PDL has offered advice on whether a prescription could be forged, and what pharmacists should do if they suspect they’ve been handed a fake
Scott Ames, principal at Meridian Lawyers, with assistance from solicitor Heather Nieuwenhoven, has written a practice alert for PDL members which looks into the issue of suspicious scripts.
“Pharmacists are expected to take reasonable steps to satisfy themselves that a prescription has been issued by an authorised prescriber,” he warns, pointing out that S4 and S8 medicines subject to abuse, such as benzodiazepines and opioids, are most likely to be forged.
Other medicines should also be considered, though: including anabolic steroids, which may be abused, and drugs such as Catapres, which can be used to mask the symptoms of withdrawal from drugs of dependence – for example, if a patient has sold their prescribed takeaway dose of an opioid substitute.
Pharmacists should be familiar with their own state or territory’s drugs and poisons legislation – outlining the requirements for valid scripts, and their statutory obligations if a forged script is received or detected – and should also ensure that they understand the requirements in a script’s state of origin, should it be from another jurisdiction, such as if the patient says they are on holidays, or the pharmacy is near a state border.
“Generally, pharmacists have an obligation to notify the state health department and in some jurisdictions, the police if they reasonably believe a prescription has been forged or fraudulently altered,” writes Mr Ames.
He advises pharmacists to ask themselves questions such as:
- Do you know the patient?
- Is there a patient medication history?
- Is the medication consistent with the patient’s known dispensing history?
- Is it reasonable for the patient to visit this pharmacy, given their home address?
- Is the patient on holidays or visiting a friend or relative?
- Do you know the prescriber, including their practice or speciality?
- Is it reasonable for the patient to see this prescriber?
- Is the prescriber from out of town?
- Are the medicines prescribed tailored to the individual, or do all the prescriber’s patients seem to get the same drug?
Pharmacists should also be alert to patients who seem to be in a hurry and unable to return later; or whether they have presented at the pharmacy late in the evening or on the weekend, when it might be difficult to confirm the script with the prescriber.
They also need to ascertain whether the date of a script is consistent with a patient’s urgency to fill it; and can also look out for whether the pharmacy is particularly busy or if there is a diversion used to try to distract them – or pressure applied to encourage them to fill the script quickly, such as a crying baby or feigned illness.
Mr Ames also writes that if a script looks too good to be true, it might be – and that pharmacists can also look out for signs such as quantities or directions which differ from the usual prescribing pattern; unusual symbols, terminology or abbreviations; the use of white-out or smudging or different coloured ink on the script.
Another suspicious symptom could be the appearance of previous dispensing stickers having been removed, or too many staple holes in a repeat.
Electronic scripts also can’t automatically be trusted, Mr Ames writes.
These are as prevalent as handwritten forgeries, and may be more difficult to spot.
Mr Ames suggests:
- Looking for perforated edges, which are often lacking on scanned or coloured photocopies of genuine scripts;
- Checking whether the prescriber’s information on the prescription matches the pre-printed information on the back of the prescription;
- Checking to see if the font size is the same as usual;
- Checking for spelling errors in the name of a medicine, or incorrect abbreviations for the prescriber’s instructions;
- Checking whether the quantity or number of repeats appears to have been manually altered, as medical practitioners are not authorised to make manual corrections to computer-generated scripts.
Mr Ames cautions that one or more of these factors could still be present in a genuine prescription.
“Above all, trust your own professional judgement,” he writes. “If the prescription seems wrong, it probably is and you should not dispense it.
“If a decision is made to refuse to supply, a detailed note of the reasons why should be noted in the patient’s history.”
If a pharmacist thinks a script might be forged, they can take a number of steps, including asking the patient for further information to clarify their clinical need for the medication and general health status.
They can contact the prescriber to confirm whether they wrote the script, but obtain the doctor’s phone number from a source other than the script itself.
Some states allow for an emergency supply to be provided if the prescriber is unavailable. Two days’ supply can be made and the script must be retained until verification is possible.
Ask for identification and use professional judgement to establish if the patient is who they say they are, and has a genuine need for the medication.
Record the details of all intervention communications with prescribers to ensure colleagues know what they need to, and do not assume your colleagues have confirmed that a script is genuine unless there is evidence to support that belief.
It may be difficult for a pharmacist to justify dispensing a forged script if they failed to contact prescribers in circumstances where they might otherwise be expected to do so – for example, excessive prescribing; or if they failed to contact the relevant department to report excessive supply.
This may also be difficult to justify if they relied on the fact that the handwriting on one forged script was consistent with an earlier script that was also forged; or failed to discover that a prescriber’s details had already been added to a published list of stolen prescriptions.