What checks stop people from fraudulently writing their own prescriptions?

Do no need answer fast, I am not asking this because I want to do it* or help others in doing it, it’s just that I’m wondering how this potential problem is dealt with.
I’ve seen a few paper prescriptions and usually, no checking appears to be done with the prescribing physician. The pharmacist just looks at the prescription and sells the drugs. Surely there must be some effective means of stopping someone from copying** the prescription form, writing the drugs they want on it and then either

  1. using the same name and number and phone numbers as the original prescribing physician, hoping that no checking up is done

  2. making up a fictitious physician whose phone number links to the fraudster’s cellphone.

  • I have an understanding physician who is sympathetic to me.

** Either by looking at a prescription form and then recreating it or by getting a prescription for something minor and then whiting out some bits and reprinting it.

  1. Special paper
  2. The pharmacist can check the doctor (and phone number) against a state database. This is done with abused drugs.
  3. Neat handwriting is a dead giveaway.
  4. Pharmacist calls the doctor’s office. Doctor’s don’t answer their own phone from pharmacists.

Yes, it can be done.

Wholesale fabrication of a prescription is hard because every prescriber has a DEA ID number that is usually checked. Beyond that, most laypeople do not know the dosage levels, abbreviations, and directions for a given medication. This trips up most people who think the can just write “100 Vicodin”, and get it filled. Lastly, pharmacists are supposed to note irregularities like mismatched phone numbers, photocopies, frequent scripts from one doctor or patient, and other things. When things like that arise, they may make the effort to follow up to endure the script is valid.

Add to all that that handwritten prescriptions are slowly dying out - these days, if I need a new prescription, my doctor just taps some keys in his laptop and sends the order to the pharmacy of my choice. A prescription that comes on a handwritten document is going to get heightened scrutiny in the same way that someone writing a paper check at the store does in this day and age, especially if it’s for a controlled substance or something one might have an unsavory reason for wanting to acquire.

This may be a state-level condition, but controlled substances I take can’t be sent in automatically. I have to go out to the doctor monthly and pick up a handwritten prescription to be handed to the pharmacist. It’s not just my physician. My wife goes to a different practice and has the same procedure.

That’s the way it works for my father in Connecticut, who is on various pain meds. They need to go to the physician’s office, pick up the paper prescription and bring it to the pharmacy.

  1. A chemist will usually know which doctors work in his/her area. S/he will be familiar with their stationery and writing

  2. As well as their preferences: “Dr Khan always prescribes xyz for this, while Dr Smith goes for abc”.

  3. Most prescription drugs are not of the type that your average addict will abuse. The ones which are, like say narcotics, some type of beta blockers, drugs with hallucinogenic side effects, are only available in many jurisdiction with something beyond a mere prescription. When we needed to get hardcore narcotics for my Grandmother pain relief, we needed both a doctors slip, and permission from the local authorities and IIRC for some meds, only a technician could come and administer, we did not have it at her house.

My Dr. has neat handwriting. His Rx also have blocks on them for each item where he writes so it’s very easy to read. A block for drug name, dose, and how often to take it.

And he’s not young, he’s around 60 at least.

There’s not much stopping someone from using a forged prescription from their own doctor for an additional bottle of pills if it’s not a class 1 drug. The pharmacy will see the record of that prescription for the patient and the doctor and they won’t have any reason to be suspicious.

New patients, new doctors, and new medications will be scrutinized. Dates, dosages, and amounts and will be carefully checked, even more so for the class 1 drugs. Also changes in the frequency and/or amount of the medication will be looked at carefully, and a sudden increase in prescriptions and/or patients from a particular doctor will raise a red flag also. It’s basically about detecting a change in a pattern.

Small amounts of drugs can slip through this system, it’s primarily stopping efforts to obtain drugs in larger quantities through high volume or multiple prescriptions.

Individuals working through multiple doctors and pharmacies obtain lots of extra drugs without having to use forged prescriptions.

Prescriptions for drugs that are frequently abused will get heightened scrutiny, and large dosages/frequent refills are red flags (not just for patient hanky-panky, but also docs who may be abusing the system). If on the other hand someone is forging scrip for non-mind altering meds, it probably would take much longer to detect on average.

In my experience physicians don’t just leave prescription pads lying around to be stolen, although it happens.

Are you certain it’s electronic prescriptions that can’t be used for controlled substances and not over the phone/faxed prescriptions? Starting next year,NYS is mandating electronic prescriptions for both controlled substances and other prescriptions and it seems odd that some some states would mandate it while other states would forbid it.

That reminds me of a news story a few years ago in which a guy stole a prescription writing pad and wrote himself a prescription for a pound of weed. Needless to say, calling it a pound of weed wasn’t exactly the proper pharmacological description for medical marijuana.

He didn’t get his weed.

There are some electronic ordering systems in some states which are allowable for controlled substances, but if your doctor doesn’t have the right system, it’s paper for you.

Last week I went to a walk in clinic inside a drugstore, and the doctor gave me three prescriptions: an albuterol inhaler, a non-narcotic cough suppressant called Tessalon Perles* and a cough syrup with guaifenesin and codeine. She was able to send the inhaler and Tessalon to the pharmacy electronically. The cough syrup with codeine, she had to print for me in her office and I had to take the paper to the same pharmacy counter 20 feet away. I mean, she literally could have stuck her head outside the office door and waved to the pharmacist to confirm it was legit, but state law required a dead tree to be part of the transaction.
*OMG, where have you been all my life?! These things are magic.

I think this is a big factor. 99% of prescriptions probably aren’t worth forging. Pharmacies just focus their suspicions on the other one percent.

Well, my optometrist rubber stamps the drug information and then signs it. Though I doubt eye drops get abused, so it’s really not an issue.

My doctor has switched turning in the prescriptions electronically.

AFAIK, Schedule II drugs must have a paper prescription written in order to be filled, while prescriptions for Schedule IV and III controlled substances can be sent electronically/by phone.
ETA: I may be wrong about the status of Schedule III drugs, however)

There are plans going forward nationwide to enable Schedule II drugs to be prescribed electronically, but I’m not aware of any places that do that yet, outside of a few closed hospital inpatient systems. I still have to write a paper script for any morphine, oxycodone, and now hydrocodone Rx too, since it got reclassified as a sched II. PITA, but there it is.

Incidentally, since the crackdown on diversion of Scheduled drugs, I’ve seen a LOT more heroin use out there, than I did 3 years ago. People want their opioids, it seems. <<sigh>>

Apparently, schedule II drugs don’t need a paper prescription in NY. If you read the article, you’ll see that “electronic prescriptions” (at least in NY ) doesn’t include fax/phone/emailed prescriptions- the reason implementation is being delayed a year is because too many doctors don’t have the proper software and the necessary DEA approvals.

Imagine that.

I’ve also been arranging a ton more referrals to pain management clinics, as PCPs don’t want to deal with the narcotics anymore. Your Medicare dollars at work. More visits, more tests, more specialists, more dollars.

I recently had single-day surgery (check into the hospital in the morning, surgery around Noon, recovery all afternoon, then home by 5pm). I had a prescription for Percocet (Schedule II). I did not have a paper script. The prescription was electronically transmitted (not faxed) by my doctor to my pharmacy (Costco). I had to show my driver’s license to pick up medicine.