Being Red Flagged By Your Doctor

In our latest question and answer, the pharmacist discusses what it means to be "red flagged" by your doctor.

Question

I take oxycodone 10/325 for chronic back and knee pain and have been on it for 5+years, I go to my doctor every month to get my script. I also take Klonopin 0.5mg. Today when I went to my doctor to get scripts for this month, he said I had been RED FLAGGED. what does that mean??

Asked by Avery On Sep 21, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Sep 21, 2022
Last updated Sep 21, 2022

Key points

  • The term 'red flag' is an informal term to signify suspicious behavior to be on the lookout for, behavior that could indicate the presence of drug misuse, abuse, or diversion.
  • Although there are drug monitoring programs on both state and federal levels, there is no permanent 'red-flag' designation for a particular individual in a central database.
  • Individual providers or health systems may have ways of designating a patient as 'suspicious' based on certain behaviors, but there is no shared database for such designations.

Thanks for reaching out to us! Being 'red flagged' is a term used to signify that there is potentially suspicious behavior in regard to controlled substance abuse, misuse, or diversion. In other words, it is simply a warning sign.

However, there is no state or federal database that lists or records patients with a permanent "red flag" however.

Being "red flagged" doesn't mean that you were assigned a tangible flag that can, or can't, be "removed". Again, it is a term that denotes suspicious behavior.

Nevertheless, how your doctor, pharmacy, or legal authority determines "red flag" behavior and utilizes that information, is variable. All of this isn't to say either that your doctor has some sort of way of marking or noting a particular patient as being suspicious in their medical chart (but this wouldn't be in any sort of state or federal database.

Red Flag Behavior

It is important to note that an action that leads to increased scrutiny or a "red flag" itself doesn't signify illegal behavior. However, multiple "red flags" certainly increase the likelihood that some sort of clandestine activity may be occurring.

Common Red Flag Behaviors For Patients

Below are common "red flag" behaviors for patients:

  • Requesting only brand-name controlled substances
  • Seeing multiple pain management doctors
  • Traveling long distances to a pharmacy in comparison to the location of prescribing doctor
  • Multiple early controlled substance refills
  • Multiple ER visits that result in controlled substance prescriptions
  • Shared address between multiple patients receiving controlled substances
  • Cash payments for controlled substance
  • Failing to disclosure controlled substance history to the doctor

Most states have "Prescription Monitoring Programs" that lists all of your controlled substance fills in a central database, which allows doctors and pharmacists to check your fill history. These databases don't have "red flags" on suspicious fill history. It is up to the doctor or pharmacist to infer potential suspicious behavior (i.e. red flag behavior).

Red Flag Behavior For Doctors

Patients aren't the only group that is susceptible to suspicious behavior that could be considered a red flag. The DEA (Drug Enforcement Administration) looks for certain red flag indicators to determine if a doctor or office should be scrutinized for investigation:

  • The office only takes cash
  • Has multiple out-of-state patients
  • Prescribes a high proportion of controlled substance medications
  • High number of patients per day
  • Pain management practice with little to no support staff (e.g. nurses)

Red Flag Behavior For Pharmacies

Pharmacies also have certain indicators that the DEA may look out for in regard to potential illegal activity. These include:
  • Charging higher than normal "cash" prices for controlled substances
  • Filling multiple controlled substance prescriptions early
  • Filling a high proportion of controlled substance prescriptions from one doctor or practice
  • High number of controlled substance inventory discrepancies
  • High proportion of controlled substance wholesale purchases that don't line up with the prescription volume

Being Red Flagged

In your situation, with your doctor telling you that you have been red-flagged, it could mean a lot of things, and you'd really need to ask what they mean. You are taking two controlled substances (Klonopin and oxycodone), which are two of the most commonly abused drugs, but this alone I wouldn't think would get you flagged for suspicious behavior.

Perhaps you have been picking up prescriptions a little early at the pharmacy? Does your doctor send them in early? Do you call for refills too soon? Is your doctor out of state? I highly recommend speaking with your doctor and talking about the situation.

Remember, being 'red-flagged' doesn't mean you have been permanently marked in any kind of central database that will follow you everywhere. It means that your doctor has noted suspicious behavior (or been told about it), and marked it as such on your medical file.

Summary

A "red flag" is an informal term for "suspicious behavior". It could also be described as a warning sign.  There are multiple activities that could potentially draw increased scrutiny for patients, doctors, and pharmacies. Red flag behaviors can indicate controlled substance abuse, misuse, or diversion.

Due to the seriousness of controlled substance misuse, from a legal and public health standpoint, healthcare providers and law enforcement agencies are aware of certain "red flags" to look out for. If a patient has been "red flagged", it simply means there is some potentially suspicious behavior that warrants caution.

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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