# What checks stop people from fraudulently writing their own prescriptions? **URL:** \ **Category:** Factual Questions\ **Created:** [March 29, 2015, 4:18pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276 "2015-03-29T16:18:18Z")\ **Posts on this page:** 12\ **Page:** 3
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [March 30, 2015, 8:24pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/41 "2015-03-30T20:24:21Z")
> [@Eva\_Luna](#): > > seriously, I imagine many people who need opiates are post-surgical and in no shape to go to the pharmacy themselves. Aren’t there provisions for such situations? Thankfully I haven’t been post-surgical in quite some time. It seems still to be regulated in detail by the states under a broad Federal mandate. Here in FL, pill-mill capital of the World, as of this month I can pick up my wife’s morphine & other esoteric highly abusable drugs showing either her or my driver’s license. The scrip does have to be paper, not electronic though. And no refills allowed. ---
**Author:** ![D18](https://avatars.discourse-cdn.com/v4/letter/d/c57346/32.png) [@D18](https://boards.straightdope.com/u/D18)\ **Post date:** [March 30, 2015, 10:41pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/42 "2015-03-30T22:41:28Z")
> [@Moriarty](#): > > Beta Blockers are also banned at the Olympics. Apparently it provides a performance advantage in the biathlon, where shooting accuracy is paramount, and having a lowered blood pressure/heart rate is an advantage. Interestingly, beta blocker usage is very widespread in the performing arts. Philosophically, I always thought that it’s funny that we don’t care at all if an opera singer needs a beta blocker to manage stage fright, but we get huffy about a biathlete from using it to be a better shot. ---
**Author:** ![Habeed](https://avatars.discourse-cdn.com/v4/letter/h/a587f6/32.png) [@Habeed](https://boards.straightdope.com/u/Habeed)\ **Post date:** [March 30, 2015, 11:40pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/43 "2015-03-30T23:40:27Z")
So…uh…why is paper more secure than electronic? It sounds like it would be straightforward to forge a piece of paper correctly (albeit harder to do when high, I guess, explaining why would-be forgers fail to get the handwriting or terminology correct) but near impossible to break into a reasonably well secured computer system. It isn’t like the movies. Hacking computers is possible, but not something that can be done by just anybody, and it usually requires mistakes made by the computer system operators and/or programmers. Anybody can grab some colored paper, print onto it a reasonable facsimile of a prescription form, and grab a pen and fake some messy handwriting. ---
**Author:** ![gazpacho](https://avatars.discourse-cdn.com/v4/letter/g/6f9a4e/32.png) [@gazpacho](https://boards.straightdope.com/u/gazpacho)\ **Post date:** [March 30, 2015, 11:59pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/44 "2015-03-30T23:59:40Z")
> [@Habeed](#): > > So…uh…why is paper more secure than electronic? It sounds like it would be straightforward to forge a piece of paper correctly (albeit harder to do when high, I guess, explaining why would-be forgers fail to get the handwriting or terminology correct) but near impossible to break into a reasonably well secured computer system. > > It isn’t like the movies. Hacking computers is possible, but not something that can be done by just anybody, and it usually requires mistakes made by the computer system operators and/or programmers. > > Anybody can grab some colored paper, print onto it a reasonable facsimile of a prescription form, and grab a pen and fake some messy handwriting. When I had some back issues and was prescribed some narcotic pain killers the prescription was on paper with a special hologram type seal on it, serial number and lots of really fine lines like you see on money to prevent forgery. It was definitely more than collared paper and a laser printed form. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [March 31, 2015, 12:27am UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/45 "2015-03-31T00:27:11Z")
> [@D18](#): > > Interestingly, beta blocker usage is very widespread in the performing arts. Philosophically, I always thought that it’s funny that we don’t care at all if an opera singer needs a beta blocker to manage stage fright, but we get huffy about a biathlete from using it to be a better shot. The opera singer isn’t competing against other opera singers. /duh ---
**Author:** ![Habeed](https://avatars.discourse-cdn.com/v4/letter/h/a587f6/32.png) [@Habeed](https://boards.straightdope.com/u/Habeed)\ **Post date:** [March 31, 2015, 6:21am UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/46 "2015-03-31T06:21:23Z")
> [@gazpacho](#): > > When I had some back issues and was prescribed some narcotic pain killers the prescription was on paper with a special hologram type seal on it, serial number and lots of really fine lines like you see on money to prevent forgery. It was definitely more than collared paper and a laser printed form. I’ve seen several prescriptions for vicodin and they were nothing special. Whenever I got an ingrown toenail whacked, I’d always end up with a script for about 30 vicodin. Always wondered if this was sort of a nudge nudge “party favor” or something, I never needed to take more than about 2-4 of the pills (for the immediate pain in the 12 hours or so after the minor surgery). I ended up with something like over 100 vicodin tablets sitting in my medicine cabinet. I guess I don’t have the genes to get a buzz out of them or something, cuz they have sat there for 5 years or so. ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [March 31, 2015, 10:29pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/47 "2015-03-31T22:29:59Z")
> [@Habeed](#): > > I’ve seen several prescriptions for vicodin and they were nothing special. Whenever I got an ingrown toenail whacked, I’d always end up with a script for about 30 vicodin. Always wondered if this was sort of a nudge nudge “party favor” or something, I never needed to take more than about 2-4 of the pills (for the immediate pain in the 12 hours or so after the minor surgery). > > I ended up with something like over 100 vicodin tablets sitting in my medicine cabinet. I guess I don’t have the genes to get a buzz out of them or something, cuz they have sat there for 5 years or so. I’d hold on to them if I were you since they don’t degrade like antibiotics, doctors in the USA are really stingy with them. My dad had yearly kidney stones to the point he was peeing blood and vomiting, and ERs were all over the place on pain meds, stockpiles came in handy for assholes RXing ibuprofen. ---
**Author:** ![gigi](https://avatars.discourse-cdn.com/v4/letter/g/a587f6/32.png) [@gigi](https://boards.straightdope.com/u/gigi)\ **Post date:** [April 1, 2015, 4:29am UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/48 "2015-04-01T04:29:10Z")
I keep Ativan as a safety net for panic, and that one I do still have to take to the pharmacy on paper (printed-out slip with his signature). It is written with three refills. I have noticed lately that they don’t ask for ID anymore so maybe something has changed with this one? I assume it is still a controlled substance? ---
**Author:** ![JayRx1981](https://avatars.discourse-cdn.com/v4/letter/j/71e660/32.png) [@JayRx1981](https://boards.straightdope.com/u/JayRx1981)\ **Post date:** [April 1, 2015, 1:30pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/49 "2015-04-01T13:30:27Z")
> [@MichaelEmouse](#): > > 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. Gets tried, but there are often clues (as others have pointed out) that a prescription is questionable. Prescribers, in my experience, tend to be fairly predictable in their selection of drugs and dosages for a given condition, so any deviation from that is generally going to prompt me to take a closer look. Then too, I’ve actually caught prescriptions which were verified as fake where the person in question tried to just change small bits here and there on a valid prescription to make it seem normal. They just happened to not change some of the security features, and we image all prescriptions and share a central database with other stores in our chain so we can compare if needed. That and the one person attempting to get ahold of Adderall 30mg changed only certain numbers on the hardcopy, but failed to consider that their 3’s were most similar to serif font, and the 3’s (and other numbers) that were actually original to the script (electronically generated, but physical piece of paper) were not. 😛 2. is generally the easier to spot, since we have centralized databases (several of them) which we can consult to see if that prescriber and the phone number given match what’s being presented to us. A differing phone number is usually going to prompt a call to the “official” number listed in one or more of our databases to confirm that Dr X really did just call in that script. > [@The\_Second\_Stone](#): > > 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. 1. and 2., yes. 3., and 4.–not necessarily. Neat handwriting with a doc whose handwriting has occasionally confused even the doc (and their office staff) themselves, sure. Likewise, I’ve had a doctor phone in from their cellphone, on vacation, in a foreign country, in the middle of the night, to confirm that they did in fact call in a prescription that they wanted me to fill, and I can confirm it WAS legitimate. > [@WhyNot](#): > > 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. Doctor or pharmacy, though to my knowledge most of the major pharmacy chains are now compliant with the DEA rules for e-prescribing. \*Trust me on this one, heed the warning of the label/your pharmacist, and DO NOT chew/crush/break open the tessalon perle. I speak from experience (what can I say, I was curious) on this. > [@Qadgop\_the\_Mercotan](#): > > 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. \<\\> It’s actually currently legal in several states, including Ohio. We’ve had several e-prescribed C-II’s so far. I wish I could say that the increase in heroin use has surprised me. Sadly, I kindof had a feeling based on some lit I read a few years ago that this was probably going to happen. > [@Qadgop\_the\_Mercotan](#): > > Yeah, that’s where the money is. But I do a lot of pain management in my practice, too. Just not with a lot of prescribing of opioids. If they ever perfect human cloning, can I clone you and replace quite a few of the area docs with you? 😛 > [@Ambivalid](#): > > 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) All schedules, except for Schedule I (for obvious reasons), can be sent electronically, provided the sending and receiving e-prescribing and pharmacy systems have been certified to be in compliance with DEA rules on the matter (I can dig up a link if you want), subject to differing state laws of course, because when dealing with prescriptions and medical/pharmacy practice acts, there are 50 different sets of rules. > [@grude](#): > > Beta-blockers are abuseable? In what sense? > [@WhyNot](#): > > Not to get high, but as an off label anxiety medication. It’s stretching the term a bit, but there are people who see their use as a “performance enhancing drug.” Not kidding: [Inquirer.com archives](http://articles.philly.com/2010-08-16/news/24973169_1_beta-blockers-graduate-student-performance-anxiety) > [@AK84](#): > > My pharmacist acquaintance mentioned lower dosages of propranolol as a drug he gave extra scrutiny to when I asked him the OP’s question many moons ago. Apparently it sees a lot of use for " nerves". Use for performance anxiety, while off-label, isn’t actually unusual. As others have pointed out, in competitive sports, their use is banned, but use to combat the physical manifestation of performance anxiety (doesn’t really do much for the psychological aspects) in other areas is actually not regarded badly. They can, however, be used to mitigate some of the effects of withdrawal from various drugs of abuse (as can other non-controlled medications), so in certain patients, their use can prompt additional scrutiny. > [@Morgenstern](#): > > The FDA (or DEA, whoever oversees this sort of thing) changed that about 2 months ago. I know, I used to call the office and get the prescription filled by mail too. > [@Eva\_Luna](#): > > seriously, I imagine many people who need opiates are post-surgical and in no shape to go to the pharmacy themselves. Aren’t there provisions for such situations? Thankfully I haven’t been post-surgical in quite some time. Rules might vary in different states, but it isn’t a DEA (or FDA) rule, so far as I know. Policy where I work is that positive identification is required when dropping off and picking up controlled substances, but positive ID can include me recognizing you without needing to see a driver’s license because I’ve filled your prescription for the past several years. Likewise, people other than the patient themselves regularly pick up controlled medications. I’ll track who drops off (via a DL or Passport or other state-issued ID) and who picks up (if different from who dropped off), but it’s not at all unusual for a friend or family member to fill a scheduled medication on behalf of a patient because the patient themselves is doped up to high heavens, vomiting, asleep, or unable to walk, or some combination of all of the above. > [@grude](#): > > I’d hold on to them if I were you since they don’t degrade like antibiotics, doctors in the USA are really stingy with them. My dad had yearly kidney stones to the point he was peeing blood and vomiting, and ERs were all over the place on pain meds, stockpiles came in handy for assholes RXing ibuprofen. First, they do degrade over time, albeit perhaps not as quickly as manufacturer expiration dates would suggest, so eventually they may not be worth holding on to. Second, stockpiling is generally frowned upon, if only because if burglarized/robbed, that stockpile might go towards continuing to drive the current problems we’re facing with opioids. Third, ibuprofen, if dosed appropriately, can actually stand toe to toe with opioids in pain relief via both direct and indirect comparisons in various medical lit sources, so those prescribers aren’t, perhaps, quite the assholes you seem to think they are. > [@gigi](#): > > I keep Ativan as a safety net for panic, and that one I do still have to take to the pharmacy on paper (printed-out slip with his signature). It is written with three refills. I have noticed lately that they don’t ask for ID anymore so maybe something has changed with this one? I assume it is still a controlled substance? They may just recognize you (if you frequent the same pharmacy for your medications each time you need one filled) and no longer feel the need to see your ID. I’ve got quite a few patients like that. I do assure you, however, that Ativan is still very much a controlled substance, falling into Schedule IV. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [April 1, 2015, 5:08pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/50 "2015-04-01T17:08:46Z")
> [@Jackmannii](#): > > 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. Yeah, if you forge a 'script from a dentist for penicillin, it’s likely to be filled without question. But any of the controlled drugs are monitored. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [April 1, 2015, 5:10pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/51 "2015-04-01T17:10:52Z")
> [@DrDeth](#): > > Yeah, if you forge a 'script from a dentist for penicillin, it’s likely to be filled without question. > > But any of the controlled drugs are monitored. Or Viagra. ---
**Author:** ![Duckster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/duckster/32/1244_2.png) [@Duckster](https://boards.straightdope.com/u/Duckster)\ **Post date:** [April 1, 2015, 6:11pm UTC](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276/52 "2015-04-01T18:11:24Z")
> [@Eva\_Luna](#): > > seriously, I imagine many people who need opiates are post-surgical and in no shape to go to the pharmacy themselves. Aren’t there provisions for such situations? Thankfully I haven’t been post-surgical in quite some time. In my post up-thread, I had a prescription for opiates. Luckily the pain medication I was given with my day surgery was still working that going to the pharmacy later that day was not a problem. My wife had to do all the driving though. In fact, I was banned from driving for 72 hours post-op (not that I was going anywhere anyway). [Previous page](https://boards.straightdope.com/t/what-checks-stop-people-from-fraudulently-writing-their-own-prescriptions/716276.md?page=2)