Preventing Diversion

DISCLAIMER: This list is not all-inclusive. It is not the intent of this publication to reduce or deny the use of controlled
substances where medically indicated.
Possible Red Flags
Potential Diversion: Patients
Report forged, altered, or
counterfeit prescriptions to
local police.
Report drug diversion:
DEA Tip Line: https://
www.dea.gov/ops/
submit.php
Diversion Hotline:
1-877-792-2873
 Patient demands immediate attention
 Patient recites textbook symptoms
 Patient gives very vague medical history
 Patient exaggerates medical condition
 Patient wants appointments towards the end of office hours or
arrives after regular business hours
 Patient is not interested in an examination or undergoing diag-
nostic tests
 Patient is unwilling to give permission to obtain past medical
records
 Patient claims they failed to pack medication, lost it, or that it
was stolen
 Patient claims that hospital or clinic, with past medical rec-
ords, is out of business or burned down
 Patient deceives doctors or seeks alternate doctors while nor-
mal doctor is out of the office
 Patient solicits Medicaid recipients to use Medicaid cards as
payment method
 Patient offers to buy other patient’s pills
 Patient alters prescriptions
W W W . D E A D I V E R S I O N . U S D O J . G O V
Possible Signs of Drug-Seeking
 Fictitious records
 Wounds inflicted to self, family members, and pets
 Requests specific medication due to allergies
 Vacationing in area, no local address
 Requests pain medications for a pet

DISCLAIMER: Doing one or more of these does not make prescribing illegal. It is the totality of the circumstances. This
list is not all-inclusive.
Potential Diversion: Practitioners
Questions to Consider
 Does the practitioner follow state laws when prescribing controlled substances?
 Does the practitioner conduct cursory medical exams or any medical exam at all?
 Does the doctor do diagnostic testing or refer patients out for diagnostic testing?
 Is the practitioner referring patients to other specialists (surgery, physical therapy, etc.)?
 Are the initial office visits or follow-up visits brief?
 Does the practitioner prescribe multiple drugs within the same drug category?
 Does the practitioner prescribe excessive quantities of controlled substances relative to the medical condition
the prescription is purported to treat?
 Do patients travel a great distance to see the practitioner?
 Does the practitioner ignore signs of abuse?
 Patient appears to be under the influence
 Patient asks for the controlled substances he wants
 Patient is doctor shopping in PDMP
 Practitioner is warned by family members that the patient is abusing or selling his controlled
substances
 Does the practitioner ignore toxicology reports?
 Does the practitioner only treat patients with narcotic controlled substances?
 Does the practitioner start on a low-dose or low-level controlled substance and then over time work up to
higher levels, or does the practitioner just start patients on a high-dose narcotic?
 Does the practitioner continue to prescribe controlled substances to patients even though it would be
ineffective for treatment purposes?
 Does the practitioner allow the non-medical staff to determine the narcotic to be prescribed, the practitioner
just signs the prescription?
 Does the practitioner coach patients on what to say so that patients can get the narcotics that they want?
 Does the practitioner violate his own pain management policies and guidelines?
 Does the practitioner ignore warnings from insurance companies, law enforcement, other practitioners, family
members, etc.?
 Does the practitioner receive other compensation for narcotic prescriptions (sex, guns, drugs, etc.)?
 Does the doctor still charge patients for visits if the patients do not receive narcotic prescriptions?
 Are patient deaths attributed to drug abuse or overdose?
 Does the practitioner use inventory for personal use?