How do you address a patient who may be getting Adderall from another non-prescribed source while you're treating them with Adderall for ADHD?

If I find out a patient is abusing/misusing Adderall from another source, even having it prescribed by another licensed provider at the same time they are having it prescribed by me, I immediately stop prescribing any dea controlled medication (I once had a patient tell me “I’m selling the meds from the other doctors, but I need your medication to help me with work!”). They fired me when I told them I would be willing to prescribe atomoxetine as an alternative to help them focus.

I believe every physician treating adults with ADHD must approach their practice through an addiction-informed lens. I make this clear at the first visit, emphasizing that our therapeutic relationship is built on absolute transparency and essential safety parameters. When a patient demonstrates behavior that breaks that trust, it is a clinical priority that must be addressed immediately, and that includes halting prescriptions. If a patient is not willing to engage in the work required to address that behavior, it becomes clear they are looking for a stimulant shopping experience rather than professional psychiatric care, which is something I cannot facilitate.

I agree with the above-noted responses but would make three additional comments:

1. I would ask (require) the patient to sign a release allowing me to communicate with his other physicians, and if he/she agrees, write to the other prescribing physician and inform them of the situation.
2. I would consider the above but with the belief that the patient may be displaying new trust in therapy and use the revelation as a re-directional focus of therapy.
3. At least in the state of NJ, MDs can check the statewide website and immediately know of all controlled substances being prescribed for any patient… nb: this "checking in" does not require the patient's permission!

An important question we all must keep in mind.

Gary M. Glass, MD
New Jersey

I check the PMP every time I prescribe a stimulant. If I saw a patient receiving Adderall from another source, my concern would go up quickly. I would not assume bad intent, but I would want to understand what they thought they were doing and why. Sometimes there is a reasonable explanation, like an old script finally being filled, but it often points to some level of misuse.

I would talk with the patient directly and ask them to walk me through it. If the explanation made sense, I would use very short prescriptions and tight monitoring. If it suggested misuse or loss of control, we would then look for an appropriate next step in care. That might mean limited quantities, stopping the stimulant, or, in some cases, ending the prescribing rela...