Narcotic and Controlled Drug Accountability
Pharmacists must perform an inventory and reconciliation of narcotics, controlled and targeted drugs every three months and after a change in pharmacy manager.
Discrepancies between the inventory count and the pharmacy’s perpetual inventory should be investigated. Any discrepancies that are unexplained or the result of theft must be reported.
For more information please see:
- Narcotic and Controlled Drug Accountability Guidelines
- Drug Distribution and Storage Practice Direction
Reporting Unexplained Loss or Theft
Pharmacists must report any unexplained losses, theft, or successful forgery attempts of to
- Health Canada using the loss/theft report form or online reporting platform at the following link:
https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/controlled-substances/compliance-monitoring/loss-theft.html. Please see Health Canada’s Guidance Document: Reporting Loss or Theft of Controlled Substances and Precursors (CS-GD-005) for additional information on reporting successful forgeries, losses, and thefts to Health Canada; AND
- The College of Pharmacists of Manitoba (CPhM). Please print and fax your Health Canada report to CPhM by fax (204-237-3468) or email (email@example.com).
A copy of the report must be retained by the pharmacy for a period of five years and must be available for regulatory review upon request.
Reporting Forgeries and Forgery Attempts
Prescription forgery of all types (in-person, fax, verbal, and electronic) are on the rise, and it is important for all pharmacy staff to be alert and follow the guidance and reporting requirements below.
It is important to fill out the forgery reports as soon as possible so CPhM can assess the need for an alert to be sent to all pharmacy managers to prevent another pharmacy from dispensing a forged prescription. When the pharmacy receives a forgery alert, it is the responsibility of the pharmacy manager to ensure all staff are aware of the forgery details.
Record of all successful and attempted forgeries must be kept by the pharmacy for five years.
Forgery Attempts (unfilled) *UPDATED*
If your pharmacy experiences a forgery attempt, meaning that the prescription was not filled, you must report the attempt to:
- The pharmacy’s local police service. In Winnipeg, if the suspect is no longer in the pharmacy, report the forgery attempt to the Winnipeg Police Service (WPS) report line at 204-986-8666, Monday through Friday, 8 am – 4 pm. For information about online reporting to the WPS, please visit https://www.winnipeg.ca/police/report/default.stm; AND
- CPhM using the following steps:
- Complete the secure web form: https://forms.office.com/r/8abeQy3cf1. A summary of the report will automatically be emailed to the address you provide on the form, and the CPhM Field Operations team will automatically be notified of your report.
- Please send a copy of the prescription used in the attempted forgery to CPhM by fax (204-237-3468) or email (firstname.lastname@example.org). Include the name of your pharmacy and the report number as indicated on the Attempted Forgery Report Summary you receive after submitting your attempted forgery report.
Note: Attempted forgeries are no longer reported to Health Canada. Please use the form listed above to report forgery attempts to CPhM only.
A paper form is available on request, but CPhM encourages all pharmacy professionals to try using the new form if possible. To request a PDF copy of the form, please email email@example.com.
CPhM welcomes your feedback. Please forward your comments, questions, or suggestions on this new process by email to firstname.lastname@example.org .
All prescription forgery attempts that were filled by your pharmacy must be reported to:
- The pharmacy’s local police service. In Winnipeg, if the suspect is no longer in the pharmacy, report the forgery attempt to the WPS report line at 204-986-8666, Monday through Friday, 8 am – 4 pm. For information about online reporting to the WPS, please visit https://www.winnipeg.ca/police/report/default.stm;
- Health Canada AND the College of Pharmacists of Manitoba following the reporting procedure for unexplained loss or theft. In the description area of the form, please indicate that this was a filled prescription forgery.
Note: Health Canada no longer requires pharmacies to report attempted forgeries. Health Canada continues to require pharmacies to report all loss and theft of narcotic and controlled substances. Forged prescriptions that are filled are considered to be theft.
Identifying Prescription Forgeries
Pharmacy staff must objectively review all prescriptions for signs of forgery. Please review the following tips for identifying potential forgeries.
General Signs of a Potential Forgery
- Spelling and/or punctuation mistakes, unusual abbreviations, symbols, terminology, sig codes used inappropriately
- Unusually large quantities
- The dosage or directions do not fall within guidelines/outside of the usual dosage patterns
- Directions are fully written out with no medical or appropriate abbreviations or terminology
- Changes in font size or type or other inconsistencies in formatting (margins, spacing)
- Evidence that the prescription was presented to another pharmacy and not filled
- The patient comes at the end of the night, just before close or on the weekend, when it’s difficult to confirm the prescription with the prescriber
- A new patient presents a prescription for narcotic or controlled drug and does not have identification
- Quantity differs from the normal pattern of prescriptions dispensed. For example, the patient might usually get 20 Tylenol #3 and presents a prescription for 120 or 200 tablets by adding a number at the beginning or end of the prescribed quantity.
Faxed Prescription Forgeries
- Incorrect/missing clinic fax, phone number and address on the prescription header
- The fax number origin does not match the fax number registered to the medical clinic or prescriber
- Missing the signed certification and confidentiality statement as per the Facsimile Transmission of Prescriptions Joint Statement
- The signature does not match that of the prescriber (if the signature is unknown to the pharmacist, it should be verified)
- The template looks different from the clinic’s typical template
Verbal Prescription Forgeries
- The individual providing the verbal order cannot answer identifying questions such as clinic information, the prescriber license number etc.
- White-out, overwriting, smudging, or different colour ink (especially if involving the date, drug quantity or the addition of a trailing zero)
- Changes without initials
- No ink signature or a photocopy of a signature (you can most easily identify this before electronically scanning a prescription)
- The signature does not match that of the prescriber (if the signature is unknown to you, it should be verified)
- The template looks different from the clinic’s typical template
Verifying the Prescription
Pharmacies should follow these steps if a forgery is suspected:
- Verify the prescriber’s signature. Remember that a computer-generated prescription printed and handed to the patient musthave an original ink signature by the prescriber to be valid.
- Check the patient’s DPIN record, especially for new and inactive patients.
- Confirm the prescription with the prescriber, using a phone/fax number from another verified source such as the regulatory body’s directory — not the prescription itself. This is especially important for out-of-province prescribers.
- Keep the prescription if possible. If the patient demands the prescription back, make a photocopy of the prescription and mark the original with a pharmacy stamp to alert the next pharmacy to the unfilled prescription.
If the patient presents a prescription and indicates they are from out of province and do not have a PHIN, best practice is as follows:
- Ask the patient for photo identification containing their date of birth. This information can be used to contact DPIN to double check whether the patient has a valid PHIN.
- Contact the prescriber’s office to verify the patient does not have a Manitoba Health Card.
After a forgery has been verified
- If the individual is still in the pharmacy or is expected to return, call the non-urgent line of your local police service. In Winnipeg, you can call the WPS at 204-986-6222. Inform the operator that the suspect is still in the pharmacy.
- For your own safety and the safety of your patients do not try to restrain or detain the individual. Instead attempt non-confrontational stalling techniques, such as giving a longer “wait time.”
If the individual leaves the pharmacy record a description of the individual, their vehicle and licence plate if possible.