The U.S. is currently in the throes of a prescription drug epidemic and physicians are on the front lines, working to prevent abuse while providing access for patients who legitimately need medications.
To assist physicians, the AOA partnered with the National Association of Boards of Pharmacy, the U.S. Drug Enforcement Administration and other groups to prepare a list of red flags to watch for when treating, prescribing to and monitoring the progress of patients.
Initial visit and presentation:
- Patients travel to the physician’s office as a group and all request prescriptions for controlled substances on the same day.
- The patient declines a physical exam and diagnostic tests and won’t give the physician permission to obtain past records.
- Speech and conduct of the patient suggest abuse of controlled substances. The patient may appear sedated, confused or intoxicated. Withdrawal symptoms or physical signs of drug abuse may also be present.
- The patient insists on paying cash though he or she has health insurance.
- Unnecessary travel: The patient travels an exceptionally long distance or out of state for the visit and doesn’t explain why.
- Multiple unexplained dose escalations or other nonadherence to the treatment plan.
- The patient chooses a route of drug administration other than the method prescribed, such as injecting or inhaling oral formulations or ingesting transdermal formulations.
- Repeatedly, the patient seeks medications from noncoordinated sites of care such as the emergency room, urgent care facilities or walk-in clinics.
- The patient suffers a drug overdose.
Patient behavior and communication:
- A Prescription Drug Monitoring Program report provides evidence that the patient is obtaining controlled substance prescriptions from multiple health care practitioners without the prescribers’ knowledge of the other prescriptions.
- The patient was discharged from another physician practice for egregious behavior.
- Threats: The patient pressures the physician or the practice staff to prescribe drugs.
- The patient has an unusually vast knowledge of opioid medications or other controlled substances, uses drugs’ street names, or requests large quantities of drugs.
- The patient repeatedly resists changes in the treatment plan despite evidence of adverse physical or psychological effects from the drug.
- Refusal to sign or failure to comply with an opioid pain care agreement governing use of opioid analgesics.
- The patient claims to be allergic or intolerant to alternative nonopioid pain medications.
- Refusal to try nonpharmacologic therapies.
- Attempts to alter, forge or rewrite prescriptions.
- Diverting or selling medication or borrowing drugs from others.
- The patient requests prescriptions written in the names of other people for whom the patient is not the designated caregiver.
For a more detailed list of red flags and more information on prescribing controlled substances, email the AOA’s Bureau on State Government Affairs.