DEA's "Red Flag" List for Pharmacists

• Red flags are warning signs that may indicate a controlled substance prescription is not being obtained for legitimate medical purpose but rather for diversion or abuse.

Prescription Red Flags

• Prescriptions for large quantities of a "cocktail" or "holy trinity" of opioids, benzodiazepines, and carisoprodol
• Diagnosis of "lower lumbar pain" (DEA testified that 90% of pill mill doctors use this diagnosis code)
• Inordinately large quantity of controlled substances prescribed
• Suspicion of forged or altered prescriptions
• Pattern prescribing (prescriptions for same drugs and quantities coming from one prescriber)
• Prescriptions done in "factory-like" manner—no reason to prescribe 15 mg AND 30 mg oxycodone because 30 mg tabs are scored down the middle

Patient Red Flags

• Shared addresses by customers presenting prescriptions on the same day
• Customers going to pharmacy counter with dilated pupils and difficulty concentrating
• Physical distance between the doctor, patient, and pharmacy
• Patients paying in cash or sometimes using insurance and other times cash
• Patient uses medicines from multiple physicians or filled at multiple pharmacies (from PDMP)
• Prescriptions refilled at inconsistent intervals based on quantity
• Use of street drug name by patient or prescriber
• Suspicion of forged or altered ID, or refusal to provide