'Red Flag' Document Offers Guidance on Prescribing Controlled Substances

AAFP Joins Physician, Pharmacist Associations, Retail Chains to Create Resource

March 13, 2015 01:01 pm Chris Crawford

The AAFP, along with a coalition of stakeholder organizations representing physicians, pharmacists and pharmaceutical retailers , released a consensus document(www.nabp.net) on March 12 that highlights the challenges and "red flag" warning signs related to prescribing and dispensing controlled substances.

[Doctor explaining prescription to young female patient]

As detailed in the 18-page consensus document, the resource offers physicians and pharmacists an understanding of their shared responsibility to ensure that all controlled substances are prescribed and dispensed for a legitimate medical purpose, as well as to provide guidance on which warning signs warrant further scrutiny.

The red flags -- both for physicians or pharmacists -- were divided into two categories: factors more indicative of substance abuse or diversion, and other aberrant medication-related behaviors and factors potentially indicative of substance abuse or diversion.

Story highlights
  • The AAFP, along with a coalition of stakeholder organizations, released a consensus document on March 12 that highlights the challenges and "red flags" associated with prescribing and dispensing controlled substances.
  • The resource offers physicians and pharmacists an understanding of their shared responsibility to ensure that all controlled substances are prescribed and dispensed for a legitimate medical purpose.
  • The involved stakeholders initially met on Oct. 2, 2013, and again numerous times in 2013 and 2014 to discuss these issues.

For example, patients who exhibit any of the following behaviors or signs should raise red flags:

  • travel to the prescriber's practice as a group and all request controlled substance prescriptions on the same day;
  • decline physical examination, permission to obtain past records or to undergo diagnostic tests; and
  • appear sedated, confused, intoxicated, exhibit withdrawal symptoms or have physical signs of drug abuse.

For prescribers, the consensus document also lists red flags related to medication use/supply, patient behavior/communication, patient treatment plan or illicit/illegal activities.

AAFP's Take on the Document

Amy Mullins, M.D., AAFP medical director for quality improvement and Academy liaison to the stakeholder group, told AAFP News that the consensus document is a first step toward reducing opioid misuse and abuse.

"As providers, we have a lot of challenges in front of us when patients come to see us and a lot of different steps we have to take," she said. "A call from a pharmacist to verify a prescription can slow workflow. But we need to start seeing things from their perspective, as well. Pharmacists are trying to prevent diversion of substances and protect the public in their own way.

"So there needs to be an open line of communication through a collaborative relationship with the pharmacists in our medical neighborhoods. We need to treat them as partners in patient care and not as adversaries."

Background on Red Flag Project

The involved stakeholders initially met on Oct. 2, 2013, and again numerous times in 2013 and 2014 to discuss the challenges and red flag warning signs.

Members of the coalition of stakeholders that, along with the AAFP, support the consensus document are:

  • American College of Emergency Physicians
  • American Medical Association
  • American Osteopathic Association
  • American Pharmacists Association
  • American Society of Anesthesiologists
  • American Society of Health-System Pharmacists
  • Cardinal Health
  • CVS Health
  • Healthcare Distribution Management Association
  • National Association of Boards of Pharmacy
  • National Association of Chain Drug Stores
  • National Community Pharmacists Association
  • Pharmaceutical Care Management Association
  • Purdue Pharma L.P.
  • Rite Aid
  • Walgreen Co.

Mullins said the consensus document does not represent the "end game" in the fight against opioid misuse and abuse. "This is just one step in the journey to improve quality of life around pain management and hopefully decrease unnecessary deaths from misuse of prescription drugs," she said. "If we don't all work together toward that goal, it's not going to happen."


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