Why are paper RXs considered more secure than electronic?

This musing due to spending a day with wifey in ER last week, culminating in electronic RXs put in for Flexeril and a paper script for vicodin.

Why on earth are paper RXs considered more secure? Not that I’m inclined to do so, but as a former graphic designer eyeing the script, I think most folks of moderate skill and equipment could forge the RX. The scrip was watermarked and had a barcode, but no special in-paper filaments, etc.

OTOH, as with most transactions, electronic transfer on a secure line seems vastly more secure. Sure, there are skilled hackers who probably can, and do, secure illegal scripts electronically – but surely there are more attempts with paper forgery?

Please enlighten!

Was the electronic prescription digitally signed? It could be a cohort in the doctor’s office sending the prescription, and not the actual doctor.

It had a signature, probably that of the resident ER doc. But electronic signatures are quite easy to forge . . .

I should mention that in NY, NJ, and PA any drug vaguely described as narcotic requires an electronic script be sent directly to a pharmacy – paper RXs are not accepted.

Not the type of electronic signatures that I’m familiar with.

Writing //signed Dr. J is NOT an electronic signature.

But not sure why other states require electronic prescriptions while some don’t.

Vicoden is a SCHEDULE II Controlled substance and has different rules, they just may not have caught up with the technology yet. The link below does say it can be faxed…but the person MUST present the hardcopy when picking up the script.


I just did some quick research, looks like the DEA only somewhat recently allowed places to send electronic prescriptions for Schedule II drugs. But, it requires certain security features in the software, and some states and offices haven’t caught up yet, or still have “written” prescription codified in state law.

We recently had to get my husband’s scripts, and for his percoset, the signature is pretty basic.

It wasn’t even a full name, just a letter, S, for the doctor. Seems to me that would be easier to forge.

The script for Sch II (at least in SF and Sacramento) is a triplicate form with engraved scrolling like US currency.

It is “NCR paper” - carbonless carbon paper.

I have to present photo ID to pick up the script (top copy) and when I give it to the pharmacist.

DEA requires that these pills be counted twice before delivery to patient.

The first of these forms (at least 2 fields cross-check other info) actually required, in addition to the MD’s DEA number, a friggin’ thumb print.

The war on opioids has done nothing if not increase gasoline consumption.

I can get every other 'script delivered by mail.

Once a month, I call the doc’s office, tell them the drug/dosage/quantity.
They call me when the 'scripts are ready.
I drive across town and give them the ID. They put the ID on the copiers glass with the 'scripts and press the button.
I then take the forms and ID to the pharmacy (they really hate for me to use more than one store to fill the 'scripts) and they scan the forms and ID.

Yes, I can be required to present ID again 30 minutes later to pick up the pills. They usually don’t.

I am 67 with a graying scruffy full beard and a ponytail. They all know me by sight at this point.

This was an accidentally timely thread – I ended up driving 44 miles in rush-hour traffic to pick up an RX from the doc for me wife: the paper RX for Tylenol 3 cost me more than two+ hours of time.

For frickin’ Tylenol 3!! :dubious:

As above: a doctor’s thumbprint? This War on Properly Prescribed Drugs has tipped into being truly foolish.

It just seems to me that electronic transmission is so much safer; identity theft happens (and always will) but I feel much, much, much safer paying bills electronically than I ever did sending a check through snail mail with all my info and signature on it.

As someone mentioned above, technology hasn’t caught up. More accurately, bureaucracy and tradition hasn’t caught up. This is the same industry that relies on fax because email is “insecure.”

The special “trip scrip” forms go back to the era when all prescriptions were written on paper, and the need to control access to Schedule 2 meds arose. Much like how US currency keeps its value against counterfeiting, the effort was not so much to control what’s written on the paper, but to control the paper itself. IME, the prescription pad was numbered and assigned to a specific doctor. They kept one copy, you got the original and the third went off to audit, probably by the DEA. Various laws and codes were built around this - essentially saying “Prescriptions for Schedule 2 meds must be on special copy-proof paper.”

Eventually e-script came into being, allowing doctors to squirt your prescriptions to the pharmacy over the web. But, those laws for Schedule 2 stuff are still in force. The last Schedule 2 prescriptions I got were on fairly elaborate paper made by Crane (the same mill that makes US currency paper) with microprint, void pantographs, a Eurion constellation, color-shifting ink and heat-sensitive ink. This is just what I could spot in the ten minutes or so between getting it and giving it to the pharmacist.

Some day, we’ll probably get to the point where doctors can e-prescribe Schedule 2. My guess is the process will involve two-factor authentication with something like an RSA token or an app on their phone.

I think the idea is that is is more troublesome to get a paper prescription - thus you must really need it to go through the hassle.

And less prone to fraud as someone must show up at the doctors office to pic it up.

If you want to see a MD either squirm or (more likely) get pissed at you, ask:

How did the Doctor/Pharmacist handshake work before the DEA got involved?

Even after 10 years and my being an above-reproach patient, the MD just said"I don’t think I can tell you that".

This is guy who quickly wrote out another doctor’s name and phone number as a referral.

The phone number was the doc’s unlisted, always answered in person, not for publication, number.

The doc trusted me, but not enough to even hint at how that works.

So, how does the person in the MD’s back office get authority to prescribe drugs? The “phone the 'script in” routine long predates the FAX, let alone the web.

You just got a Medical License and now can write prescriptions all day long.
You decide that cityname looks like a place you’d like to live and work.
How do you get every pharmacist in cityname to accept your prescriptions?
By now, there have to be 1000’s of people who know how to print a prescription pad (hint: your inkjet ain’t gonna work). Why would a pharmacist accept one such piece of paper but not another?

The clinging on to fax technology puzzles me in general. At work, we are required to list our departmental fax number – really? I think the last fax I sent was a copy of my W2 to a mortgage company in 1997. Once in a while I’ll be asked, usually by a government-type bureaucracy, if I can fax a doc to them. “No, but there’s this GREAT, brand-new technology called email and I can send these amazing things called editable .pdfs; it’s so cutting edge, I understand if you haven’t worked with it before!”

On the “trip scrip” (BTW, great way to put it): WAG that folks seeking SchedII meds would crawl to the doc’s office with two broken legs to pick up a scrip.

Way back in the mists of late '80s, early '90s, I had a friend who was a receptionist in a GP’s office. For several years she got away with calling in prescriptions for herself and people who would act as surrogates to pick up drugs for her (not me!) I think all she had to do, once she established herself with local pharmacies as the doc’s office representative, was give his DEA number.

There was practically nothing she couldn’t get, and she loved the benzo family. This lasted about three years until she was caught and fired.

Because you’re talking about an industry that still not only uses, but *relies *on fax.

ETA - I see that’s already been mentioned. It’s fresh for me because I was in the “advanced fax” industry ca. 1995 (hi-res imaging, faxback info systems, auto fax routing, that sort of thing) and when the Mrs. recently set up as a quasi-medical provider I found that none of my legacy fax gear - most of it commercial grade and originally quite expensive - will work for shit on modern digital lines. For the absolute requirement to have it and minimal actual need for it, going with a service (FaxAge) was the solution. But we still get requests to fax 50-100 page documents, because doctors.

Why would a paper script be required for Tylenol 3, which is schedule III?

I’ve had trouble with doctors offices and pharmacies not knowing which drugs require a paper prescription. In one case the pharmacy said my dog needed a paper prescription for an epilepsy drug, but the vet said it was not necessary, they should be able to fax it in.

The vet said in these cases the pharmacy wins. They are not going to fill the prescription without a paper prescription, so best to play along!

Any scheduled drug requires a scrip in New Jersey!