Physicians may accidentally (and sometimes intentionally) be involved in prescribing a controlled substance inappropriately. This can result in a variety of serious penalties, including loss of license or criminal charges. The risk of being involved in such a situation may be reduced by attention to policies and practices.


Prescription writing:

(1) Never sign a blank or incomplete prescription.

(2) Use tamper-resistant prescription pads that cannot be photocopied.

(3) Write the quantity and strength of drugs in both letters and numbers.



(1) Take a complete history and perform a thorough physical examination.

(2) Look for drug abuse signs, such as inflamed nares, skin tracks and a perforated nasal septum.



(1) Be wary or cautious of patients:

(1a) who are not interested in having a physical examination

(1b) who are unwilling to authorize release of prior medical records

(1c) who want a prescription "now"

(1d) who have an unusual knowledge of controlled substances

(1e) who request a specific controlled drug

(2) Call police if you believe someone is trying to divert prescription medication


"Red Flags" suggesting that a patient may be trying to obtain a controlled substance:

(1) multiple insurance filings

(2) family members seeking similar drugs

(3) dog ate prescription

(4) house burglarized and drugs stolen

(5) purse stolen, with medications in purse

(6) drugs fell into the toilet or sink

(7) purse in car when the care was stolen, drugs in purse

(8) requesting or demanding specific drugs

(9) going out of town, requesting early refill on prescription

(10) allergic to all medications but …..

(11) family members picking up medications for other family members

(12) patient claims to be terminal (cancer, AIDS) but no documentation available

(13) non-compliant patients: refuse to follow plan of practice including specific evaluations

(14) dental patient wants an M.D. to treat

(15) renal colic with patient putting blood in urine sample

(16) husband "beats up" spouse

(17) lost drugs and/or prescription

(18) patient has pharmacist fill only controlled substances prescription and refuses legend drug


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