In accordance with the New Jersey Uniform Blanks Program (N.J.AC. 13:45A-27), licensed prescribers and healthcare facilities shall notify the Office of Drug Control  (NJPB Unit) as soon as possible but no later than 72 hours of becoming aware that any New Jersey Prescription Blank (NJPB) in their possession has been lost, stolen or altered in any way. The NJPB unit can be reached at 973-504-6558.  In addition, an incident report shall be filed in writing with the Office of Drug Control within seven days after such notification.  This incident report form is available from the above office.

Under the same administrative code, all licensed prescribers and healthcare facilities are required to establish and implement a security protocol for the storage, maintenance and distribution of these prescription blanks. The objective of this regulation is to ensure that controlled substances continue to be available for legitimate medical and scientific purposes while preventing their diversion into the illicit market and abuse of prescription drugs.

As healthcare professionals and providers, we are charged with the responsibility of preventing prescription abuse and diversion. Physicians have a personal responsibility to protect their practice from becoming an easy target for drug diversion. They need to be aware of potential situations where drug diversion can occur and must put in safeguards to prevent this diversion; i.e. making sure that prescription pads are not left unattended and refraining from using pre-stamped prescription blanks.  

Pharmacists, on the other hand, must maintain constant vigilance against forged or altered prescriptions. What does this mean to the pharmacist? The pharmacist who reviews the prescription prior to dispensing may use the following screening criteria if he or she suspects that the purported prescription was not issued for a legitimate medical purpose:

• The prescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in your area.
   
• The patient appears to be returning too frequently. A prescription which should have lasted for a month in legitimate use is being refilled on a biweekly, weekly or even a daily basis.
   
• The prescriber writes concurrent prescriptions for antagonistic drugs, such as depressants and stimulants. Drug abusers often request prescriptions for "uppers and downers" at the same time.
   
• Patient presents prescriptions written in the names of other people.
   
• A number of people appear, or within a short time of each other, all bearing similar prescriptions from the same physician.
  
• Numerous "strangers," people, who are not regular patrons or residents of the community, suddenly show up with prescriptions from the same physician.

Characteristics of Forged Prescription:

1. Prescription looks "too good"; the prescriber's handwriting is too legible;
    
2. Quantities, directions or dosages differ from usual medical usage;
    
3. Prescription does not comply with the acceptable standard abbreviations or appear to be textbook presentations;
    
4. Prescription appears to be photocopied;
    
5. Directions are written in full with no abbreviations;
    
6. Prescription is written in different color inks or written in different handwriting.

Knowing the above, here are some preventive techniques that a pharmacist can use:

• Know the prescriber and his or her signature;
   
• Know the prescriber's DEA registration number;
   
• Know the patient, and
   
• Check the date on the prescription order. Has it been presented in a reasonable length of time since the prescriber wrote it?

When there is any question concerning any aspect of the prescription, the pharmacist should clarify the order with the physician. If the pharmacist believes that the prescription is forged, altered, or counterfeited, he shouldn’t dispense it. 

In this particular case, he has an obligation to notify the local police. If the pharmacist believes that he/she has discovered a pattern of prescription abuses, he should contact the State Board of Pharmacy and the local DEA office. Both DEA and state authorities consider retail-level diversion a priority issue.

Hospital personnel with access to prescription blanks have to follow the same precautions in safeguarding and storing them. Some hospitals keep these blanks under lock and key or some form of limited access so there is easy accountability.  The growing prevalence and impact of prescription drug abuse call for increased efforts to combat and prevent it. Yet this kind of campaign has to be waged without compromising effective pain management and quality healthcare.

As healthcare providers, we must take a careful, balanced approach to combat the dangers of prescription drug abuse while ensuring that patients have access to the benefits of drug therapy.  

These two goals need not be mutually exclusive.  They can be synergistically accomplished by sharing the responsibility for ensuring that prescription medications, particularly pain medications, are available to the patients who need them and for preventing these drugs from becoming a source of harm or abuse. 

Loose or routine dispensing procedures, without controls and professional caution, are invitations to the drug abuser.

Proper controls against fraudulent prescriptions are best accomplished by following common sense, sound professional practice, using proper dispensing procedures and maintaining good communication between the local pharmacists and physicians.