Controlled-Substance Prescriptions: Watching for "Red Flags"

The National Association of Boards of Pharmacy in conjunction with various other stakeholder organizations has recently released a consensus document titled “Stakeholders’ Challenges and Red Flag Warning Signs Related to Prescribing and Dispensing Controlled Substances.”

This excellent document provides an interdisciplinary approach to controlled-substance prescriptions and identifies “red flags” that health care professionals should recognize.¹ Additionally, the document is supported by various pharmacy and physician organizations. Most important, it details the challenges that pharmacists face when verifying controlled-substance prescriptions.

The Drug Enforcement Administration's corresponding responsibility doctrine discusses that a corresponding responsibility rests with each pharmacist to determine whether a prescription is issued for a legitimate medical purpose.² Many health care professionals may not be aware of the onus that is placed on pharmacists; therefore, education is crucial. I would recommend sending a copy of these regulations to any health care professional who asks why a pharmacist is contacting them to verify a prescription.²

Important red flags include patients presenting in groups with the same prescriptions for the same controlled substances, prescriptions that look altered, and patients presenting with signs of abuse (e.g., needle tracks, withdrawal symptoms, confusion). Additional red flags include “doctor shoppers” and prescriptions with large quantities of controlled substances.

It is imperative to have an interdisciplinary approach to prescribing and dispensing controlled-substance prescriptions in order to identify individuals who are abusing these substances and to ensure that legitimate patients are not denied these medications.

References

• National Association of Boards of Pharmacy. Stakeholders’ challenges and red flag warning signs related to prescribing and dispensing controlled substances. www.nabp.net/system/rich/rich_files/rich_files/000/000/870/original/consensusdocumentmarch2015.pdf. Accessed March 13, 2015.
• US Department of Justice Drug Enforcement Administration. 1306.04 Purpose of issue of prescription. www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm. Accessed March 13, 2015.