Textbook of Psychopharmacology/Opioids/Prescription Forgery

Description
Prescription forgery is a means by which illicit drug users obtain medication illegally. By definition, its comprises the submission of a copied and/or handwritten prescription (Medical Doctor's order for medication) to a legitimate pharmacy in order to obtain controlled substances. Forged prescriptions are most often used to obtain narcotic painkillers, benzodiazepine anti-anxiety medications, erectile disfunction treatments, and other drugs which are popular on the black market.

Methods
Forgers are creative and enterprising people who are using their creativity and motivation for unethical reasons.

Copying
In this method, the forger would copy a legitimate prescription using electronic copying devices. The two prescriptions would then be submitted to different pharmacies, so that double the intended amount of medication may be purchased. In some areas, prescription forms are watermarked or otherwise marked with anti-copy markings. The absence or alteration of these markings would alert the pharmacist to a forgery.

A slight variation of the copying method occurs when the forger "whites out" the handwritten prescription on a form and uses an electronic copier to obtain blank prescription forms which the forger can then write on as he/she wishes.

Pad Theft
In this method, the forger steals blank prescription forms from a medical doctor's office. The forger can then write prescriptions for himself. This method is the forger's only choice when using prescription forms with anti-piracy mechanisms embedded.

Jargon or Lingo
Although plain-language writing of prescriptions is becoming more popular, there exists a "code" of abbreviations used by Medical Doctors for the writing of prescriptions. The forger will learn these abbreviations and become a master of them in order to make the forged prescription look more legitimate. Most of these abbreviations are derived from Latin language words. They are used to speed the writing of the script, to make the script harder for a layperson to decipher, and to avoid ambiguity and confusion on the part of the pharmacist. According to about.com, the Latin language was used for the earliest prescriptions, around 1400 AD; and is used to this day because Latin is a "dead" language, and is thus unlikely to be misinterpreted.

Examples
1 - 2 tab po q 4 - 6 hrs prn pain Unless you have a medical background, this phrase probably makes little sense. It means: "Take 1 or 2 tablets by mouth every 4 to 6 hours as needed for pain." The following table is only a short sampling of abbreviations and is not exhaustive.

Abbreviation Table
Abbreviation | meaning Sig | Signa - "to write" - used to indicate patient's dosing instructions tab | tablet - A normal "pill" - not a capsule cap | capsule or caplet prn | "as needed" or "as needed for" po | "by mouth"

DEA License Numbers
In the USA, the Drug Enforcement Administration (DEA) issues licenses to medical professionals that enable them to prescribe controlled substances. This number is sometimes preprinted on prescription forms, or is filled in on prescriptions for narcotics only.

Checksum Formula
There is a formula which can be used to verify DEA numbers. It is in use to prevent forgers from simply making up a random number for use as a DEA license number on a forged prescription. An example of a valid DEA number for a doctor named Dr Adams would be "#BA1424326". The following information was copied from www.uspharmd.com: DEA numbers are two letters followed by a seven digit number. The first letter is always either an 'A' or a 'B'. This letter is used to designate the nature of the prescriber's practice and/or indicate any special privileges or restrictions attached to the license. For example, physician's with a special license permitting the prescription of opoid replacement therapy medications (ie., Suboxone [buprenorphine/naloxone], and Subutex [buprenorphine]) will be designated with an introductory "X". Other examples of introductory letter designations include "A" and "B" for regular care providers (medical doctors, dentists, and non-physician care providers [CRNP's and PA's], and an introductory "C" for clinicians practicing in and /or operating healthcare practices such as a {C}linic or ambulatory/urgent care center. This introductory letter can be any one of many and no longer has any relationship relative to the date of license issuance. Most pharmacies pay a fee to subscribe to an electronic database of all current DEA numbers, giving them the ability to access and confirm the validity of any given number.  The second letter is always the first letter of the doctor's last name. The seven digits have a mathematical relationship that is always followed. Do this exercise with your DEA number to verify it: Let's use the first six digits (142432) as an example to determine what the final digit must be in order for it to be a valid DEA number: Add the first, third and fifth numbers. In this case we have 1+2+3 = 6 Now add the second, fourth and sixth numbers. 4+4+2 = 10. Double the sum you just calculated 10x2 = 20. Add this to the first sum. 20+6 = 26. Take the last digit in that sum (the sum is 26, the first digit is 2, the last digit is 6).<BR> The final digit in the above DEA number must be 6.<BR> 1424326 is a valid DEA number. Any other digit (other than 6 in this example due to the mathematical relationship that must exist) as the last digit, is a fraud.