McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Cluster 5: Managing Opioid Misuse and Addiction in CNCP Patients

R22. Recommendation Statement

No. Recommendation Keyword
R22 To reduce prescription fraud, physicians should take precautions when issuing prescriptions and work collaboratively with pharmacists (Grade C). Prescription fraud
  • R22. Discussion

R22. Discussion

1. Taking Precautions

In issuing prescriptions, physicians should take the following precautions, which are considered to reduce opioid misuse:

1. Fax prescriptions directly to the pharmacy.

2. If using a paper prescription pad:

  • Use carbon copies or numbered prescription pads.
  • Write the prescription in words and numbers.
  • Draw lines through unused portions of the prescription.
  • Keep blank prescription pads secure.

3. If using desk-top prescription printing, it is especially important to write a clear signature and not use a scribbled initial.

4. If using fax or electronic transmission of the prescription (in jurisdictions that permit it) ensure confidentiality, confirm destination, and retain copies.

5. Promote patient’s use of a single dispensing pharmacy.

2. Accessing Drug Databases

If available, physicians and pharmacists should access electronic prescription databases that provide information about patient prescription history.

3. Collaborating

Greater collaboration with other healthcare providers can also contribute to reduction in prescription fraud.

1. Pharmacists are often in a position to alert physicians to possible opioid misuse, e.g., double-doctoring, potential diversion or prescription fraud. Pharmacists are considered part of the patient’s “circle of care;” special consent is not required to speak with the pharmacist.

2. If double-doctoring is suspected, expect the patient to consent to a consultation with the “other” prescriber(s), or taper the opioid dose and discontinue. Note: The prescribing physician may contact the “other” physician(s) without the patient’s consent if the patient is considered to be at significant risk of overdose.