Forgery: Management and Reporting of Fraudulent Prescriptions

April 15, 2020 Reminder: Executive Officer Notice: Changes to Prescription Forgery Notifications during the COVID-19 Public Health Emergency

If a pharmacist identifies a forgery, please ask the prescriber to notify the Ministry’s Drug Programs Delivery Branch via email, instead of by fax, with the following details:

  • A letter on their clinic or hospital letterhead which shows the reporting physician’s/pharmacist’s full information (name, address, phone/fax numbers, etc.)
  • The areas / cities where the forgeries have been identified (if known)
  • The name(s) of the drug(s) mentioned on the forgeries (if known)
  • Attach any forged prescription pages they may have
  • Details about how the prescriber/pharmacist would like the pharmacists to handle the situation (e.g. not dispense, call the clinic directly)
  • Any other important information that should be included on the notice
  • Email: DrugProgramsDelivery@ontario.ca

FACT SHEET

Published: July 2013; Updated July 2019; April 2020

Legislative References:
Additional References:

College Contact: Pharmacy Practice

Report a fraudulent prescription for any controlled substance to Health Canada using the Loss or Theft Report Form.

A report is only required if a forged prescription is partially or fully filled, as this constitutes theft.

Background:

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. The 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.[1]

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[2] and forgery[3]. Pharmacy professionals are advised to follow up on NMS drug utilization review messages and co-operate with pharmacies requesting information regarding these alerts.

Suspected forgeries

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.

Fraudulent prescriptions for controlled substances that have not been dispensed may be voluntarily reported to Health Canada using the Forgery Report Form.

Once a forgery is identified or confirmed
  1. 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.
  2. 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
  3. Do not attempt to physically restrain the suspect. This jeopardizes your safety, and possibly the safety of your staff, patients, and customers.
  4. 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.
  5. Preserve the evidence. Whenever possible, retain the prescription, or, if that is not possible, make a copy of it. Minimize handling the forged prescription to preserve fingerprints left by the suspect by placing it in a plastic ”Ziploc®” type bag.(If the prescription is wet, do not place in plastic; if possible, place in a paper bag instead.)
  6. If the suspect demands the return of the prescription, comply with this request in the interest of safety.
  7. 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).
  8. Contact other pharmacies in the area to inform them of the situation.
  9. If the fraudulent prescription was dispensed, send a Loss or Theft Reporting Form to Health Canada’s Office of Controlled Substances, Drug Strategy and Controlled Substances Program within 10 days of discovery.
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

 

CONTACT INFORMATION

College of Physicians and Surgeons of Ontario
Tel: 416-967-2600, Toll Free: 1-800-268-7096
www.cpso.on.ca, select “Find a Doctor

Office of Controlled Substances
Health Canada National Compliance Section
Tel: 613-954-1541 Fax: 613-957-0110
E-mail: hc.ocs.reporting-rapporter.bsc.sc@canada.ca

  1. https://www.canada.ca/en/health-canada/corporate/about-health-canada/branches-agencies/healthy-environments-consumer-safety-branch/drug-strategy-controlled-substances-programme.html
  2. Controlled Drug and Substances Act, s 4(2)
  3. Criminal Code s. 366- Forgery and Offences Resembling Forgery