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.
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.
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.
The opera singer isn’t competing against other opera singers. /duh
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.
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?
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. 
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.
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.
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.
If they ever perfect human cloning, can I clone you and replace quite a few of the area docs with you?
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.
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.
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.
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.
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.
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.
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).