Forged Prescriptions - Be on Alert! Dec. 22, 2022

FORGED PRESCRIPTIONS – BE ON ALERT!

There has been a vast increase in the number and quality of forged prescriptions for controlled substances in pharmacy practice. With the advancements in technology and the increase in computer generated prescriptions, it is essential that registrants remain alert and vigilant in identifying the validity of prescriptions and ensuring that forged prescriptions are not dispensed to the public. Releasing unauthorized narcotic containing substances to patients can have serious negative implications on a patient’s health and public safety as a whole. Given the current overdose crisis, it is imperative that registrants ensure these medications are dispensed appropriately and as intended by a patient’s prescriber. 

As such, please be reminded of the following legislative requirements regarding prescription authenticity outlined in the Health Professions Act, Bylaws, Schedule F, Part 1 – Community Pharmacy Standards of Practice:

6 (1) – Prescription

A registrant must ensure that a prescription is authentic.

10 (3) – Dispensing

If a registrant doubts the authenticity of a prescription, the registrant may refuse to dispense the drug.

WHAT TO DO IF YOU SUSPECT A FORGED/UNAUTHENTIC PRESCRIPTION?

• Confirm the patient’s identification
  • Patients presenting a forged prescription don’t always use their own information. As required when dispensing any prescription, confirm the patient’s identification by reviewing picture ID and checking patient identifiers. This is especially important when generating and assigning a personal health number (“PHN”) to a patient who identifies with no PHN. In the case of the recent Adderall forgeries, each prescription had the PHN field left blank. Furthermore, when asked, the patient presented a fake piece of identification. The reports indicate that the identification did not originate from BC (it was either from another province or country). Please refer to Professional Practice Policy – 54: Identifying Patients for PharmaNet Purposes.
• Review the patient’s PharmaNet profile
  • Identify if the forged prescription has been filled elsewhere, identify any pattern of prescribing or dispensing that is questionable, or if there are notes made by other pharmacies (Note: If a patient misrepresents themselves as another person, accessing the named patient’s information on PharmaNet may be considered a breach of confidentiality).  
• Contact the prescriber
  • Patients often use prescribers of whom they are not a patient. The prescriber’s office will be able to provide you with this information and confirm if the prescription in question is legitimate. Please note, in the reported Adderall forgeries, the prescriber’s phone and fax number as listed on the prescription was NOT the prescriber’s actual number. The phone number was also altered. Instead of relying on the information on the prescription, it is recommended to look up the prescriber’s phone number as listed on PharmaNet or on the College of Physicians and Surgeons of British Columbia’s directory. 

WHAT TO DO ONCE A FORGERY HAS BEEN CONFIRMED?

• Keep the prescription
  • If the patient is adamant and the original prescription cannot be kept, make a copy and retain it for your records. 
• Mark the prescription
  • Provide your pharmacy information on the original prescription and make written notations such as “refused to fill” to flag the prescription and to alert other pharmacies of the forgery. 
• Document on the PharmaNet profile
  • Make an entry on the patient’s PharmaNet profile as a “refusal to fill”, use the code “CF – Falsified or Altered Prescription”, and indicate that the prescription is forged in the “sig” section. PharmaNet must be reviewed by a registrant each time a prescription product is dispensed to a patient, so by entering this information on the patient’s PharmaNet profile, you are providing this information to all other pharmacies. If the same patient profile were used in an attempt to fill the forged prescription elsewhere, this information would be available to them. 
• Document on your local profile
  • Make notes on the patient and prescriber’s local profile. Busy pharmacies can have a large number of staff members or relief pharmacists working from time to time. By making notes on the local profiles, you alert all pharmacy staff to important information and ensure they are aware of any concerns or incidents that may have occurred with a particular patient or prescriber profile. If your software allows, set the alert to pop-up each time the patient or prescriber’s profile is selected. 
• Contact local pharmacies
  • Often patients will attempt to fill forged prescriptions at more than one pharmacy in a local area, especially once it has been refused at one location. By contacting your local pharmacies, you ensure that they are aware and on alert for the forged prescription and increase the possibility of it being identified prior to dispensing.
• Contact the Authorities
  • Contact the non-emergency phone number for your local police department to inform them of the forged prescription, if applicable.

WHAT TO DO IF A FORGERY HAS BEEN DISPENSED?

• Contact the documented prescriber
  • It is important that prescribers are made aware when their name is used for a forged prescription so they can be on high alert for these types of incidents and take appropriate steps to aid in preventing similar incidents from recurring. 
• Complete an incident report
  • It is important to document a record of the incident when an unauthorized prescription has been dispensed. This serves not only to inform all pharmacy staff of the incident, but acts as a learning tool to identify gaps and make systemic and impactful changes to a pharmacy’s processes if necessary.
• Report the forgery and the loss
  • Professional Practice Policy – 74 Community Pharmacy and Telepharmacy Security, requires that pharmacy managers notify the College of any incident of loss of narcotic and controlled drug substances, including forgeries. The College often receives this information in the form of a copy of the mandatory Health Canada report (Form HC 4010 or HC 4004). 

According to their website, the Ministry of Health issues FanOut messages to pharmacies to communicate critical information about PharmaNet outages and lost or stolen prescription pads. Prescribers can report a lost or stolen prescription pad or duplicate prescription pad to PharmaNet Support Services for communication to pharmacies via FanOut. Critical information about issues other than lost or stolen prescription pads may be reviewed for FanOut by PharmaNet Support Services on a case-by-case basis. They will only communicate forgeries in exceptional circumstances.