Fenske et al reported red flags to alert a provider prescribing opioids to a chronic pain patient.
Patient selection: chronic pain patient
Red flags for the opioid prescriber:
(1) continuing to request opioids despite the lack of benefit and/or presence of adverse effects
(2) threatening, aggressive or other negative behavior
(3) sedated or intoxicated appearance/behavior
(4) refusal to authorize release of medical records
(5) refusal to sign controlled substance agreement
(6) refusal to try non-opioid therapies not previously tried (will only accept an opioid)
(7) concurrent use of multiple pharmacies
(8) recurrent ER visits for non-emergent pain
(9) obtaining controlled substances from multiple practitioners
(10) allergies or intolerance to multiple, unrelated non-opioid analgesics
(11) fixating on controlled substances and/or request for drugs by name
(12) request for early refills of controlled substances
(13) loss or stolen controlled substance prescriptions
(14) prescription for controlled substances that have been forged or tampered with
(15) obtaining controlled substances from family, friends or drug dealers
(16) history or suspicion of drug diversion
(17) history of depression or anxiety
(18) history of drug or alcohol abuse
The presence of one or more of these findings may indicate that the patient is at risk for opioid misuse.
