they can and all because we as a nation are stuck in the 30's when it comes to legalizing pot. There is something to be said for "we get the government we deserve".
Comment by Mike — May 1, 2009 @ 9:57 pm
I removed the date from my prescription to have it filled before it was due to be filled. Pharmacist kept script and told me she was contacting DR. I am a idiot. I still had med's left. I want to call the dr and apoligize. I dont fell sorry for myself, i fell bad for what i did. Im a good person who has never done anything like this before. Im scared. does the dr have to turn me in? please excuse the typos
Comment by stupid — May 3, 2009 @ 8:42 pm
No legal trouble, no. If I were you I would:
1) Contact the doctor and apologize profusely.
2) Write the pharmacist a note and either mail it to her or give it to a technician to give to her explaining yourself and apologize profusely.
You'll be marked either way for the next 1-5 years as a potential script alter-er, depending on how long each hold memories, and whether or not they're enlightened enough to understand that people learn lessons.
Either way, expect to have each script scrutinized closely every time you come in for the next year or so.
We have reformed script forgers and changers that come to our pharmacy. We tend not to hold grudges so long as its behavior that doesn't repeat itself. Alas there are some pharmacists and physicians who are bottom-feeders just like in every walk of life who might bust your balls just because. You'll just have to wait and find out.
Comment by RJS — May 3, 2009 @ 9:28 pm
you are very kind, thank you for your post. the guilt of this is killing me. I just want to crawl into a hole and die.
Comment by stupid — May 3, 2009 @ 9:43 pm
Best to deal with it head-on, then, rather than letting it eat away at you. If you demonstrate that you're a decent human being who made a mistake rather than a habitual offender, I think you'll be okay.
Telling both individuals how guilty you feel wouldn't go amiss if you write those letters. Share with them how the mistake made you feel. We've all done things we regret… things that seem mind-bogglingly awful in retrospect.
We're all human.
Comment by RJS — May 3, 2009 @ 10:34 pm
Andrew, you are an asshole!!
Comment by cyndi madison — July 1, 2009 @ 11:35 am