Title: Background information

Context:
Current or history of SUD: For patients with untreated SUD, see Recommendation 4. For  patients with diagnosed OUD, see Recommendation 17. Frequent requests for early refills or atypically large quantities required to control pain can signal an emerging SUD as well as  diversion (see Evidence for or history of diversion of controlled substances). See the VA/DoD  SUD CPG.4 Depression or history of depression: Zedler et al. (2014) reported that among patients  being treated by the VHA system that received opioids, a history of depression was  significantly associated with opioid-related toxicity/overdose compared to no history of  depression.[58] LOT has been associated with worsening depressive symptoms.[63] See the  VA/DoD MDD CPG.5 PTSD: Seal et al. (2012) (n=15,676) noted that among patients on OT, a prevalence of self inflicted injuries was significantly higher among patients with a history of PTSD (with or  without other mental health diagnoses) as compared to patients with other (or no) mental  health diagnoses.[65] For more information, see the VA/DoD PTSD CPG.6 History of drug overdose: A history of overdose is a red flag and providers should proceed with  utmost caution when considering LOT for these patients. Under 30 years of age: See Recommendation 6.

Question: What is a red flag in the presence of which providers should proceed with utmost caution when considering LOT for these patients?

Answer: A history of overdose