Rx forgers are getting pretty talented.

[WVUPharm2007]

---

Members do not see this ad.

We got a fake script this week. I was actually rather impressed with it. It looked 100% legit. On the right type of paper. The words "void" were all over it when copied. There were other security features (one of those thermal "place thumb here, watch it turn colors" dealies). Yet it was fake. And the ONLY reason we suspected it was fake was because the sig was weird. We thought it was maybe just a stolen script pad. The pharmacist on duty called the number on the front of the script...it went to a cellular voicemail. Then she realized "Why does a Doctor in Langhorne have a 610 area code?" Yeah, well, he didn't. It was linked to a burner cell phone. She called the physician using the central computer search and he said it wasn't from him.

Making a crappy looking counterfeit prescription with a fake phone number isn't completely new...but this was different. This thing was legit looking. If the sig didn't look stupid and the pharmacist was calling to verify the Rx with the phony number...guess what. It probably gets filled. This thing had security features...the fake phone number was the same font and everything as the rest of the Rx...really, really professional stuff. I honestly tip my hat to them. They have an artist of a printer somewhere.

Freakin' organized crime. Lesson to all you kids out there. NEVER call the number on the prescription. Look up the physician in your computer system.

 

[Old Timer]

Mikey:

This aint nothin. A couple of yearts a ago a NY state drug investigator came in to one the stores (in Philadelphia) to ask about written by a NY MD. NY has triplicate blanks that get ordered from the state. Turns out this guy got a doctor's credentials for the state site, logged in, changed the address, ordered new blanks then logged back in to change the doctor's address back. They were smart enough to use a land line so it took a little while longer to figure them out. But you are right, never trust the phone# on the blank. In fact, I Google the phone # and you can tell if it's a business listing for a doctor or a cell phone.

 

[MountainPharmD]

In Texas it is easy to forge a script for anything other than a C-II.

Doctor's in Texas are some of the most arrogant, pompas, jack asses I have had the displeasure of dealing with. Most think the rules the rest of the United States follow do not apply to them.

Most of the doctors around here for some reason print out their electronic prescriptions and give them to patients to bring in. Just a generic printed off the office printer prescription with no security features that anyone could easily and do quite easily replicate. Half do not even have a pen to paper signature. It just says "electronically signed by doctor *******" and under that says "prepared by nurse *******".

 

[hereticmnk]

Reading this thread really makes me miss working in a retail pharmacy.

 

[Rxnupe]

In Texas it is easy to forge a script for anything other than a C-II.

Doctor's in Texas are some of the most arrogant, pompas, jack asses I have had the displeasure of dealing with. Most think the rules the rest of the United States follow do not apply to them.

Most of the doctors around here for some reason print out their electronic prescriptions and give them to patients to bring in. Just a generic printed off the office printer prescription with no security features that anyone could easily and do quite easily replicate. Half do not even have a pen to paper signature. It just says "electronically signed by doctor *******" and under that says "prepared by nurse *******".

Very True MPD- it drives me crazy- funny thing to the OP- I had the narcotics unit of Dallas asked me to fax them 2 prescriptions we filled earlier this year that turned out to be fakes. The detective told me the patient visits the MD- gets control prescription and then makes multiple very good forgeries of the "original" prescription. The ones we filled had the "void" mark as well- I couldn't believe it.

 

[SoylentGreen]

The mistakes they made were stupid - it wouldn't be that dfficult to have an appropriate-sounding message on a burner cell phone, an appropriate area code, and an unremarkable sig. Makes me wonder how often this is done successfully by people who aren't stupid.

 

[farmadiazepine]

I filled a fake oxycodone 30 mg #120 on my first week as a night RPh. Looking back at it now, it was the most obvious fakest looking Rx ever. Did I learn my lesson? Yes.

We don't even carry oxy 30 anymore. No 24 hour store in our district and surrounding districts carry it anymore.

Anyways, yea, people will do almost about anything to get their adderalls and oxy's. that's all I see fake scripts for, but once we stopped carrying oxy for a year now the fakes don't ever come in anymore. Even if they come in during the day we tell them we don't order it and refuse to carry it. MD's gotta write for other pain meds if they want it from us.

 

[WVUPharm2007]

I filled a fake oxycodone 30 mg #120 on my first week as a night RPh.

They know. There must be Twitter feed or something. Once word gets out that a new guy is there, they all try to come in and roll the dice.

 

[Momus]

I normally give them a ton of barriers to make it hard to ever want to fill in my pharmacy, each one fail follows by another... until they go away lol

1. We never have stuff in stock if you call to check stock
2. If it's outside of area Dr. We don't have it
3. Must verify with doctor in the morning
4. If you pay cash, we don't have it
5. Must order and it can take up 3 days and there is no guarantee it will come in
6. We didn't receive it this morning - We have difficulty getting them in

 

[diplomat]

I normally give them a ton of barriers to make it hard to ever want to fill in my pharmacy, each one fail follows by another... until they go away lol

1. We never have stuff in stock if you call to check stock (LIE)
2. If it's outside of area Dr. We don't have it (LIE)
3. Must verify with doctor in the morning
4. If you pay cash, we don't have it (LIE)
5. Must order and it can take up 3 days and there is no guarantee it will come in
6. We didn't receive it this morning - We have difficulty getting them in (LIE)

So basically you spend most your day lieing to people. Good job, they teach you that in school??? Valuable member of a healthcare team, yeah.....right...

 

[cycloketocaine]

So basically you spend most your day lieing to people. Good job, they teach you that in school??? Valuable member of a healthcare team, yeah.....right...

So says the pre-pharmacy student.

 

[All4MyDaughter]

I don't think it's necessary to lie to patients. We don't quote control prices over the phone. I just tell people that. We don't fill scripts for certain doctors. I just give them back and explain.

 

[MountainPharmD]

I don't think it's necessary to lie to patients. We don't quote control prices over the phone. I just tell people that. We don't fill scripts for certain doctors. I just give them back and explain.

I never found it necessary to lie. I straight up told them the truth. When confronted they always break their ankles trying to get out so they don't get caught.

 

[Lubeckd]

So basically you spend most your day lieing to people. Good job, they teach you that in school??? Valuable member of a healthcare team, yeah.....right...

Do you work in a pharmacy?

 

[All4MyDaughter]

I never found it necessary to lie. I straight up told them the truth. When confronted they always break their ankles trying to get out so they don't get caught.

Yep. I've only had one person get ugly with me (it wasn't necessarily a forger, more like just a run-of-the-mill druggie in a hurry). His script was from an out-of-town dentist with no DEA number. When I told him I'd have to call to verify/get the DEA, he started hollering. I handed him back his script and pointed at the door. He yelled, "**** you, I'm going to Walgreens!" so I called the RPH at Wags (a friend of mine) to tip her off. She was like, "He'll love it here, we're on a two hour wait!"

 

[Socrates25]

In Texas it is easy to forge a script for anything other than a C-II.

Doctor's in Texas are some of the most arrogant, pompas, jack asses I have had the displeasure of dealing with. Most think the rules the rest of the United States follow do not apply to them.

Most of the doctors around here for some reason print out their electronic prescriptions and give them to patients to bring in. Just a generic printed off the office printer prescription with no security features that anyone could easily and do quite easily replicate. Half do not even have a pen to paper signature. It just says "electronically signed by doctor *******" and under that says "prepared by nurse *******".

Ummm...... that doesnt work unless the pharmacist filling the script doesnt know the state law. In Texas you cant use electronic scripts for outpatient narcs. It has to be handwritten on a special narc pad. Electronic narc scripts are only allowed for inpatient use.

 

[All4MyDaughter]

Ummm...... that doesnt work unless the pharmacist filling the script doesnt know the state law. In Texas you cant use electronic scripts for outpatient narcs. It has to be handwritten on a special narc pad. Electronic narc scripts are only allowed for inpatient use.

Well yes, but the real problem is the physicians not following proper prescribing protocols for controll substances, isn't it? That's what Mountain was pointing out. In our state, we're being encouraged to report crap like that.

 

[ancienbon]

I normally give them a ton of barriers to make it hard to ever want to fill in my pharmacy, each one fail follows by another... until they go away lol

1. We never have stuff in stock if you call to check stock
2. If it's outside of area Dr. We don't have it
3. Must verify with doctor in the morning
4. If you pay cash, we don't have it
5. Must order and it can take up 3 days and there is no guarantee it will come in
6. We didn't receive it this morning - We have difficulty getting them in

Actually, that is the best way to go.Unfortunately, in my district we are told to use proper verbiage saying that we don't feel comfortable to fill them. Last week , i had a patient argue with me for one hour when i told her that i could not fill her dilaudid 8 mg, oxycodone , morphine, soma,adderall, and xanax.She was from another county. It would have been easier for me if could have just said i dont have them .

 

[All4MyDaughter]

Actually, that is the best way to go.Unfortunately, in my district we are told to use proper verbiage saying that we don't feel comfortable to fill them. Last week , i had a patient argue with me for one hour when i told her that i could not fill her dilaudid 8 mg, oxycodone , morphine, soma,adderall, and xanax.She was from another county. It would have been easier for me if could have just said i dont have them .

Really? I don't mean to be rude, but how can someone argue with you for an hour without your permission? I just say whatever I have to say and smile, thank the patient and walk back to my work station. If someone lingered in the pharmacy for an hour trying to fight with me, I'd call the police.

 

[ancienbon]

Really? I don't mean to be rude, but how can someone argue with you for an hour without your permission? I just say whatever I have to say and smile, thank the patient and walk back to my work station. If someone lingered in the pharmacy for an hour trying to fight with me, I'd call the police.

Yeah, she argued for one hour. She was asking the same questions over and over and became so annoying at one point. Had to call the store manager. I walked back , and she was still standing at the consultation window and was crying like a baby.

 

[MountainPharmD]

Ummm...... that doesnt work unless the pharmacist filling the script doesnt know the state law. In Texas you cant use electronic scripts for outpatient narcs. It has to be handwritten on a special narc pad. Electronic narc scripts are only allowed for inpatient use.

Thanks for the input but you have no idea what you are talking about. Leave the hard stuff like pharmacy law to the pharmacist. Thank you for proving my point. Doctors do not have a damn clue what the law is governing controlled substance prescriptions. Thanks for trying!

 

[joetrisman]

I foresee this going down hill quick...

 

[MountainPharmD]

I foresee this going down hill quick...

Well, what do you expect? The very topic of the discussion walks in and spouts off something completly incorrect proving exactly what I was talking about.

 

[All4MyDaughter]

Well, what do you expect? The very topic of the discussion walks in and spouts off something completly incorrect proving exactly what I was talking about.

I wasn't sure which thread would attract them first. This one or the generic substitution thread. Those topics are like the bat signal for prescribers who want to bag on pharmacists.

 

[MountainPharmD]

I wasn't sure which thread would attract them first. This one or the generic substitution thread. Those topics are like the bat signal for prescribers who want to bag on pharmacists.

Don't worry I will keep it civil!

Like this guy comments it's hilarious how wrong and/or uninformed they are.

 

[All4MyDaughter]

Don't worry I will keep it civil!

Like this guy comments it's hilarious how wrong and/or uninformed they are.

I freely admit I don't know Texas law. Do you have security blanks? If you do and MDs aren't using them, it's hardly the pharmacist's fault.

 

[rxlea]

So has anyone had to talk to a doctor about getting his X number and saying that suboxone (tablets) is not for pain, especially outside of a narcotic treatment program?

 

[joetrisman]

So has anyone had to talk to a doctor about getting his X number and saying that suboxone (tablets) is not for pain, especially outside of a narcotic treatment program?

No more tabs soon! I'm waiting for the patients to complain about that one...

 

[All4MyDaughter]

I'm pretty sure suboxone can be Rx'ed off label for pain.

 

[sodiumd]

I'm pretty sure suboxone can be Rx'ed off label for pain.

What?

 

[All4MyDaughter]

What?

How can I clarify for you?

 

[MountainPharmD]

I'm pretty sure suboxone can be Rx'ed off label for pain.

Any drug can be written for any indication on or off label. Yes, I have filled prescriptions for Suboxone for pain from doctors without an 'X' DEA number. There are pain docs around here that prescribe both Norco 10 and Suboxone so the patient doesn't have to take so much hydrocodone. (?)

I got into an email war with corporate once because they put a hard halt in the system that would not let you process a Suboxone prescription with out the 'X' number. It was beyond their comprehension that doctors write prescriptions for off label indications and a doctor without an 'X' number could write a rx for Suboxone for pain.

I got into an argument with an auditor once who pulled scripts for Suboxone and said they were not valid because the 'X' number wasn't on the script.

 

[All4MyDaughter]

Any drug can be written for any indication on or off label. Yes, I have filled prescriptions for Suboxone for pain from doctors without an 'X' DEA number. There are pain docsround here that prescribe both norco 10 and suboxone so tne patient doesn't have to take so much hydrocodone.

I got into an email war with corporate once because they put a hard halt in the system that would not let you process a Suboxone prescription with out the 'X' number. It was beyond their comprehension that doctors write prescriptions for off label indications and a doctor without an 'X' number could write a rx for Suboxone for pain.

I got into an argument with an auditor once who pulled scripts for Suboxone and said they were not valid because the 'X' number wasn't on the script.

Yes, this is what I learned in my law review. That it could be RXed for pain without the X but using it for narcotic treatment required an X and the special registrations, limits to the number of patients, etc. In practice, I have only ever dispensed it for narcotic treatment.

 

[joetrisman]

Any drug can be written for any indication on or off label. Yes, I have filled prescriptions for Suboxone for pain from doctors without an 'X' DEA number. There are pain docsround here that prescribe both norco 10 and suboxone so tne patient doesn't have to take so much hydrocodone.

I got into an email war with corporate once because they put a hard halt in the system that would not let you process a Suboxone prescription with out the 'X' number. It was beyond their comprehension that doctors write prescriptions for off label indications and a doctor without an 'X' number could write a rx for Suboxone for pain.

I got into an argument with an auditor once who pulled scripts for Suboxone and said they were not valid because the 'X' number wasn't on the script.

We have a hard stop as well. How'd you dispense it without the x? What finally happened with corporate?

 

[rxlea]

We just talked about it in law. It's not a valid script without an X number. Read the law book/document and tell me your interpretation. I'll pull the exact wording from the law when I get home. The professor we fly out from florida to teach us law told us a story about a pharmacist going down for it.

I've never done it but I was just curious.

Also, the transdermal has New indication for pain that docs are going to love I'm sure

EDIT 2: so I looked it up. For pain no X number. for treatment, need X number. That's kind of confusing and weird, don't you think?

it's not like I'm exactly alert at 8am on monday morning

 

[MountainPharmD]

We have a hard stop as well. How'd you dispense it without the x? What finally happened with corporate?

Nothing as usual.

We used a made up one to get it to process. Of course I called the doctor to confirm why it was being dispensed and documented the call on the back of the script.

 

[owlegrad]

We just talked about it in law. It's not a valid script without an X number. Read the law book/document and tell me your interpretation. I'll pull the exact wording from the law when I get home. The professor we fly out from florida to teach us law told us a story about a pharmacist going down for it.

I've never done it but I was just curious.

EDIT: btw this guy teaches at 5 schools around the country and I was told he's worth the money of a plane ticket every monday.

Also, the transdermal has New indication for pain that docs are going to love I'm sure.

I have to review my notes, but that is my understanding as well. Could be a state vs federal law thing though. Do we have the same law professor?

 

[rxlea]

I have to review my notes, but that is my understanding as well. Could be a state vs federal law thing though. Do we have the same law professor?

yes I believe we do

 

[rxlea]

I have to review my notes, but that is my understanding as well. Could be a state vs federal law thing though. Do we have the same law professor?

look at your notes. I googled some **** and some state websites say the above and others say something different. I'm not home yet to look at the actual law document

 

[owlegrad]

look at your notes. I googled some **** and some state websites say the above and others say something different. I'm not home yet to look at the actual law document

Sorry, I am not home right now either, lol

 

[BenJammin]

"Why does a Doctor in Langhorne have a 610 area code?"

Because people don't have to register phone numbers in the area code where the business is being conducted. My uncle's rugby shop in Massachusetts has a 214 area code since his phone is registered through Skype.

 

[owlegrad]

yes I believe we do

That's cool, he certainly knows his stuff and really wants his students to succeed.

 

[rxlea]

That's cool, he certainly knows his stuff and really wants his students to succeed.

He's awesome.

 

[All4MyDaughter]

Reasonably confident that the X is only for narcotic treatment:

Can Subutex® or Suboxone® or approved generic versions of these products be prescribed for conditions other than opioid addiction, e.g., pain control?

Subutex® and Suboxone® or approved generic versions of these products have received FDA approval only for the treatment of opioid addiction. However, once approved, a drug product may be prescribed by a licensed physician for any use that, based on the physician's professional opinion, is deemed to be appropriate. Neither the FDA nor the Federal government regulates the practice of medicine. Any approved product may be used by a licensed practitioner for uses other than those stated in the product label. Off-label use is not illegal, but it means that the data to support that use has not been independently reviewed by the FDA. Information on FDA policy regarding off-label use of pharmaceuticals is available on the FDA Web site, http://www.fda.gov/cder/cancer/tour.htm, or http://www.fda.gov/cder/present/diamontreal/regappr/index.htm

Physicians and other practitioners who are authorized to prescribe Schedule III controlled narcotic medications under Federal and State laws are eligible and the unique identifier under the Drug Addiction Treatment Act is not required.

Source: http://buprenorphine.samhsa.gov/faq.html#A21

 

[MountainPharmD]

We just talked about it in law. It's not a valid script without an X number. Read the law book/document and tell me your interpretation. I'll pull the exact wording from the law when I get home. The professor we fly out from florida to teach us law told us a story about a pharmacist going down for it.

I've never done it but I was just curious.

EDIT: btw this guy teaches at 5 schools around the country and I was told he's worth the money of a plane ticket every monday.

Also, the transdermal has New indication for pain that docs are going to love I'm sure.

If it is being prescribed for the treatment of narcotic addiction. If it is being dispensed off label for pain there is no such requirement.


From the current online version of the pharmacists manual.

Opioid (Narcotic) Addiction Treatment Programs


The Narcotic Addiction Treatment Act of 1974 and the Drug Addiction Treatment Act (DATA) of 2000 amended the CSA with respect to the use of controlled substances in the medical treatment of opioid addiction. These laws established the procedures for approving and licensing practitioners involved in the treatment of opioid addiction as well as improving the quality and delivery of that treatment to the segment of society in need.

Practitioners wishing to prescribe and dispense FDA approved schedule II controlled substances (i.e., methadone) for maintenance and detoxification treatment must obtain a separate DEA registration as a Narcotic Treatment Program via a DEA Form 363 which may be completed online at www.DEAdiversion.usdoj.gov. In addition to obtaining this separate DEA registration, this type of activity also requires the approval and certification by the Center for Substance Abuse Treatment (CSAT) within the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services as well as the applicable state methadone authority.

If a practitioner wishes to prescribe or dispense schedules III, IV, or V controlled substances approved by the FDA for addiction treatment (i.e., Suboxone® or Subutex® drug products), the practitioner must request a waiver from CSAT which will then notify DEA of all waiver requests. These practitioners are referred to as DATA waived practitioners.

DATA waived practitioners may treat 30 or 100 patients at any one time, dependent on individual authorization from CSAT. Upon authorization by CSAT, DEA will issue a new DEA certificate of registration bearing (1) the DEA registration number, (2) a unique identification number, and (3) the corresponding business activity to identify whether the physician is authorized to treat 30 or 100 patients. Pursuant to 21 C.F.R. §1301.28(d), the practitioner is required to include the identification number on all records when dispensing and on all prescriptions when prescribing Schedules III, IV, or V narcotic controlled drugs for use in maintenance or detoxification treatment. The listing of the identification number on a prescription is in addition to all other information required on a valid prescription to include the practitioner’s DEA registration number (see Section IX, Valid Prescription Requirements).
]

 

[MountainPharmD]

http://buprenorphine.samhsa.gov/faq.html

Can Subutex® or Suboxone® or approved generic versions of these products be prescribed for conditions other than opioid addiction, e.g., pain control?


Subutex® and Suboxone® or approved generic versions of these products have received FDA approval only for the treatment of opioid addiction. However, once approved, a drug product may be prescribed by a licensed physician for any use that, based on the physician's professional opinion, is deemed to be appropriate. Neither the FDA nor the Federal government regulates the practice of medicine. Any approved product may be used by a licensed practitioner for uses other than those stated in the product label. Off-label use is not illegal, but it means that the data to support that use has not been independently reviewed by the FDA. Information on FDA policy regarding off-label use of pharmaceuticals is available on the FDA Web site, http://www.fda.gov/cder/cancer/tour.htm, or http://www.fda.gov/cder/present/diamontreal/regappr/index.htm

Physicians and other practitioners who are authorized to prescribe Schedule III controlled narcotic medications under Federal and State laws are eligible and the unique identifier under the Drug Addiction Treatment Act is not required.

 

[All4MyDaughter]

MountainDude... quit copying off me!

 

[MountainPharmD]

https://www.naabt.org/links/DEA_Bup_for_pain_letter.pdf

The following letter was sent to Dr. Howard Heit by Patricia M. Good
Chief Liaison and Policy Section, Office of Diversion Control an official of the U.S., DEA and therefore should be considered an Official clarification of federal policy.

Dear Dr. Heit:

This is in response to your correspondence dated October 14, 2003, in which you re-quested the Drug Enforcement Administration (DEA) to respond to the following questions:
Can a clinician prescribe off-label use of buprenorphine with or without naloxone (Suboxone®/Subutex®) for the treatment of pain? If a clinician uses buprenorphine (Suboxone®/Subutex®) for the treatment of pain, does the prescriber have to have a DEA registration or does he or she need the special waiver that is required to prescribe buprenorphine for addiction?

The buprenorphine products Suboxone® and Subutex® are the two Schedule III narcotic medications currently approved for the treatment of opioid dependence under the federal Drug Addiction Treatment Act of 2000 (DATA). The off-label use of the sublingual formulations of buprenorphine (Suboxone®/Subutex®) for the treatment of pain is not prohibited under DEA requirements. However, off-label use does pose a dilemma for pharmacists. Currently, there is no requirement under the DATA for a qualified practitioner to put the Unique Identification Number (UIN) on a prescription for Suboxone® or Subutex® for maintenance or detoxification treatment.

On June 24, 2003, the DEA published a Notice of Proposed Rulemaking (NPRM) that will require qualified practitioners to include the UIN on all prescriptions written for either Suboxone® or Subutex® for narcotic addiction treatment. This requirement will be the only way to determine whether a prescription for Suboxone® or Subutex® was written for maintenance or detoxification treatment or some other condition. Buprenex®, a Schedule III, injectable formation of buprenorphine, is approved and marketed in the United States as an analgesic and is widely used in the treatment of pain.

If a physician prescribes, dispenses or administers buprenorphine (Suboxone®/Subutex®) for the treatment of pain or for any other reason, a DEA registration is required because both products are Schedule III controlled substances. The DATA waiver specifically authorizes qualified practitioners to treat narcotic dependent patients, using FDA approved Schedule III-V narcotic controlled substances for maintenance and detoxification. The DATA waives the requirement for obtaining a separate DEA registration as a narcotic treatment program for physicians using the approved drugs for maintenance and detoxification; however, it does not apply to physicians using Suboxone® or Subutex® forthe treatment of pain. A physician using Suboxone® or Subutex® for the treatment of pain would be required to register with DEA as practitioner with Schedule III privileges.

The Narcotic Addict Treatment Act of 1974 and the DATA amend the Controlled Substances Act (CSA) to allow for the use of opioid drugs to treat addiction either through maintenance or detoxification under specific criteria. Schedule II opioids approved for addiction treatment are limited to methadone and LAAM, and may only be administered and dispensed (not prescribed) by DEA registered Narcotic Treatment Programs. Schedules III through V opioids specifically approved by the Food and Drug Administration for use in addiction treatment maybe prescribed, administered and dispensed by certified practitioners who have obtained the appropriate waivers from the Center for Substance Abuse Treatment.

The above legal allowances were established to allow for the treatment of addiction with opioid controlled substances. These limitations and requirements in no way impact the ability of a practitioner to utilize opioids for the treatment of pain when acting in the usual course of medical practice. Consequently, when it is necessary to discontinue a pain patient's opioid therapy by tapering or weaning doses, there are no restrictions with respect to the drugs that may be used. This is not considered "detoxification" as it is applied to addiction treatment.

I hope this information is of assistance to you in your continued efforts to promote the effective and responsible treatment of pain. If I can of further assistance, please do not hesitate to contact me….

Sincerely,
Patricia M. Good
Chief Liaison and Policy Section
Office of Diversion Control Drug Enforcement Administration
U.S. Department of Justice

 

[MountainPharmD]

MountainDude... quit copying off me!

Great minds think alike!

 

[All4MyDaughter]

Great minds think alike!

I almost posted the Dr. Heit letter, but was thinking someone might balk b/c it's 9 years old. But as far as I can tell, it has not been superceded by any new rules. The SAMHSA page is the most current info.