Duties and responsibilities
Responding to prescription fraud
An article for physicians by physicians
Originally published March 2004 / Revised June 2008
Considerations for managing suspected prescription or narcotic fraud, forgery or theft.
Of interest to physicians prescribing and administering medications
Members sometimes ask how they should respond to a suspicion that one of their patients has attempted to obtain a narcotic or other controlled drug through fraud, forgery or theft. When deciding on what steps to take, physicians need to be cognizant of patients' rights to confidentiality. This is especially relevant in view of privacy legislation. Improper disclosure to the police of information about a patient's identity and other details learned in the context of a doctor-patient relationship may expose the physician to a legal claim or a complaint of professional misconduct.
To assist members in understanding this often confusing subject, some general advice is provided below for five common scenarios.
NOTE: Regulatory authority (College) policies and provincial/territorial regulations regarding prescription drug fraud vary across Canada. Several provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Nova Scotia have adopted multiple copy prescription programs, for example. Members may wish to review the specific regulations that apply in their own province or territory.
A prescription pad has been lost or stolen:
- If you are confident you know the patient who may be responsible and are satisfied it would not put you in any danger, you may consider resolving the matter directly with the individual.
- If you suspect a theft and direct resolution is unsafe or not possible, consider notifying the police.
- When speaking with police, provide all the requested information about your missing and presumed stolen prescription blanks being careful not to identify any individual patient.
- Notify the multiple copy prescription monitoring program, depending on the province/territory.
- Consider adopting prescription pad theft reduction strategies such as secure storage, monitoring of inventory, and being careful not to leave pads anywhere accessible to patients.
Narcotic or controlled drugs have been lost or stolen from clinic stock:
- Mandatory reporting within 10 days of knowledge of loss/theft to: Health Canada,
Office of Controlled Substances, Compliance, Monitoring and Liaison Division (613 954-1541).
- If you are confident you know the individual who may be responsible and are satisfied it would not put you in any danger, you may consider discussing the matter directly with the individual.
- Comply with any search warrant or court order provided by the police.
- Provide all the requested information about the missing and presumed stolen drugs being careful not to identify any individual patient.
- Be aware of regulations governing storage of such drugs, consider the need to store them, and the most appropriate way to safeguard them.
A pharmacy reports a suspected prescription forgery by your patient:
- You have no obligation to notify the police, but you do have an obligation of confidentiality. The pharmacist will generally notify the authorities.
- If you believe you can do so without endangering yourself, consider discussing the matter directly with the patient. If you believe this to be part of a drug dependency problem, manage it accordingly.
- Consider terminating the doctor-patient relationship with persistently exploitive non-cooperative and non-compliant patients.
- If the suspected forgery does not involve a known patient, confidentiality is not an issue and you may report the incident to the police if the pharmacist has not already done so.
A pharmacist reports "double doctoring" by your patient:
- No physician obligation to report to authorities.
- If you are confident it would not put you or the pharmacist in any danger, you may consider discussing the matter directly with the patient. If you believe this to be part of a drug dependency problem, manage it accordingly.
- Consultation with other treating doctors may be appropriate, but broader notification to facilities and pharmacies could breach confidentiality.
- If you are suspicious about a patient's access to drugs from other practitioners, prior to prescribing or renewing a prescription for controlled drugs you may wish to ask your patient if he or she has sought or obtained narcotics or other controlled drugs from another physician in the past 30 days. The federal Controlled Drugs and Substances Act makes it an offence for a patient to fail to disclose this information to a prescribing physician.
- Consider terminating the doctor-patient relationship with persistently exploitive, non-cooperative and non-compliant patients.
Police investigating suspected offences regarding controlled drugs and substances may request information from you about the accuracy of prescriptions issued in the name of your patient.
- Verify whether any of the prescriptions in the possession of the investigating officer and alleged to have been written by you are authentic. Do not volunteer patient information except to verify the information on the prescription such as the name, date and drug amount.
- Since College policies regarding acceptable release of other patient information to police vary between provinces, contact your College or the CMPA for specific guidance, if possible before any police interview.
The bottom line
- In cases of suspected prescription fraud or other wrongdoing by a patient, consider whether the matter can be resolved directly within the context of the doctor-patient relationship.
- In those situations where notification of police or other authorities is appropriate, it is important to keep patient confidentiality in mind.
- Fraud prevention should be a concern for all physicians prescribing narcotics and other controlled drugs.
- If you are unsure about how to proceed when faced with suspected prescription fraud, you may contact your regulatory authority (College) or the CMPA for advice.