I once asked this of me then-PCP, who responded: “I don’t think I can tell you that”. I had been seeing him for 8-9 years, we were both intelligent adults, he knew I knew some things medical I was not supposed to know, etc. Yes, I was offended.
Anyway:
Without giving away the details, How DOES the physician-pharmacist handshake work? Even 30 years ago, anybody with half a brain could print 'cript forms and copy the scribbles. So, generally, how does the druggist know it’s a real 'script?
Actually he could if he wanted to.
And you can probably also find out for yourself, by looking up the appropriate statutes for your state. I don’t remember the title or section, but in California it’s incorporated into the Health and Safety Code. The requirements for prescription forms are set forth in detail; more strictly controlled substances have to have your address on them. The part about the address may be part of the Federal Controlled Substances Act, but the California code describes the type of paper to be used, how the doctor’s name and DEA license should be placed, and required watermarks and other security features.
Just try going to www.findlaw.com and you should be able to find a listing of the state statutes. You may have to pretend to be a legal professional to find that part of the website, but you won’t be asked for a bar membership number or anything like that.
There are things “medical your not supposed to know”? Like, the existence of a top-secret second organ (the inner uvula?) or the real story of the birds and the bees?
I have it on good authority that storks are, shall we say ‘intimately involved.’
Seriously, though what kind of stuff would an MD not want to discuss? I can understand something like, “And this is where we keep the morphine!” But just not telling you about watermarks and generic security features seems trivial. I know about the watermarks and fibers in my money, but that doesn’t bring me any closer to running a counterfeiting ring.
Some of it has to do with the language. Yes we have our own. Some of it has to do with the structure, certain elements concerning route, frequency, dose, all must be present on doctors’ orders whether there in patient or prescription for it to be a legal order. Also, there are really very few medications that anybody wants to fake, so they get higher vigilance. We get calls from pharmacists on occasion about scripts they don’t think are filled out right.
For almost any medication without abuse potential, the “handshake” in most states is pretty casual, and frankly prescriptions wouldn’t be hard to fake. I call in most of my prescriptions for friends here in Illinois, so it’s not like there’s some secret paper or anything.
All physicians who are licensed to prescribe have a DEA (Drug Enforcement Agency/formerly BNDD Bureau of Narcotics and Dangerous Drugs) number. That’s the closest thing to a cross-check; pharmacies have access to that number and can check it against the physician’s name.
Ordinary prescription blanks are easy to forge or steal, and for the most part there is no absolute standard for ordinary medications.
For medications with higher abuse potential, special paper and requirements for a written prescription exist. See this link for a company which supplies special paper meeting CMS guidelines, for example. http://www.medicaidrxpaper.com/ It’s a bit trickier to get hold of such paper.
I only see things from the physician side, and perhaps a pharmacist would like to weigh in, but in general most pharmacists have a pretty good nose for forgeries. They know which doctors and doctors’ offices call in; which doctors practice in their area; which patientsand prescriptions appear suspicious, and so on. Most retail pharmacists are superb at spotting prescriptions which smell funny and calling for verification. They recognize things like signatures, slightly-off sigs (the written instructions), which doctors tend to write for what, and so on.
There is nevertheless, a great deal of prescription fraud so various mechanisms are being implemented at the State and Federal level to combat it. Illinois tracks all prescriptions for commonly-abused drugs; Ohio has fairly detailed regulations around electronic prescribing; CMS (Medicare) has special paper http://www.cms.hhs.gov/DeficitReductionAct/Downloads/MIPTRPFAQs9122007.pdf , etc etc.
Somebody you might have heard of just got convicted of forging prescriptions.
http://www.etaiwannews.com/etn/news_content.php?id=888764&lang=eng_news
Pharmacy tech checking in - I don’t work in a huge city or anything (about 300k people), so we see prescriptions from the same doctors all the time, and are familiar with what kinds of things they prescribe. There are a few red flags that we notice from time to time -
- New patient, especially paying cash
- Requesting name-brand things on controlled drugs (Dilaudid is really popular lately)
- Obscene quantities or dosages (like Xanax 2 mg #120)
- This one sounds funny, but clear handwriting. We are used to the ‘doctor scrawl’ so when something comes along that we can read clearly it freaks us out
- The “I got my prescription wet” phenomenon. I’ve only seen this a couple of times, but once it was MY NEIGHBOR who washed out the ink on the quantities and changed them, we all the doctor, the doctor says “OK - go ahead and fill it!” :smack:
Having said all that, I’m sure some do slip through the cracks. We have had a couple this last week printed on security paper, with the anti-photocopy background, properly formatted prescription writing, and the heat-sensitive ink on the back, where someone just had some prescription blanks printed up, the only thing wrong was that they put a phone number for one doctor, and the name of a different one at the top. But they fulfilled several of the other red flags.
And in the end, we have a communication system between pharmacies where we can scan pictures of the fake ones and send them to everyone else. And if we don’t think it’s legit, we’ll keep it to verify with the doctor, and if it’s after 5 PM, and they’re closed, sorry bucko, we’re keeping it overnight.
We actually, I think, have too much power sometimes. We had an Adderall prescription from a shady-looking guy a couple of weeks ago, I ask for ID at the pickup window (as we have a sign posted that we do that for all drugs at that level of control) - he doesn’t have it. I tell him he can’t have it then, until he comes back with an ID. He then wants the written copy back. We won’t do it without an ID. He never did come back for the Adderall…
I went to my doctor to get a refill for valium and he was sick that day, and his office assistant said that the office can’t call in a script for valium. They have to fax it with the doctor’s signature, then the pharmacy calls back and has to verify it with the doctor himself.
Then the assistant said, “If it had been for Ziac (high blood pressure) or Albuterol (asthma inhaler) I could’ve just phoned, they aren’t too concerned about that.”
So I reckon different meds have different means.
I don’t know about local laws, but anything except for schedule II drugs can be called in here in AR. (Schedule II drugs include stimulant drugs like Adderall/Ritalin, and high-powered pain medicine like oxycodone/morphine).
Amazing coincidince. I take it you are referring, in part to the bizarre blue script with about 4 different cross checks, watermarks, and, in one cast, the Dr’s thumbprint?
Yeah, I no that on (see previous thread about osteoarthritis)
would you conside a script for 240 dilaudid (4mg) a red flag?
Can you elaborate on that one a little bit please? Are you saying that if a patient is willing to pay extra for brand name instead of generic, it’s a red flag?
Does generic hydromorphone not work the same as dilaudid for addicts? Do drug addicts have higher brand loyalty?
I think he’s saying that doctors and pharmacists actually know the names of the drugs they handle, whereas most addicts don’t know anything but the brand name. Hence, a Rx for Dilaudid is suspicious.
That makes sense, however now that I think about it – a lot of the prescriptions I’ve had were written out for brand names (even though they were filled with generics anyway), but none of the ones for narcotics ever were – is this the reason?
It’s not that it doesn’t work; it’s that the brand name tablets / capsules are more recognizable on the street. The generics are made by many companies and usually look quite different both from the brand name and from each other.
When you’re buying something on the street, you don’t have a lot of assurances that it’s genuine unless it looks like something you recognize.
My point is that as far as we know, the brand-name version of a drug commands a higher price on the street. As far as people will claim, the generic will either not work, or will cause insufferable ___________. I would think that if I were trying to pass off an illegal prescription, I’d try to be as low-key as possible. And on preview, damn you Bambi! 
An unrelated sidenote: I have the displeasure of working with a woman in the store (not in the pharmacy) who insists that any generic medicine gives her terrible diarrhea. My first experience with her since transferring to my current store involved two very old drugs, I wish I could remember what they were, that she of course requested name brand in. I got on our supplier and discovered the brand name of one of them wasn’t even available, and I flat out told her I wasn’t going to order a 100-count bottle of the other so that we could fill 30 of them and let the others sit on the shelf. She got pissy, took the generic, warned me it was my fault when she developed terrible diarrhea, and then never came back to complain. :rolleyes:
And don’t get me started on ‘codeine allergies’
And also, usedtobe, they ARE on blue paper, but we didn’t see any fingerprints.
I use dto be good friend with a Pharmacist. One day I stopped in to chat and I asked how the day was going. She told me she had a fake Rx that day. I asked how she knew was fake.
“I could read it.” was the reply.
Only one Dr. did the thumb print.
Gotta know: what’s a “codeine allergy”
And, on the subject: I have a very fuzzy memory (this would have been 1954-1957) of my father going back to the pharmacy counter (a rarity - we didn’t have money for pills), sigfning a ledgger, and getting codeine? Did this actually happen? Now, we have to do that to get friggin’ pseudofed…
I just completed the course work to be licensed in California. All of my textbooks said the same thing—handwriting that is too legible is a red flag.
My brother the pharmacist said the same thing. Doctors just dash these things off. Forgers think about them.