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From: Diana King Handwriting Expert , Diana King : 785-309-0997

Prescription Forgery

  The Scale of Prescription Medication Abuse

It is estimated that 3 billion prescriptions were written in the United States in 2002 – up from 1.5 billion in 1989; and the numbers continue to grow exponentially.  In a study done by Zickler ¹, the number of people who abuse prescription drugs is greater than the number of people who abuse many illegal street drugs. The National Institute on Drug Abuse (NIDA) reports that in 2003, 6.3 million Americans reported currently using prescription drugs for non-medical purposes and 15 million reported having used a prescribed drug for a non-medical reason at least once in the year ².

●  What Legally Constitutes a "Prescription"?

By definition, a prescription is "an order for medication which is dispensed to or for an ultimate user "(e.g., an order to dispense a drug to an inpatient for immediate administration in a hospital is not a prescription). To be valid, a prescription must be issued for a legitimate medical purpose by a practitioner acting in the usual course of sound professional practice.

In most jurisdictions, both pharmacists and physicians are regulated professions; and a prescription, as a communications mechanism between them, is also regulated as a legal document. State legislation is empowered to define what constitutes a prescription, the contents and format of the prescription (including the size of the piece of paper) - and how prescriptions are handled

●  The "Typical" Prescription Forgers

The demographics of prescription forgery are strongly correlated to the motivations prompting the crime. Thus, in that youth (as a group) have evidenced the most dramatic increase in illegal prescription drug use in recent years, as a result, they comprise a significant portion of prescription forgers. Demographics are impacted as well by social factors. Recent statistics have indicated that women may be more likely than men to commit prescription fraud, as they are 48% more likely to be prescribed an abusable drug.³  More specifically, among men and women who are prescribed sedatives, hypnotics, or anti-anxiety medications, women are twice as likely to become addicted. ⁴ Yet a third group with a higher-than-average correlation with prescription fraud is healthcare workers. Because of their profession, they are in a unique position to acquire and obtain prescription drugs. While some steal medications outright, others steal prescription pads to either produce illegitimate prescriptions (by forgery/alteration), or to sell the stolen pads to others for similar criminal pursuits.

●  The Forger's Drugs of Choice – "Controlled Substances Demystified"

A "controlled" substance (as a drug) is one whose use and possession is regulated by Federal law. Almost without exception, forged prescriptions are for those medications designated as "controlled substances", and are further classified as "Schedule II or III" (examples below).

Why is drug "scheduling" important to be aware of? To the document examiner, having knowledge of a medication's Controlled Substances Classification provides crucial information when evaluating both the physical paper and written characteristics of a prescription. As a result of this Act, further legislation at the individual state level, mandates different physical characteristics and text inclusions for prescriptions based upon a drug's classification.

Examples of Drugs by Schedule Classification

Schedule I drugs are defined as those considered to have high potential for abuse, with no recognized medical use. (i.e. GHB, Heroin, Ecstasy).

Schedule II drugs are those with a high potential for abuse, but recognized medical use; and a high incidence of physical or psychological dependence. These are available only by prescription, and distribution is carefully controlled and monitored by the DEA. (i.e. cocaine, morphine, oxycodone and amphetamines).

Schedule III drugs are those deemed to have less potential for abuse than Schedules I and II; recognized medical uses; and a moderate to low incidence of physical or psychological dependence. These are available only by prescription. (i.e. anabolic steroids, barbiturates, synthetic marijuana, codeine and hydrocodone).

Schedule IV drugs are those deemed to have a low potential for abuse relative to drugs in Schedule III; recognized medical uses; and a low risk of dependence relative to drugs in Schedule III. These are controlled similarly to Schedule III drugs (i.e. Xanax, Valium, Darvon, Talwin).

Schedule V drugs are deemed to have a lower potential for abuse relative to drugs in Schedule IV and a small incidence of physical or psychological dependence. These are sometimes available without a prescription and includes, among others, cough suppressants containing small amounts of codeine.

The federal law has only five schedules, but some states have added a "Schedule VI" to cover certain substances which are not "drugs" in the conventional sense, but are nonetheless
abused recreationally; these include toluene (found in many types of paint, especially spray paint) and similar inhalants such as amyl nitrite and nitrous oxide (found in many types of aerosol cans).

Through recognizing that drug addiction exists as a precipitant to prescription forgery, it then becomes apparent why most forgeries are for Schedule II and III substances.  Data from pharmacies (further annotated by The Controlled Substances Act schedule) indicate the following medications as the "Rx Forger's Drug of Choice": ⁵

A complete list of controlled substance with their classification schedule may be found on the Department of Justice website

●  Recommended Resources

Other Articles Index
Prescriptions Part II
Prescriptions Part III

Literature:

• Dictionary of Commonly Accepted Medical Abbreviations (any)
• Physician's Desk Reference (lists prescriptive medications by trade/generic name with their classification of use, usual dosage, and forms supplied.)
• State Administrative Code governing Prescriptive Procedures and Documents

Online:

• List of Controlled Substances Schedule (U.S. Dep't. of Justice)
  http://www.deadiversion.usdoj.gov/schedules/alpha/alphabetical.htm
• A Pharmacist's Guide to Prescription Fraud (U.S. Dep't. of Justice)
  http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm#char

1. Zickler, P. (2001). "NIDA Scientific Panel Reports on Prescription Drug Misuse and Abuse." Research News, NIDA Notes 16(3) (August).
2. NIDA. http://www.drugabuse.gov/drugPages/PrescripDrugsChart.html.
3. Prescription Forgery Demographics (2002) - http://www.cops.usdoj.gov/mime/open.pdf?Item=1267
4. Rationale for Prevalence of Women over Men as Prescription Forgers - http://www.cops.usdoj.gov/mime/open.pdf?Item=1267
5.  "Rx Forger's Drug of Choice" - http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=116582

  Want more information about Document Examination, call the author
Diana King : Tel: 785-309-0997 Fax: 785-309-0935 .

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  Want more information about Document Examination, call the author
Diana King : Tel: 785-309-0997 Fax: 785-309-0935 .

Forgery Detection is a complicated and skilled profession which takes years of training.