- Controlled Drugs and Substances Act (CDSA)
- Food and Drug Regulations, G.03.002
- Narcotics Safety and Awareness Act (NSAA)
- NAPRA Model Standards of Practice for Canadian Pharmacists
- Health Canada: Abuse and Diversion of Controlled Substances: A Guide for Health Professionals
- Health Canada: Loss, Theft and Forgery
- Narcotic Monitoring System Questions and Answers, List of approved forms of identification and reference manual
College Contact: Pharmacy Practice
Report a fraudulent prescription for any controlled substance to Health Canada: Forgery Report Form
Controlled substances (identified in the schedules to the Controlled Drugs and Substances Act (CDSA)) such as narcotics, controlled drugs, benzodiazepines and other targeted substances, are regulated by federal legislation under the authority of Health Canada’s Controlled Substances Directorate and the Drug Strategy and Controlled Substances Programme. Its Office of Controlled Substances (OCS) works with other federal departments (such as the Canada Border Services Agency), provincial/territorial agencies (such licensing authorities for medicine and pharmacy) and law enforcement for the purposes of protecting public health and safety by minimizing the diversion of controlled substances for illegal use.
Provincially, Ontario’s Narcotics Strategy promotes the proper use, prescribing and dispensing of monitored drugs (i.e., controlled substance, opioids, and any drug product designated in the regulations by the Minister of Health) to help reduce the misuse, addiction, unlawful activities and deaths related to these medications. The Narcotic Safety and Awareness Act (NSAA) permits the monitoring, analyzing and reporting of information related to the prescribing and dispensing of monitored drugs via the Narcotic Monitoring System (NMS).
The NMS alerts pharmacies of potential issues with monitored drugs, such as patients who obtain prescriptions from more than one prescriber or who are filling prescriptions at multiple pharmacies. Ideally, proper use of the system also helps reduce unlawful activities involving controlled substances, such as double-doctoring and forgery. Pharmacy professionals are advised to follow up on NMS drug utilization review messages and co-operate with pharmacies requesting information regarding these alerts.
When there is suspicion that a prescription may be fraudulent, it is recommended that the pharmacy attempt to retain the prescription. If its authenticity cannot be confirmed before the “patient” requests to have their prescription back, create some documentation on the prescription itself. For example, complete missing patient information (e.g. demographics, allergy status, drug plan, etc.) or add the pharmacy’s contact information (handwritten or using an ink stamp). This action itself could thwart an attempted forgery, or if the individual takes the prescription elsewhere, the other pharmacy will be alerted to the suspicion of its validity.
If a forgery occurs it must be reported to the local police immediately and to the Office of Controlled Substances no later than 10 days after its discovery.
Once a forgery is identified or confirmed
- Use a delaying tactic to stall for time. This generally frustrates perpetrators who are usually in a hurry and do not want to come back. Even if they do not seem rushed, waiting a long time or having to return later may make them abandon their attempt, thinking that the forgery has been detected.
- Notify the police.
- Use the emergency number 9-1-1 if the suspect is still in the pharmacy and advise the operator that the suspect is at the pharmacy and that there is a forgery in progress
- If the suspect has left, report the offence to your regional non-emergency police number. Advise the police if the suspect is expected to return to “pick up” the prescription so they can arrange to be present
- Do not attempt to physically restrain the suspect. This jeopardizes your safety, and possibly the safety of your staff, patients, and customers.
- Make note of the suspect’s description and, in the event the suspect leaves, note their direction of travel and, if in a vehicle, try to obtain the license plate number, make, model and color.
- Preserve the evidence. Whenever possible, retain the prescription, or, if that is not possible, make a copy of it. Minimize handling the prescription to preserve fingerprints left by the suspect. If possible, place it in a plastic or paper bag. If the suspect demands the return of the prescription, comply with this request in the interest of safety.
- Advise physicians to contact the College of Physicians and Surgeons of Ontario (CPSO) for guidance on how to report fraudulent prescriptions using their credentials to the Ontario Public Drug Program Division (OPDP) so that this information can be disseminated to all pharmacies (see below).
- Contact other pharmacies in the area to inform them of the situation.
- Send Forgery Report Form to Health Canada’s Office of Controlled Substances, Drug Strategy and Controlled Substances Program whether the prescription was filled or not.
Prescription Forgery Alerts
Ontario pharmacies receive Prescription Forgery Alert notices via email from the OPDP’s Drug Programs Delivery branch of the Ministry of Health and Long Term Care. These notices contain important information from Ontario physicians reporting forgeries or lost/stolen prescription pads to the Ministry. These notices are NOT available publicly and Designated Managers should have a system in place to ensure this information is communicated promptly to front-line dispensary personnel.
For additional information, refer to the article Diversion of Prescription Medication, CPSO Dialogue Volume 15, Issue 1, April 2019
Office of Controlled Substances
Health Canada National Compliance Section
Tel: 613-954-1541 Fax: 613-957-0110