Forged prescriptions a growing concern in Alberta, pharmacists say

Prescription forgeries are, once again, on the rise in Alberta, and pharmacists are being warned to be on the lookout for anything suspicious.

The number of forgeries reported to the Alberta College of Pharmacy (ACP) jumped from 101 in 2022 to 279 last year.

So far this year, 101 have been reported.

Nearly one-third of them are connected to out-of-province prescribers, the college said.

"There are cycles of forgeries coming through," said Randy Howden, president of the Alberta Pharmacists' Association.

"They seem to ebb and flow over time, and different patterns emerge."

Howden, who is the owner of two Calgary Medicine Shoppe locations, has identified fake prescriptions in the past.

"The ones I've caught were pretty easy. There was something pretty fishy about the situation But some of these individuals are getting very, very good at setting up stories and making sure the forgeries look legitimate."

Oxycodone is the drug of choice when it comes to these forgeries, according to the ACP.

Ongoing battle

"There's always demand for opiates within the system," said Greg Eberhart, college registrar.

"We're all aware of the problems with opioid use disorder that are plaguing our system today, and I think this is just another element of individuals who are seeking substances either to support their own habits or possibly … for sale to individuals on the street."

This is the latest twist in a long battle to keep higher-risk prescription drugs off the streets, according to Eberhart.

"These are trends that we've been addressing for decades," he said.

"Every time that there's a policy or action that's implemented, we tend to see a reaction."

Prescription forgeries spiked in 2019 when cough syrups containing codeine were in high demand.

The college worked to have the medication classified as a high-risk drug, monitored by Alberta's Tracked Prescription Program, and forgeries dropped off after that.

"When we implemented that, all of the sudden we saw an increase in the number of armed robberies," said Eberhart.

That resulted in a requirement that community pharmacies keep narcotics and other risky drugs locked up in time-delayed safes.

• Suspects sought after 23 Calgary pharmacies robbed since June
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Now forgeries are on the rise again, according to Eberhart, noting Calgary appears to be a hot spot.

This time the college has noted nearly a third of the fake prescriptions are originating outside Alberta, often in the form of a fax. Many are coming from Ontario.

"We're communicating and reminding our members about their responsibilities in being vigilant and diligent in assessing all of the prescriptions that they receive," said Eberhart.

That includes calling prescribing physicians to check on the authenticity of a prescription if anything unusual is noticed.

"They should be diligent about prescriptions that come from out of the province, diligent about prescriptions arriving from patients that they don't know." 

Forgeries reported to the Alberta College of Pharmacists:

• 2019 — 343
• 2020 — 218
• 2021 — 220
• 2022 — 101
• 2023 — 279
• 2024 — 101 forgeries as of May 1 (32 connected to out-of-province prescribers)

Alberta's Tracked Prescription Program — which monitors the use of medications that are prone to abuse or diversion, including oxycodone, fentanyl and codeine — requires the use of special duplicate prescription pads with built-in security features.

In its advisory to pharmacists, the ACP noted a rise in forgeries related to lost or stolen TPP prescription pads.

The College of Physician and Surgeons of Alberta said forgeries related to the specific class of high-risk drugs monitored by the TPP are still uncommon.

Its data shows 512,300 TPP prescription forms were ordered by providers last year and 63 forgeries were reported. As of Tuesday, 100 forgeries had been reported in 2024 out of a total of 201,050 prescription forms.

"I'm not surprised. We are in the middle of an opioid epidemic," said Lisa Guirguis, associate professor in the faculty of pharmacy at the University of Alberta.

"Pharmacists know about this. We've always known about it. It's not new. It's the numbers that are different."

Guirguis believes moving away from paper-based prescriptions to electronic communication would help.

"The fact that we're still relying on paper provides the opportunity for, No. 1, things to be stolen, and, No. 2, things to be copied."

Randy Howden agrees.

"That will eliminate some of these forgeries going on," he said.

"We have a lot of prescribers that are starting to move towards that. Just getting everybody on board with all these different systems we use within the health-care system has been a little challenging."

Pharmacists are being urged to report any attempted or successful forgeries.