AI, fake me a prescription

NEW DELHI: Artificial Intelligence is making it easier for people to procure restricted drugs, from antibiotics to addictive pills and high-risk psychotropic compounds, raising serious concerns over patient safety, drug misuse and regulatory failure.Alerted by a doctor who said one of his patients was taking antibiotics based on a fake prescription generated through AI, TOI launched an investigation to find out if such prescriptions could be convincingly created and used to buy medicine.We asked ChatGPT to create an AIIMS OPD card using the institution’s logo and name of an AIIMS doctor. It refused, stating this would “amount to impersonation and could be used as an official medical document.”

ChatGPT suggested alternatives such as a generic govt hospital OPD card without branding, a private clinic prescription with fictional details, or a clearly labelled mock sample. When prompted, it created a generic govt hospital OPD card.

However, another AI platform, Grok, produced an old OPD card bearing the AIIMS logo.TOI found that prescription images from both govt and private hospitals can be easily downloaded from the internet and edited, with changes made to the patient’s name, age, diagnosis, medicines and date.

ChatGPT also offered to format prescriptions in standard govt style, complete with dosage and frequency instructions such as BD or SOS.Prescriptions carrying the name of any hospital, real or fictitious, can thus be created, enabling purchase of antibiotics and psychotropic drugs from online platforms or general chemist shops without any doctor’s consultation. TOI has copies of bills and AI-generated prescriptions that closely resemble genuine medical documents.These fake prescriptions were used to purchase antibiotics including Norflox 400, Metrogyl 400 and Azithromycin 500, all restricted medicines, from an online platform. The hospitals mentioned on the prescription, “Elevate Health Clinic” and “Family Healthcare Clinic”, were fictitious and carried no addresses. Despite this, the pharmacy delivered the medicines. One online pharmacy, however, called back for verification and refused to dispense the drug.More worryingly, Nimesulide 200 mg, recently banned by the govt, was available on an online platform, pointing to weak enforcement even after official prohibition.Dr Sunil Rana, associate director and head of Internal Medicine (unit III) at Asian Hospital, said cases are emerging of people using AI-generated prescriptions to buy medicines. This is especially dangerous with antibiotics, as wrong drugs, doses or duration can lead to antimicrobial resistance.

“I increasingly see infections that are difficult to treat because antibiotics were taken incorrectly,” he said, warning that poor prescription verification by some pharmacies was adding to the risk.Though some drugs were unavailable on online platforms, TOI was able to procure Tramadol, an opioid painkiller with a high risk of dependence, and Alprax (alprazolam), a psychotropic antianxiety drug, from offline chemist shops, highlighting serious loopholes in drug sale verification.

At one store, the seller hesitated initially but eventually handed over the medicines without issuing a bill, later scribbling the details on plain paper after the correspondent insisted on documentation.Dr Om Prakash, professor at the Institute of Human Behaviour and Allied Sciences (IHBAS), said drugs such as alprazolam and tramadol are meant for short-term, doctor-supervised use, usually for a few days, to treat acute pain, anxiety or distress.

Taken without medical evaluation, they carry a high risk of abuse and dependence with chronic use, he warned.In countries such as the US and Canada, patients cannot access prescriptions directly. Doctors send prescriptions electronically to pharmacies, and medicines are dispensed only after identity verification.Under India’s drug laws, Schedule H and Schedule X medicines can only be sold against prescriptions issued by registered medical practitioners.

However, weak enforcement and poor verification at both online and offline pharmacies have long subverted the law. The rise of AI-generated prescriptions has now created a new grey zone, allowing documents that appear legitimate to pass muster without scrutiny.Rajiv Singhal, general secretary of the All India Organisation of Chemists and Druggists, said if govt wants to control antimicrobial resistance and misuse of medicines, platforms or AI tools enabling such practices must be acted against immediately. “This kind of activity should be condemned and stopped. Otherwise, it could turn into a serious public health issue with unpredictable consequences,” Singhal said.